Swallowing outcomes and PEG dependence in head and neck cancer patients receiving definitive or adjuvant radiotherapy +/− chemotherapy with a proactive PEG: A prospective study with long term follow up

Crombie, Jane; Ng, Stephanie; Spurgin, Ann‐Louise; Ward, Elizabeth C.; Brown, Teresa; Hughes, Brett

doi:10.1016/j.oraloncology.2015.03.006

Cited by 22 publications

(13 citation statements)

References 32 publications

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“…Ward et al [15] analysed long-term swallow outcomes (defined as need for oesophageal dilatation/hospitalisation for aspiration pneumonia/further use of feeding tube after initial tube removed) in 78 patients who had required enteral tube feeding support during chemoradiotherapy; the 5 year incidence of severe late dysphagia was 30.8% in the reactive NG group (n ¼ 36) vs. 56% in a reactive PEG group (n ¼ 17) and 60.9% in a prophylactic PEG group (n ¼ 25). By contrast, a report of series of patients managed with a gastrostomy showed low rates of long-term tube dependence and favourable longterm swallow outcomes for the majority of patients [20]. This study seeks to explore the critical clinical question of whether a prophylactic gastrostomy or NG tube as required has superior outcomes in terms of long-term swallow recovery.…”

Section: Discussionmentioning

confidence: 98%

“…Advantages of a reactive NG tube approach include the avoidance of tube insertion in patients in whom enteral feeding support is not required, avoidance of morbidity associated with gastrostomy insertion [18], shorter duration of enteral feeding [7,17] and reduced cost [17]. Approaches to enteral feeding remains an area of highly variable practice [19], with some centres routinely opting for a prophylactic gastrostomy [20,21] and others preferring the NG tube route [8].…”

Section: Introductionmentioning

confidence: 99%

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Impact of choice of feeding tubes on long-term swallow function following chemoradiotherapy for oropharyngeal carcinoma

Prestwich¹,

Murray²,

Williams

et al. 2019

Acta Oncologica

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Background: Prior reports have raised concerns that a prophylactic gastrostomy may be detrimental to long-term swallow function. This study evaluates patient-reported swallow function following chemoradiotherapy for oropharyngeal carcinoma in relation to the use of a prophylactic gastrostomy or nasogastric (NG) tube as required. Material and methods: The MD Anderson Dysphagia Inventory (MDADI) was posted to 204 diseasefree patients at least 2 years following chemoradiotherapy for oropharyngeal carcinoma between 2010 and 2014. Results: Overall, 181/204 (89%) patients returned questionnaire at a median of 34 months post-treatment. 97/181 (54%) and 84/181 (46%) were managed with an approach of a prophylactic gastrostomy or NG tube as required, respectively. A prophylactic gastrostomy was associated with higher rates of enteral feeding (92% vs. 58%, p < .001), lower median percentage weight loss (7.0% vs. 9.4%, p < .001), increased duration of enteral feed (median 3.3 vs. 1.1 months, p < .001). There was no significant difference in patient-reported swallow function measured by MDADI summary scores and subscales for patients managed with an approach of prophylactic gastrostomy or NG as required. Duration of enteral feed correlated negatively with composite MDADI scores. A subgroup of 116/181 (64%) patients were documented as having been offered a choice of enteral feeding approach and therefore can be considered to represent clinical equipoise; there were no significant differences in MDADI scores according to route. Conclusions: Despite concern regarding the use of a prophylactic gastrostomy in prior studies, the approaches of using a prophylactic gastrostomy or an NG tube as required to support patients during/after chemoradiotherapy for oropharyngeal carcinoma were associated with similar long-term swallow outcomes.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Impact of choice of feeding tubes on long-term swallow function following chemoradiotherapy for oropharyngeal carcinoma

Prestwich¹,

Murray²,

Williams

et al. 2019

Acta Oncologica

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“…[33][34][35][36][37] Studies have shown that prophylactic PEG can improve quality of life 38 and reduce the risk of aspiration, hospitalization, medical costs, 39 weight loss, length of stay, 40 and radiotherapy interruption rate. 47,48 A survey implied that 82.1% of doctors thought that prophylactic PEG was not necessary, but 88.1% agreed that nutritional consultation should be a routine step in the radiotherapy process. 42 Although PEG catheterization is more receptive than nasogastric tubes, studies [43][44][45] have also shown that PEG may result in a decrease in swallowing process.…”

Section: Discussionmentioning

confidence: 99%

“…46 However, whether PEG could cause swallowing disorders remains controversial. 47,48 A survey implied that 82.1% of doctors thought that prophylactic PEG was not necessary, but 88.1% agreed that nutritional consultation should be a routine step in the radiotherapy process. 49 Most Chinese patients cannot accept PEG because they consider it as an invasive procedure, so nutritional therapy mostly presents in the form of HEN.…”

Section: Discussionmentioning

confidence: 99%

Home enteral nutrition may prevent myelosuppression of patients with nasopharyngeal carcinoma treated by concurrent chemoradiotherapy

Zhou

Chu

et al. 2019

Head & Neck

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Background The aim of this study is to assess the effect of home enteral nutrition (HEN) on the myelosuppression of patients with nasopharyngeal cancer (NPC) during the course of concurrent chemoradiotherapy (CCRT). Methods A total of 18 outpatients with NPC administered oral nutritional supplementation intervention at home during the course of CCRT were designated as the HEN group, whereas 36 patients with NPC who had previously completed CCRT were retrospectively included as the control group. Patient Generated Subjective Global Assessment, body mass index (BMI), and blood test were evaluated prior to CCRT. During the course of CCRT, blood test was assessed every 2 weeks. Results In male patients, hemoglobin (HB) and red blood cell were decreased (P < .05) in both HEN and control group after CCRT, whereas white blood cell (WBC) started to decrease since week 2 of CCRT in the control group but maintained in the HEN group which was significantly higher than the control (5.05 ± 1.29 vs 3.77 ± 1.5, P < .05). In female patients, HB and WBC were reduced in control group during CCRT, whereas these indicators also maintained in the HEN group. Surprisingly, all patients with lower BMI (<24 kg/m2) had a significant increase in platelet (PLT) after CCRT (200.78 ± 58.03 vs 253.00 ± 69.82, P < .05), while had steady HB and WBC values in the HEN group. At the end of CCRT, WBC and PLT of the HEN group were both higher than those in the control group (5.21 ± 1.07 vs 3.37 ± 1.52), (253.00 ± 69.82 vs 165.57 ± 59.56) (P < .05 for both). Our findings suggest that HEN is effective in preventing myelosuppression during CCRT for patients with NPC. Conclusion Our findings suggest that HEN is effective in preventing myelosuppression during CCRT for patients with NPC.

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“…G-tube placement is an invasive procedure with a small but defined risk of acute serious complications [7]; 25 to 35 % of patients retain the tube for >1 year after CRT, 10 % >2 years [8], although recent studies show reduced dependence rates [9] A G-tube has a major impact on patients’ and carers’ quality of life (QoL) [10, 11], due to leakage, soiling of clothes, and interference with family life, intimate relationships and hobbies [12]. While NG tube placement is relatively simple, the smaller diameter tube makes it prone to blockage, thus needing repeated replacement.…”

Section: Introductionmentioning

confidence: 99%

A feasibility study incorporating a pilot randomised controlled trial of oral feeding plus pre-treatment gastrostomy tube versus oral feeding plus as-needed nasogastric tube feeding in patients undergoing chemoradiation for head and neck cancer (TUBE trial): study protocol

Paleri

Wood

Patterson³

et al. 2016

Pilot Feasibility Stud

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BackgroundThere are 7000 new cases of head and neck squamous cell cancers (HNSCC) treated by the NHS each year. Stage III and IV HNSCC can be treated non-surgically by radio therapy (RT) or chemoradiation therapy (CRT). CRT can affect eating and drinking through a range of side effects with 90 % of patients undergoing this treatment requiring nutritional support via gastrostomy (G) or nasogastric (NG) tube feeding.Long-term dysphagia following CRT is a primary concern for patients. The effect of enteral feeding routes on swallowing function is not well understood, and the two feeding methods have, to date, not been compared to assess which leads to a better patient outcome.The purpose of this study is to explore the feasibility of conducting a randomised controlled trial (RCT) comparing these two options with particular emphasis on patient willingness to be randomised and clinician willingness to approach eligible patients.Methods/designThis is a mixed methods multicentre study to establish the feasibility of a randomised controlled trial comparing oral feeding plus pre-treatment gastrostomy versus oral feeding plus as required nasogastric tube feeding in patients with HNSCC. A total of 60 participants will be randomised to the two arms of the study (1:1 ratio). The primary outcome of feasibility is a composite of recruitment (willingness to randomise and be randomised) and retention. A qualitative process evaluation investigating patient, family and friends and staff experiences of trial participation will also be conducted alongside an economic modelling exercise to synthesise available evidence and provide estimates of cost-effectiveness and value of information. Participants will be assessed at baseline (pre-randomisation), during CRT weekly, 3 months and 6 months.DiscussionClinicians are in equipoise over the enteral feeding options for patients being treated with CRT. Swallowing outcomes have been identified as a top priority for patients following treatment and this trial would inform a future larger scale RCT in this area to inform best practice.Trial registration ISRCTN48569216

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Swallowing outcomes and PEG dependence in head and neck cancer patients receiving definitive or adjuvant radiotherapy +/− chemotherapy with a proactive PEG: A prospective study with long term follow up

Cited by 22 publications

References 32 publications

Impact of choice of feeding tubes on long-term swallow function following chemoradiotherapy for oropharyngeal carcinoma

Impact of choice of feeding tubes on long-term swallow function following chemoradiotherapy for oropharyngeal carcinoma

Home enteral nutrition may prevent myelosuppression of patients with nasopharyngeal carcinoma treated by concurrent chemoradiotherapy

A feasibility study incorporating a pilot randomised controlled trial of oral feeding plus pre-treatment gastrostomy tube versus oral feeding plus as-needed nasogastric tube feeding in patients undergoing chemoradiation for head and neck cancer (TUBE trial): study protocol

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