When is the optimal time for placing a gastrostomy in patients undergoing treatment for head and neck cancer?

Talwar, Bella; Findlay, Merran

doi:10.1097/spc.0b013e32834feafd

Cited by 35 publications

(31 citation statements)

References 62 publications

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“…The evidence for the need and timing of prophylactic tube feeding remains limited [32,44]. Active promotion of swallowing and swallowing exercise [28,33,34] Optimizing analgesia in the acute phase [31] Pretreatment counselling and rigorous baseline assessment [35,36] Minimize oral mucositis [37] Psychological care [38] Lymphoedema therapy [39,40] Acupuncture for xerostomia and pain [41] [24,25 & ,26] Question Response…”

Section: Considerations In Dysphagia Managementmentioning

confidence: 99%

Human papilloma virus-related oropharyngeal cancer

Goldsmith

Roe

2015

Current Opinion in Otolaryngology & Head and Neck Surgery

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Clinical trials are now underway to ascertain the effectiveness of tailored treatments for HPV-positive OPC with a focus on swallowing outcomes. It is encouraging that studies are now including detailed, multidimensional swallowing evaluation. Until such time as longitudinal data are available, patients should be treated by speech-language pathologists based on existing radiation treatment protocols and in the knowledge that patients may experience significant late swallowing difficulties.

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Section: Considerations In Dysphagia Managementmentioning

confidence: 99%

Human papilloma virus-related oropharyngeal cancer

Goldsmith

Roe

2015

Current Opinion in Otolaryngology & Head and Neck Surgery

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“…However it is difficult to compare results across other studies due to variations in how authors define the time period of tube use/duration. Limitations of several studies which report on gastrostomy dependency have not considered appropriate nutritional outcome data including degree of tube use, or the intensity and frequency of dietary counselling (Talwar & Findlay, 2012).…”

Section: Gastrostomy Outcomes At 12 Monthsmentioning

confidence: 99%

“…Some studies have reported nil impact on swallowing function (Crombie et al, 2015;Silander et al, 2010), and the most recent systematic review on this topic remains inconclusive (Shaw et al, 2015). As there is no agreed definition of the term gastrostomy dependency, its use can therefore be misunderstood (Talwar & Findlay, 2012). Although many investigators are now reporting rates of gastrostomy retention it is unclear if patients are legitimately so because of dysphagia, other nutrition impact symptoms or poor nutritional status, or if patients elect to continue gastrostomy use despite no physical barriers to oral nutrition.…”

Section: Introductionmentioning

confidence: 99%

“…The debate in the literature continues as to whether patients with head and neck cancer should have a nasogastric tube or gastrostomy tube (Corry et al, 2008;Wang et al, 2014a) and the optimal timing of gastrostomy placement (Bradley, Brown, & Paleri, 2015;Talwar & Findlay, 2012).…”

Section: Introductionmentioning

confidence: 99%

“…Treatments for head and neck cancer (HNSCC) including surgery, radiotherapy and chemotherapy have a number of side effects which can impact on nutritional intake (Talwar & Findlay, 2012), with multi-modality therapy having higher toxicity (Moroney et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

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Optimising nutrition support in patients with head and neck cancer

Brown¹

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Optimal Perioperative Care in Major Head and Neck Cancer Surgery With Free Flap Reconstruction

Dort

Farwell

Findlay

et al. 2017

JAMA Otolaryngol Head Neck Surg

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396

257

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Importance: Head and neck cancers often require complex, labor-intensive surgeries, especially when free flap reconstruction is required. Enhanced recovery is important in this patient population but evidence-based protocols on perioperative care for this population are lacking. Objective: To provide a consensus-based protocol for optimal perioperative care of patients undergoing head and neck cancer surgery with free flap reconstruction. Evidence Review: Following endorsement by the Enhanced Recovery After Surgery (ERAS) Society to develop this protocol, a systematic review was conducted for each topic. The PubMed and Cochrane databases were initially searched to identify relevant publications on head and neck cancer surgery from 1965 through April 2015. Consistent key words for each topic included "head and neck surgery," "pharyngectomy," "laryngectomy," "laryngopharyngectomy," "neck dissection," "parotid lymphadenectomy," "thyroidectomy," "oral cavity resection," "glossectomy," and "head and neck." The final selection of literature included meta-analyses and systematic reviews as well as randomized controlled trials where available. In the absence of high-level data, case series and nonrandomized studies in head and neck cancer surgery patients or randomized controlled trials and systematic reviews in non-head and neck cancer surgery patients, were considered. An international panel of experts in major head and neck cancer surgery and enhanced recovery after surgery reviewed and assessed the literature for quality and developed recommendations for each topic based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. All recommendations were graded following a consensus discussion among the expert panel. Findings: The literature search, including a hand search of reference lists, identified 215 relevant publications that were considered to be the best evidence for the topic areas. A total of 17 topic areas were identified for inclusion in the protocol for the perioperative care of patients undergoing major head and neck cancer surgery with free flap reconstruction. Best practice includes several elements of perioperative care. Among these elements are the provision of preoperative carbohydrate treatment, pharmacologic thromboprophylaxis, perioperative antibiotics in clean-contaminated procedures, corticosteroid and antiemetic medications, short acting anxiolytics, goal-directed fluid management, opioid-sparing multimodal analgesia, frequent flap monitoring, early mobilization, and the avoidance of preoperative fasting. Conclusions and Relevance: The evidence base for specific perioperative care elements in head and neck cancer surgery is variable and in many cases information from different surgerical procedures form the basis for these recommendations. Clinical evaluation of these recommendations is a logical next step and further research in this patient population is warranted.

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When is the optimal time for placing a gastrostomy in patients undergoing treatment for head and neck cancer?

Cited by 35 publications

References 62 publications

Human papilloma virus-related oropharyngeal cancer

Human papilloma virus-related oropharyngeal cancer

Optimising nutrition support in patients with head and neck cancer

Optimal Perioperative Care in Major Head and Neck Cancer Surgery With Free Flap Reconstruction

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