Toxicities and costs of placing prophylactic and reactive percutaneous gastrostomy tubes in patients with locally advanced head and neck cancers treated with chemoradiotherapy

Baschnagel, Andrew M.; Yadav, Siddhartha; Marina, Ovidiu; Parzuchowski, A; Lanni, Thomas B.; Warner, J.; Parzuchowski, Jeanne; Ignatius, Renjitha T.; Åkervall, Jan; Chen, Peter Y.; Krauss, Daniel

doi:10.1002/hed.23426

Cited by 54 publications

(56 citation statements)

References 23 publications

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“…Most of them are given nutritional therapy only when they already have difficulty in eating such as swallowing disorders. [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. 15 Study has shown that early percutaneous endoscopic gastrostomy (PEG) placement can increase the completeness rate of concurrent chemotherapy.…”

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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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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“…Reactive gastrostomy tube placement (i.e., only when significant weight loss and/or nutritional compromise becomes manifest during the course of treatment) versus prophylactic placement (i.e., placement prior to treatment initiation) remains controversial. 98–100 Therefore, the optimal timing for initiating enteral feeding support and the route of delivery remain unclear for older patients with LA-HNSCC undergoing CRT who are more susceptible to nutritional and swallowing issues. Due to these intertwined challenges in supportive care facing these patients, prospective studies evaluating the relationships among age, swallowing, nutrition, and sarcopenia and longer-term functional outcomes among younger vs. older patients with LA-HNSCC are greatly needed.…”

Section: Methodsmentioning

confidence: 99%

The Older Adult With Locoregionally Advanced Head and Neck Squamous Cell Carcinoma: Knowledge Gaps and Future Direction in Assessment and Treatment

Maggiore

Zumsteg

BrintzenhofeSzoc

et al. 2017

International Journal of Radiation Oncology*Biology*Physics

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Older adults with squamous cell carcinomas of the head and neck (HNSCC) pose unique treatment and supportive care challenges to oncologists and other cancer care providers. The majority of patients with HNSCC present with locoregionally advanced (LA) disease, for which combined modality treatment integrating chemotherapy and radiation therapy is often necessary to maximize tumor control. However, applying these approaches to an older population with concomitant comorbidities and higher risk for functional impairments remains challenging, and is exacerbated by the paucity of studies involving older adults. The purpose of this paper is to identify knowledge gaps in the evaluation and management of older adults with HNSCC and their caregivers, particularly those undergoing concurrent chemoradiation, through a review of the literature conducted by clinicians, researchers, and patient advocates. The findings highlight the importance of a geriatric assessment and the therapeutic paradigms and challenges relevant to this population. Furthermore, we identify the need for additional research and interventions related to key supportive care issues that arise during and after treatment in older adults with LA-HNSCC. Based on our findings, we prioritized these issues to guide future patient-oriented research endeavors to address these knowledge gaps and thus better serve this growing patient population.

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“…This study could not have been conducted had we had an institutional policy requiring universal prophylactic feeding tube placement. Prophylactic feeding tube placement has been recommended at some institutions to diminish the risk of hospitalization for mucositis‐induced dehydration and/or aspiration, to support nutrition, and improve quality of life during treatment . Prophylactic placement may, however, be associated with prolonged feeding tube dependence and possibly worse long‐term swallowing outcomes .…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2015

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Toxicities and costs of placing prophylactic and reactive percutaneous gastrostomy tubes in patients with locally advanced head and neck cancers treated with chemoradiotherapy

Abstract: PEG tubes placed prophylactically were associated with lower rates of strictures, aspirations, hospitalizations, and costs compared to those placed reactively.

Cited by 54 publications

References 23 publications

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

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

The Older Adult With Locoregionally Advanced Head and Neck Squamous Cell Carcinoma: Knowledge Gaps and Future Direction in Assessment and Treatment

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

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