Impact of baseline patient‐reported dysphagia on acute gastrostomy placement in patients with head and neck squamous cell carcinoma undergoing definitive radiation

Abstract

Baseline dysphagia-related symptoms before radiation are independent predictors of gastrostomy placement. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1318-E1324, 2016.

Optimising nutrition support in patients with head and neck cancer

“…Traditionally requirement for gastrostomy in patients with HNSCC has been associated with dysphagia (Lango et al, 2016) or odynophagia from mucositis (Trotti et al, 2003), as these symptoms present as the physical inability to eat or drink. A review of the influence of nutrition impact symptoms on nutritional status, weight loss, and oral intake found most studies report on dysphagia and xerostomia (Bressan et al, 2016), with loss of appetite shown to have the greatest reduction on oral intake (Farhangfar et al, 2014).…”

“…The highest level of evidence identifies: tumours of the oropharynx (Barnhart et al, 2017), followed by the hypopharynx and oral cavity (Ottosson et al, 2013); higher T stage (Brown et al, 2016a); higher overall TNM stage (Lango et al, 2016;Ottosson et al, 2013); and chemotherapy (Barnhart et al, 2017;Brown et al, 2016a;Lango et al, 2016). All of these factors were supported by a large number of level III-IV studies as well.…”

“…Two level II positive quality studies (Lango et al, 2016;Ottosson et al, 2013) provide the highest level of evidence to support the following patient risk factors: low BMI, pre-treatment dysphagia, pre-treatment nutrition impact symptoms, heavy smoker, poor performance status, and older age. Although the study by Ottosson et al (2013) has a large sample size (n=712), the findings are limited to patients receiving radiotherapy.…”

“…Although the study by Ottosson et al (2013) has a large sample size (n=712), the findings are limited to patients receiving radiotherapy. The study by Lango et al (2016) was completed in patients receiving (chemo) radiotherapy but had a small sample in comparison (n=84). Pre-treatment weight loss was the only other patient factor supported by a number of level III and IV studies (Beaver et al, 2001;Gardine et al, 1988;Mangar, Slevin, Mais, & Sykes, 2006;Mays, Moustafa, Worley, Waltonen & D'Agostino, 2014;Orphanidou et al, 2011).…”

“…The literature also suggests other parameters could include; baseline dysphagia, poor performance status, older age, and higher TNM stage (Lango et al, 2016;Ottosson et al, 2013). Consideration needs be given to the surgical population, as there is increasing evidence that patients undergoing certain surgical procedures may also warrant proPEG (Jack et al, 2012;Mays et al, 2014).…”