Nasogastric Feeding Tube/Dobhoff Placement: A Multidisciplinary Approach to the Management of Malnutrition During Radiation Therapy in Patients With Head and Neck Cancer

Abstract

Background Radiation therapy (RT)-associated oral mucositis, xerostomia, thick mucoid saliva, nausea/vomiting, and loss of taste may result in significantly compromised oral intake in patients undergoing treatment for head and neck cancers (HNC). Feeding tube placement allows patients to receive enteral nutrition and continue the planned course of treatment. Objectives RT-associated oral mucositis, xerostomia, and loss of taste may result in significantly compromised oral intake in patients undergoing treatment for head and neck cancers. We sought to determine if reactive nasogastric (NG) tube placement was an effective strategy for nutritional support in these patients and if invasive percutaneous endoscopic gastrostomy (PEG) tube insertion could be avoided. Methods This is an institutional review board (IRB)-approved study of patients treated for head and neck cancer using definitive or adjuvant RT with or without concurrent chemotherapy between June 2017 and December 2020. We evaluated the indications for NG tube (Dobhoff) placement, time of placement during the course of RT, patient tolerance of NG tube, and median duration of NG tube placement. In addition, we followed weight loss during treatment, treatment interruptions, and treatment-related toxicities. Complications associated with having the NG tube, if the NG tube needed to be replaced during treatment, and if the patient had any hospitalization during the course of treatment were tracked. Results Of the 441 patients treated for head and neck cancer during the time period of this study, 47 required reactive NG tube placement for nutritional support. Patients included 40 with primary oropharynx, three with oral cavity, two with larynx, one with nasopharyngeal, and one was unknown. Chemotherapy was given concurrently with radiation in 87.2% (n=41) patients. The median time of NG tube placement was during Week 5 of the six to seven-week course of RT. The median percentage of weight loss from baseline to the date of NG tube placement was 12.9% (range, -0.9% to 25.9%). The median rate of weight loss decreased by 8.7% from the date of NG tube placement to the end of treatment. The median duration of NG tube placement was 29 days (range, 5 to 151 days). There were no serious medical complications associated with having the NG tube in place during treatment. Twenty-seven point six percent (27.6%; n=13) of patients had the NG tube dislodged or displaced and needed replacement. Thirty-eight point three percent (38.3%; n=18) of patients with an NG tube had to be hospitalized during the course of RT, with the predominant symptoms being failure to thrive (22.2%; n=4) and nausea/vomiting 22.2% (n=4). Six point four percent (6.4%; n=3) of patients requested the removal of the NG tube due to local irritation. Seventy-six point six percent (76.6%; n=36) of patients did not require further nutritional support with the placement of a percutaneous endoscopic gastrostomy (PEG) tube. ...

A retrospective cohort study of reactive nasogastric tube feeding for head and neck cancer patients undergoing radiotherapy: Clinical and financial implications

“…The choice of prophylactic gastrostomy insertion before starting radiotherapy versus reactive NGT feeding to support HNC patients remains a difficult dilemma with both clinical and financial implications. Some centres have pioneered the use of outpatient NGT feeding services to avoid the need for hospital admission to initiate enteral feeding, 10 facilitating the earlier introduction of enteral feeding support and likely prevention of further clinical deterioration. However, given the repeated restructuring of cancer services within the United Kingdom (in part due to the coronavirus pandemic), there is undoubtedly a degree of change fatigue in many service providers.…”

“…implications. Some centres have pioneered the use of outpatient NGT feeding services to avoid the need for hospital admission to initiate enteral feeding, 10 facilitating the earlier introduction of enteral feeding support and likely prevention of further clinical deterioration.…”

Analysis of the causes of failed placement of nasoenteric tube under DSA guidance and treatment strategies for successful re-catheterization

“…However, because of their complex conditions, placement of the nasoenteric feeding tube by conventional endoscopy can be difficult (16)(17)(18). DSA-guided nasoenteric tube placement is relatively safe and reliable, serious complications are rare, and intraoperative imaging can identify the intestinal access after complex surgeries (19)(20)(21), as well as extensive abdominal metastasis and multiple intestinal strictures. By thorough analysis of cases of failed intubation (22)(23)(24), we can improve both preoperative preparation and intraoperative technique (25)(26)(27), thus improving the success rate and establishment of enteral nutrition in patients with malignant tumors.…”

Evolving Therapeutic Roles of Nasogastric Tubes: Current Concepts in Clinical Practice

“…When nasogastric tubes are used for the delivery of medications or for short-term nutritional support, a single-bore small-lumen tube such as a Levin or Dobhoff tube can be used. Both Levin and Dobhoff tubes have a small lumen; however, the Dobhoff has a weight attached to the distal end to aid in insertion past the pylorus [ 5 ].…”

“…Implementing nasoenteral feeding tubes such as Dobhoff tubes for longer than immediate use has provided safe and beneficial nutritional support in patients with head and neck cancer in the presence of dysphagia or odynophagia in a retrospective study on 444 patients needing radiation therapy for head and neck cancer. There was a significant decrease in the median weight after Dobhoff was placed during treatment [ 5 ].…”