Decreased hospital stay and significant cost savings after routine use of prophylactic gastrostomy for high‐risk patients with head and neck cancer receiving chemoradiotherapy at a tertiary cancer institution

Abstract

Prophylactic gastrostomy tubes in patients with high-risk head and neck cancer resulted in a significant decrease in hospital admissions and length of stay, and led to increased bed availability.

The Effect of Prophylactic Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement on Swallowing and Swallow-Related Outcomes in Patients Undergoing Radiotherapy for Head and Neck Cancer: A Systematic Review

“…Some physicians advocate for prophylactic PEG tube placement (i.e., placement before treatment begins) [39][40][41], especially for patients with locally advanced stages of disease. Benefits to prophylactic PEG tube placement in HNC patients undergoing radiotherapy or chemoradiotherapy include decreased weight loss [24,42,43], fewer hospital admissions [21,44], lower rates of dehydration [21,22,24], fewer treatment breaks due to acute radiationrelated toxicities [45], and lower medical costs [46]. In some cases, waiting to treat patients with PEG therapeutically (when they can no longer maintain adequate nutrition orally) can be risky, due to significant wait times for insertion in some facilities [47].…”

“…Two of the 20 studies were randomized controlled trials (RCTs) [71,72] (see Table 1), one followed a case-control design [83], and the remaining 17 involved observational cohorts (three prospective [84][85][86], nine retrospective [22,44,67,[87][88][89][90][91][92], three mixed (with some outcomes being retrieved retrospectively and others being collected prospectively) [46,93,94], and two unclear [50,95]). …”

“…Seven studies enrolled a subset of patients treated with post-operative radiotherapy [46,67,71,72,87,88,92]. Each of these studies contained at least 10 subjects treated without primary surgery but only provided aggregate results for all subjects with respect to outcomes (i.e., data were not stratified according to patients who were treated with vs. without primary surgery; see Table 1.…”

“…Four studies used IMRT [50,[85][86][87], two used 3DCRT [88,92], one used conventional radiotherapy [46], four used various forms of radiotherapy [22,67,90,91], and nine were unclear regarding the type of radiotherapy used [44,71,72,83,84,89,[93][94][95] (see Table 1). …”

“…Two additional studies did not fully stratify their samples according to pPEG vs. nPEG placement; rather, they divided patients according to treatment facility (where one site favored prophylactic placement and the other exclusively used reactive placement) [90], or according to treatment year (where patients treated during 2005 typically received a reactive PEG and patients treated in 2007 often received a prophylactic PEG) [46]. Table 2).…”