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Fong SC, Pandey R, Rajaretnam M, Delaibatiki M, Peel DN. Routine Prophylactic Percutaneous Endoscopic Gastrostomy in Head and Neck Cancers with Bilateral Neck Irradiation: A Regional Cancer Experience in New Zealand. J Med Radiat Sci 2023; 70:292-300. [PMID: 37403761 PMCID: PMC10500120 DOI: 10.1002/jmrs.699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 06/15/2023] [Indexed: 07/06/2023] Open
Abstract
INTRODUCTION Patients with head and neck cancer (HNC) are particularly susceptible to dysphagia and malnutrition. Prophylactic percutaneous endoscopic gastrostomy (PEG) placement is a method used to manage these issues, but practices vary among institutions. At Midcentral District Health Board, patients receiving radiotherapy to the primary and bilateral neck regions routinely undergo prophylactic PEG placement. This study aimed to review the nutritional and PEG-related outcomes of these patients. METHODS Records of 49 patients were retrospectively reviewed. Their demographics, tumour and treatment characteristics were recorded. We evaluated patient weight loss, non-elective hospitalisation, treatment interruption rates, PEG-related complications, usage, dependency rates and late dysphagia rates. RESULTS Oropharyngeal cancers were the most common primary site (61.2%), and 83.7% of patients received primary chemoradiotherapy. Mean weight loss at treatment completion was 5.6% ± 4.3 (4.6 kg ± 3.9). The rate of non-elective hospitalisations was 26.5%, and only 2% of patients had treatment interruptions. Peristomal infection was the most frequent PEG complication (20.4%). No PEG-related mortality was reported. Median duration of PEG dependency was 97 days (14-388 days). Two patients remained permanently dependent at 3 years due to grade 3 dysphagia, and six patients experienced grade ≥2 late dysphagia. CONCLUSION Our study showed that prophylactic PEG tube placement was relatively safe, with a high utilisation rate and low long-term dependence on PEG tubes after treatment completion. However, complications related to their use should be addressed through a multidisciplinary approach, with careful assessment by clinicians. The weight loss and hospitalisation rates observed were consistent with earlier studies that utilised prophylactic PEG tubes.
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Affiliation(s)
- Su Chen Fong
- Department of Radiation OncologyPalmerston North Hospital, Midcentral DHBPalmerston NorthNew Zealand
| | - Ramesh Pandey
- Department of Radiation OncologyPalmerston North Hospital, Midcentral DHBPalmerston NorthNew Zealand
- Department of Radiation OncologyAuckland HospitalAucklandNew Zealand
| | - Michelle Rajaretnam
- Department of Radiation OncologyPalmerston North Hospital, Midcentral DHBPalmerston NorthNew Zealand
| | - Miriama Delaibatiki
- Department of Radiation OncologyPalmerston North Hospital, Midcentral DHBPalmerston NorthNew Zealand
- Department of Radiation OncologyKathleen Kilgour Centre, Tauranga HospitalTaurangaNew Zealand
| | - David N.Y. Peel
- Department of Radiation OncologyPalmerston North Hospital, Midcentral DHBPalmerston NorthNew Zealand
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Neves MT, Ferreira A, Branco V, Abreu M, Alves FR, Baptista C, Graça J, Ferreira F, Malheiro M, Martins A. Utility of Prophylactic Percutaneous Gastrostomy in Patients With Head and Neck Cancer Receiving Concurrent Chemoradiotherapy: A Multicenter Analysis. Cureus 2023; 15:e44637. [PMID: 37671078 PMCID: PMC10476146 DOI: 10.7759/cureus.44637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2023] [Indexed: 09/07/2023] Open
Abstract
INTRODUCTION Patients with head and neck cancer (HNC) have an elevated incidence of cachexia and malnutrition due to the tumor's location interfering with oral feeding. Concurrent chemoradiation (CCRT) can have an emetic effect and cause dysphagia and oral mucositis. Adequate nutrition improves immunity, raises the response to therapy, reduces adverse effects, and improves survival. Numerous studies have suggested the utility of nutritional support from percutaneous endoscopic gastrostomy (PEG) in HNC patients. Although PEG is usually considered a safe procedure, it has a mortality rate of 0-2.2% and a risk of other procedure-related complications of 17-40%. Our work intends to evaluate the utility of PEG in patients with locally advanced HNC who underwent CCRT. METHODS We performed a cohort study at three institutions. We included patients with HNC who underwent definitive CCRT treatment from January 2013 to December 2022. The study consisted of an observational, descriptive, retrospective analysis of prespecified clinical data. Descriptive statistics were used to compare the data between the PEG group and the non-PEG group. Analysis of covariance (ANCOVA) was used for covariance analysis. Fisher's exact test was used to compare proportional data and Student's t-test was used to assess the differences in continuous data. Survival analysis was performed using the Kaplan-Meier estimator. P-values of <0.05 were considered to be indicative of statistical significance. The SPSS Statistics version 28.0 (Armonk, NY: IBM Corp.) was used to perform all statistical evaluations. RESULTS We identified 90 eligible patients diagnosed with local advanced HNC who had received definitive CCRT with three weekly cycles of cisplatin as follows: 44 with a prophylactic PEG tube and 46 without a prophylactic PEG tube. Most patients were male (84.4%) and 50% of patients were diagnosed with stage IVa HNC at the time of diagnosis. There wasn't an effect of PEG placement on BMI at the end of CCRT after controlling for the effect of baseline BMI (F {1.84}=0.065 {p=0.799}). In the study population, BMI was significantly lower after CCRT (21.30 kg/m2 vs. 23.97 kg/m2), t (86)=12.389, p<0.001. In the subgroup with baseline BMI <18.5 kg/m2 (15 patients), 90% of patients with prophylactic PEG were able to complete the three planned cycles of chemotherapy vs. 66.7% in the non-PEG group. Ten patients in the PEG group (22.7%) referred feeding tube dependency. Patients with dysphagia were 3.2 times more likely to have placed prophylactic PEG (p=0.007). The difference in overall survival and progression-free survival between the two groups was not statistically significant (p=0.57 and p=0.497, respectively). CONCLUSION In this study using real-world data, we found a potentially protective effect of PEG in underweight patients with locally advanced HNC performing CCRT in order to complete three cycles of treatment.
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Affiliation(s)
- Maria Teresa Neves
- Medical Oncology, Hospital São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental (CHLO), Lisbon, PRT
| | - André Ferreira
- Medical Oncology, Hospital São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental (CHLO), Lisbon, PRT
| | - Vanessa Branco
- Medical Oncology, Hospital São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental (CHLO), Lisbon, PRT
| | - Maria Abreu
- Medical Oncology, Hospital São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental (CHLO), Lisbon, PRT
| | - Fátima R Alves
- Medical Oncology, Hospital São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental (CHLO), Lisbon, PRT
| | | | - Joana Graça
- Medical Oncology, Hospital de Vila Franca de Xira, Vila Franca de Xira, PRT
| | - Filipa Ferreira
- Medical Oncology, Hospital São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental (CHLO), Lisbon, PRT
| | - Mariana Malheiro
- Medical Oncology, Hospital CUF Tejo, Lisbon, PRT
- Medical Oncology, Hospital São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental (CHLO), Lisbon, PRT
| | - Ana Martins
- Medical Oncology, Hospital São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental (CHLO), Lisbon, PRT
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Martinovic D, Tokic D, Puizina Mladinic E, Usljebrka M, Kadic S, Lesin A, Vilovic M, Lupi-Ferandin S, Ercegovic S, Kumric M, Bukic J, Bozic J. Nutritional Management of Patients with Head and Neck Cancer-A Comprehensive Review. Nutrients 2023; 15:nu15081864. [PMID: 37111081 PMCID: PMC10144914 DOI: 10.3390/nu15081864] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/07/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
While surgical therapy for head and neck cancer (HNC) is showing improvement with the advancement of reconstruction techniques, the focus in these patients should also be shifting to supportive pre and aftercare. Due to the highly sensitive and anatomically complex region, these patients tend to exhibit malnutrition, which has a substantial impact on their recovery and quality of life. The complications and symptoms of both the disease and the therapy usually make these patients unable to orally intake food, hence, a strategy should be prepared for their nutritional management. Even though there are several possible nutritional modalities that can be administrated, these patients commonly have a functional gastrointestinal tract, and enteral nutrition is indicated over the parenteral option. However, after extensive research of the available literature, it seems that there is a limited number of studies that focus on this important issue. Furthermore, there are no recommendations or guidelines regarding the nutritional management of HNC patients, pre- or post-operatively. Henceforth, this narrative review summarizes the nutritional challenges and management modalities in this particular group of patients. Nonetheless, this issue should be addressed in future studies and an algorithm should be established for better nutritional care of these patients.
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Affiliation(s)
- Dinko Martinovic
- Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia
| | - Daria Tokic
- Department of Anesthesiology and Intensive Care, University Hospital of Split, 21000 Split, Croatia
| | - Ema Puizina Mladinic
- Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia
| | - Mislav Usljebrka
- Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia
| | - Sanja Kadic
- Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia
| | - Antonella Lesin
- Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia
| | - Marino Vilovic
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia
| | - Slaven Lupi-Ferandin
- Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia
| | - Sasa Ercegovic
- Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia
| | - Marko Kumric
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia
| | - Josipa Bukic
- Department of Pharmacy, University of Split School of Medicine, 21000 Split, Croatia
| | - Josko Bozic
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia
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Abdelfattah T, Kaspar M. Gastroenterologist's Guide to Gastrostomies. Dig Dis Sci 2022; 67:3488-3496. [PMID: 35579798 DOI: 10.1007/s10620-022-07538-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 04/22/2022] [Indexed: 12/09/2022]
Abstract
Gastroenterologists are frequently consulted for evaluation feeding tube placement, or for management of complications in an existing feeding tube. Though a frequent topic of consultation for GI Fellows, there are few comprehensive resources for feeding tube placement and troubleshooting available. In this review, we discuss different types of feeding tubes, when each should be considered, and various methods and techniques for placement. Considerations for when one type, method, technique, or specialty may be preferred over the other will be discussed. Additionally, we discuss management of the many complications of indwelling feeding tubes. Our goal is to create a comprehensive review for gastroenterologists to cover clinically relevant questions related to feeding tube placement and management.
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Affiliation(s)
- Thaer Abdelfattah
- Division of Gastroenterology and Hepatology, Virginia Commonwealth University, 1200 E Broad Street, West Hospital, 14th Floor, Box 980341, Richmond, VA, USA.
| | - Matthew Kaspar
- Division of Gastroenterology and Hepatology, Virginia Commonwealth University, 1200 E Broad Street, West Hospital, 14th Floor, Box 980341, Richmond, VA, USA
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Dechaphunkul T, Soonthornrak P, Geater SL, Dechaphunkul A. Utility of prophylactic percutaneous endoscopic gastrostomy tube in head and neck cancer patients undergoing concurrent chemoradiation: A prospective observational cohort. Am J Otolaryngol 2022; 43:103512. [PMID: 35636089 DOI: 10.1016/j.amjoto.2022.103512] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/16/2022] [Accepted: 05/16/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE The necessity of prophylactic percutaneous endoscopic gastrostomy (PPEG) before concurrent chemoradiation (CCRT) in head and neck cancer (HNC) patients remains uncertain. We evaluated the utilization rate of PPEG tube. Weight changes and tube dependence were also assessed. MATERIALS AND METHODS This prospective cohort study evaluated the utilization rate of PPEG tube in patients with newly diagnosed HNC undergoing CCRT. Baseline characteristics, nutrition status, and weight loss data were collected and compared between use and non-use groups. RESULTS 110 patients (94.8%) used PPEG tube (70 fully-used and 40 partially-used groups). Non-users had a tendency to lose weight more than partially and fully-used groups; 9.13%, 3.42%, and 1.95%, respectively (p = 0.085). Fully-used group had significantly longer time of tube dependence than partially-used group, 7.0 months versus 4.9 months (p = 0.012). The type of PPEG tube use (full use or partial use) and presence of dysphagia were significantly related to tube dependence. The time ratio of tube dependence for partially-used patients versus fully-used patients was 0.82 (95% CI: 0.68-0.99) (p = 0.039). The time ratio for patients with symptoms of dysphagia was 1.29 (95% CI: 1.02-1.63) (p = 0.032). At the end of CCRT, 96.6% of patients agreed that PPEG tube was necessary. CONCLUSION We recommend PPEG for patients undergoing CCRT. Partial use of PPEG with continuous oral intake as tolerated is strongly encouraged to maintain weight, and to reduce risk of tube dependence. Future study to evaluate effective swallowing exercise is warranted.
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Bossola M, Antocicco M, Pepe G. Tube feeding in head and neck cancer patients undergoing chemoradiotherapy: a systematic review. JPEN J Parenter Enteral Nutr 2022; 46:1258-1269. [PMID: 35244947 DOI: 10.1002/jpen.2360] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 02/03/2022] [Accepted: 02/21/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Head and neck cancer patients are frequently malnourished at the time of diagnosis and prior to the beginning of treatment. In addition, chemo-radiotherapy (CRT) causes or exacerbates symptoms, such as alteration or loss of taste, mucositis, xerostomia, fatigue, nausea, and vomiting, with consequent worsening of malnutrition. If obstructing cancer and/or mucositis interfere with swallowing, enteral nutrition should be delivered by a nasogastric tube (NGT) or percutaneous endoscopic gastrostomy (PEG). AIM To revise the studies comparing NGT and PEG in terms of nutritional outcomes, survival, hospitalizations, number of interruptions of radiotherapy, quality of life, swallowing function. RESULTS A total of 250 publications were identified via electronic databases. After screening the titles, abstracts and full texts, 26 manuscripts that met the inclusion criteria were included for analysis. We divided the analysis in two sections: 1) comparison of enteral nutrition through NGT or PEG and 2) comparison of reactive PEG (R-PEG) and prophylactic PEG (P-PEG). RESULTS Both PEG and NGT are an effective method of providing nutritional support during chemoradiotherapy for head and neck cancer. They are essentially comparable in terms of nutritional outcomes, number of radiotherapy interruptions, survival, and quality of life, whereas swallow function seems better with NGT. PEG may be associated with major complications such as exit site infection, malfunction, leakage, pain, and pulmonary infection and higher costs. Nevertheless, NGT dislodged more often, patients find it more inconvenient, may cause aspiration pneumonia and PEG has advantages over NGT of enhanced mobility and improved cosmesis. P-PEG and R-PEG are essentially similar in terms of nutritional outcomes, number of interruptions of radiotherapy, and survival. Conflicting results have been reported about quality of life. CONCLUSION PEG is not better than NGT in terms of nutritional, oncologic, and quality of life outcomes. Prophylactic feeding through NGT or PEG, compared to reactive feeding, does not offer significant advantages in terms of nutritional outcomes, interruptions of radiotherapy and survival. However, the number of prospective randomized studies on this topic is much limited and consequently definitive conclusions cannot be drawn. Overall, it seems that further adequate prospective, randomized studies are needed to define the better nutritional intervention in head and neck cancer patients undergoing chemoradiotherapy. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Maurizio Bossola
- Dipartimento di Scienze Mediche e Chirurgiche, Policlinico Universitario Fondazione Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore
| | - Manuela Antocicco
- Dipartimento di Scienze dell'invecchiamento, neurologiche, ortopediche e della testa-collo, Policlinico Universitario Fondazione Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore
| | - Gilda Pepe
- Dipartimento di Scienze Mediche e Chirurgiche, Policlinico Universitario Fondazione Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore
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Benefits of prophylactic percutaneous gastrostomy in patients with nasopharyngeal cancer receiving concurrent chemoradiotherapy: A multicenter analysis. Am J Otolaryngol 2022; 43:103356. [PMID: 34972008 DOI: 10.1016/j.amjoto.2021.103356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/15/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE Prophylactic percutaneous endoscopic gastrostomy (PPEG) is widely used for patients with head and neck cancer undergoing concurrent chemoradiation (CCRT). Nevertheless, the necessity of its use in patients with nasopharyngeal cancer (NPC) is uncertain. This study aimed to evaluate the benefits of PPEG on prevention of weight loss and treatment tolerance in patients with NPC receiving CCRT. MATERIALS AND METHODS A retrospective multicenter chart review of 904 patients, 378 in the PPEG group and 526 in the non-PPEG group, was conducted. Baseline characteristics, weight loss, and treatment tolerance were analyzed and compared between the two groups. RESULTS There was no significant difference in the mean baseline body mass index (BMI) between the groups. At the end of CCRT, no difference in weight loss was found between the 2 groups (non-PPEG group, 6.6%; PPEG group, 5.9%). Nonetheless, the subgroup analysis demonstrated that a baseline BMI < 18.5 kg/m2 (underweight) and non-intensity-modulated radiation therapy (IMRT) technique were independent factors associated with prevention of weight loss by PPEG. More patients in the PPEG group were able to complete planned cycles of chemotherapy (73.3% vs. 49.0%, P < .0001). CONCLUSION Although the benefits of PPEG on prevention of weight loss were not observed for the entire cohort, we found a potentially protective effect of PPEG in some subgroups of patients. Additionally, PPEG significantly enhanced chemotherapy tolerance. Therefore, PPEG tube insertion should be strongly considered for patients with NPC receiving CCRT, particularly for underweight patients and those undergoing a non-IMRT technique.
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Delays in Time to Head and Neck Cancer Treatment: A South Australian Perspective. Medicina (B Aires) 2022; 58:medicina58020145. [PMID: 35208469 PMCID: PMC8877393 DOI: 10.3390/medicina58020145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/04/2022] [Accepted: 01/17/2022] [Indexed: 11/17/2022] Open
Abstract
Background and Objectives: In head and neck cancer, delays in time to treatment are associated with poorer clinical outcomes. Within Australia, it is recommended that primary treatment is initiated within 56 days of initial referral. The aim of this study was to assess whether head and neck cancer treatment was delivered within these timeframe guidelines at our institution and identify factors associated with treatment delays. Methods: This retrospective cohort study assessed patients newly diagnosed with head and neck cancer over a 24 months period (2018 to 2019) at Flinders Medical Centre, Australia. Time to treatment intervals were calculated for comparison to local timeframe guidelines. Results: A total of 72 patients met the inclusion criteria. The median time from specialist referral to treatment initiation was 45.5 days (IQR 29–61), with 72% meeting the 56 days guideline. On univariate logistic regression, patients undergoing primary radiotherapy treatment were less likely to meet this guideline than those undergoing primary surgery (OR 8.8, 95% CI 2.6–28.9, p < 0.001), as were those requiring prophylactic gastrostomy tube insertion (OR 3.1, 95% CI 1.1–9.0, p < 0.05). Treatment initiation beyond 56 days had no significant impact on 12 months overall survival or disease-free survival. Conclusions: The findings of this study demonstrate that primary radiotherapy treatment is associated with delays in head and neck cancer treatment initiation, likely related to time consuming pre-treatment factors such as gastrostomy tube insertion.
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Thirayan V, Jameson MB, Gregor RT. Prophylactic versus reactive percutaneous endoscopic gastrostomy in oropharyngeal squamous cell carcinoma patients undergoing radical radiotherapy. ANZ J Surg 2021; 91:2720-2725. [PMID: 34427036 DOI: 10.1111/ans.17159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 07/06/2021] [Accepted: 08/03/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND Radiotherapy (RT) for oropharyngeal squamous cell cancer (OPSCC) is associated with malnutrition due to treatment-related mucositis and dysphagia. While percutaneous endoscopic gastrostomy (PEG) feeding can improve nutrition, it has acute and late complications, including dependence on PEG feeding. We retrospectively evaluated patient outcomes by whether gastrostomy placement was prophylactic (P-G) or reactive to RT complications (R-G). METHODS Retrospective analysis of OPSCC patients undergoing curative-intent RT at Waikato Hospital between 2010 and 2015. RESULTS Of 103 OPSCC patients treated with RT (+/- chemotherapy) 21 had P-G, 15 had R-G and 67 had none (No-G). P-G patients were significantly more likely to be female, older, have higher tumour stage and receive bilateral RT (all p < 0.05). P-G and No-G patients had similar rates and duration of hospital admission for complications during treatment, but both were significantly less than in R-G patients (admission rates 52.3%, 49.3% and 86.7%, and mean length of stay 3.5, 3.3 and 11.9 days, respectively; p < 0.001). R-G patients also had greater RT treatment delays than P-G or No-G patients (mean 1.1, 0.7 and 0.4 days, respectively, p < 0.05). No significant differences were noted between groups in PEG dependence or weight change during, or 1, 3 or 6 months after, RT. Weight loss was not significantly different with P-G than R-G despite more frequent use of bilateral RT fields in the former group. CONCLUSIONS P-G placement affords shorter and less frequent hospital admissions than R-G during RT for OPSCC, with no increased complications or gastrostomy-dependence rates.
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Affiliation(s)
- Varun Thirayan
- Resident Medical Officer Unit, Waikato Hospital, Hamilton, New Zealand
| | - Michael Barrett Jameson
- Oncology Department, Waikato Hospital, Hamilton, New Zealand.,Waikato Clinical Campus, Faculty of Medical and Health Sciences, University of Auckland, Hamilton, New Zealand
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Saavedra R, Fahy BN. Artificial Nutrition in Patients with Advanced Malignancy. Surg Oncol Clin N Am 2021; 30:505-518. [PMID: 34053665 DOI: 10.1016/j.soc.2021.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Cancer is a progressive disease that can lead to malnutrition and cachexia. Artificial nutrition is a medical therapy used to combat malnutrition in these patients. In this article, the authors discuss factors affecting the decision to use artificial nutrition, including the patient's mental and physical health, technical factors of the procedures used to deliver artificial nutrition, and the oncologic factors affecting treatment. Through this review, the authors provide guidelines on who is and is not likely to benefit from therapy, available routes of administration, and necessary factors to consider for appropriate decision-making for palliative patients and those with advanced cancers."
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Affiliation(s)
- Ramses Saavedra
- Department of Surgery, University of New Mexico, 1 University of New Mexico, MSC 07-4025, Albuquerque, NM 87131, USA
| | - Bridget N Fahy
- Department of Surgery, University of New Mexico, 1 University of New Mexico, MSC 07-4025, Albuquerque, NM 87131, USA; Division of Palliative Medicine, University of New Mexico, Albuquerque, NM, USA.
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Predictors of the need for prophylactic percutaneous endoscopic gastrostomy in head and neck cancer patients treated with concurrent chemoradiotherapy. Int J Clin Oncol 2021; 26:1179-1187. [PMID: 34086112 DOI: 10.1007/s10147-021-01889-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 02/11/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND We investigated whether prophylactic percutaneous endoscopic gastrostomy (PEG) is used effectively for patients treated with definitive concurrent chemoradiotherapy (CCRT) and the predictors of the need for PEG. METHODS 326 patients with laryngeal, oropharyngeal or hypopharyngeal cancers were retrospectively reviewed. RESULTS The PEG tube use group had more favorable results than the total parenteral nutrition and nasogastric tube groups in terms of rate of serum albumin loss, incidence of severe fever and aspiration pneumonia, CCRT completion rate and hospitalization period. However, it was inferior to oral intake. Analysis of the relative risk of requiring enteral or parenteral nutrition revealed that performance status (PS) 2, primary site (supraglottis, oropharynx, or hypopharynx), N3 disease, and cisplatin were predictors of the need for nutritional support. CONCLUSIONS Prophylactic PEG is effective for patients treated with definitive CCRT and is especially required for patients with PS2 or oropharyngeal cancer.
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12
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Jensen AD, Langer C. [Late toxicity following primary conservative treatment : Dysphagia and xerostomia]. HNO 2020; 69:263-277. [PMID: 33180145 DOI: 10.1007/s00106-020-00961-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2020] [Indexed: 11/28/2022]
Abstract
Dysphagia and xerostomia are still among the most important acute and late side effects of radiotherapy. Technical developments over the past two decades have led to improved diagnostics and recognition as well as understanding of the causes of these side effects. Based on these findings and advances in both treatment planning and irradiation techniques, the incidence and severity of treatment-associated radiogenic late sequelae could be clearly reduced by the use of intensity-modulated radiotherapy (IMRT), which could contribute to marked long-term improvements in the quality of life in patients with head and neck cancer. Highly conformal techniques, such as proton therapy have the potential to further reduce treatment-associated side effects in head and neck oncology and are currently being prospectively tested within clinical trial protocols at several centers.
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Affiliation(s)
- A D Jensen
- Klinik für Strahlentherapie, Universitätsklinikum Gießen und Marburg, Klinikstr. 33, 35392, Gießen, Deutschland. .,FB 20 (Medizin), Philipps-Universität Marburg, Marburg, Deutschland.
| | - C Langer
- Klinik für HNO-Heilkunde, Kopf‑/Halschirurgie, Plastische Operationen, Universitätsklinikum Gießen und Marburg, Standort Gießen, Gießen, Deutschland.,Justus-Liebig Universität Gießen, Gießen, Deutschland
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13
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Ou Q, Cui C, Zeng X, Dong A, Wei X, Chen M, Liu L, Zhao Y, Li H, Lin W. Grading and prognosis of weight loss before and after treatment with optimal cutoff values in nasopharyngeal carcinoma. Nutrition 2020; 78:110943. [PMID: 32861179 DOI: 10.1016/j.nut.2020.110943] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/16/2020] [Accepted: 06/21/2020] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Weight loss has been validated as a prognostic predictor of nasopharyngeal carcinoma (NPC); however, no global unitary indicator and criteria exist for the definition of weight loss as a prognostic factor. The aim of this study was to determine the most effective indicator for weight loss, evaluate its effect on the prognosis of NPC, and further propose a cutoff value to identify patients in need of nutritional care. METHODS This retrospective cohort analysis with a median follow-up of 62.3 mo included 681 newly diagnosed patients with NPC. Principal component analysis was performed to select the best continuous variable including weight loss (kg; value of weight loss [VWL]), percent weight loss (PWL), and body mass index loss (BMIL). Multivariable Cox regression analysis and multiple correspondence analysis were performed to select the best cutoff values by different cutoff methods including the median, receiver operating characteristic curve, and threshold searching. RESULTS PWL was the highest contributor to the prognosis of NPC compared with VWL and BMIL. Cutoff values of PWL (6.3 and 12.3%) were confirmed to be more important and were proposed to differentiate patients into low-, medium-, and high-risk NPC groups, with their 5-y progression-free survival (84.5 versus 77.9%, P = 0.046; 77.9 versus 67.3%, P = 0.046). PWL was an independent adverse prognostic factor (P = 0.002) for NPC. CONCLUSIONS PWL is a promising predictor for NPC, and cutoff values could be validated for nutritional risk grading in patients with NPC. These stratified criteria may help accelerate the extensive application of grading nutritional management in NPC therapy.
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Affiliation(s)
- Qiaowen Ou
- Department of Clinical Nutrition, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, P.R. China; The First Affiliated Hospital of Clinical Medicine of Guangdong Pharmaceutical University, Guangzhou, P.R. China
| | - Chunyan Cui
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, P.R. China
| | - Xinchen Zeng
- Department of Liver Transplantation, The Third People's Hospital of Shenzhen, Shenzhen, Guangdong, P.R. China
| | - Annan Dong
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, P.R. China
| | - Xiaoyu Wei
- Sun Yat-sen University. Guangzhou, Guangdong, P.R. China
| | - Mingyang Chen
- School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China
| | - Lizhi Liu
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, P.R. China
| | - Yongyi Zhao
- Department of Clinical Nutrition, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, P.R. China; The First Affiliated Hospital of Clinical Medicine of Guangdong Pharmaceutical University, Guangzhou, P.R. China
| | - Haojiang Li
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, P.R. China
| | - Weiqun Lin
- Department of Clinical Nutrition, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, P.R. China; The First Affiliated Hospital of Clinical Medicine of Guangdong Pharmaceutical University, Guangzhou, P.R. China.
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14
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Lang K, ElShafie RA, Akbaba S, Koschny R, Bougatf N, Bernhardt D, Welte SE, Adeberg S, Häfner M, Kargus S, Plinkert PK, Debus J, Rieken S. Percutaneous Endoscopic Gastrostomy Tube Placement in Patients with Head and Neck Cancer Treated with Radiotherapy. Cancer Manag Res 2020; 12:127-136. [PMID: 32021429 PMCID: PMC6955619 DOI: 10.2147/cmar.s218432] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 12/02/2019] [Indexed: 12/12/2022] Open
Abstract
Background and aim The primary aim of our study was to evaluate percutaneous endoscopic gastrostomy (PEG) tube placement depending on body weight and body mass index in patients undergoing radiotherapy (RT) for head and neck cancer (HNC). A secondary aim was to evaluate the course of weight change following PEG placement. Methods We retrospectively reviewed the medical records of 186 patients with HNC undergoing radiotherapy (RT) or chemoradiotherapy (CRT) at our institution between January 2010 and August 2017. Initial weight and nutritional intake were analyzed prior to RT initiation and then followed throughout treatment until completion. Based on these data, the indication of PEG placement was determined. Medical records were also reviewed to analyze PEG-related acute toxicities. Results A total of 186 patients met inclusion criteria. Patients were most commonly male (n=123, 66.1%) with squamous cell carcinoma (n=164, 88.2%). Patients who had dysphagia prior to treatment initiation as well as patients with a BMI <18.5 kg/m2 needed PEG placement earlier during the treatment course. Low-grade toxicities related to PEG insertion were observed in 10.7% patients, with peristomal pain and redness adjacent to the PEG tube insertion site being most common. High-grade toxicities, such as peritonitis and organ injury, were found in 4.9% of patients. Conclusion Underweight patients and those with preexisting dysphagia should be closely screened during RT for weight loss and decreased oral intake. For weight loss greater than 4.5% during the treatment of HNC, early PEG-tube placement should be considered. Further prospective studies are needed to confirm these findings, and delineate a scoring system for timing of PEG use (prophylactic vs reactive) as well as assess the quality of life in patients with HNC who receive PEG placement.
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Affiliation(s)
- Kristin Lang
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg 69120, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), University Hospital of Heidelberg, Heidelberg 69120, Germany.,National Center for Tumor Diseases (NCT), University Hospital of Heidelberg, Heidelberg, Germany
| | - Rami A ElShafie
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg 69120, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), University Hospital of Heidelberg, Heidelberg 69120, Germany.,National Center for Tumor Diseases (NCT), University Hospital of Heidelberg, Heidelberg, Germany
| | - Sati Akbaba
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg 69120, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), University Hospital of Heidelberg, Heidelberg 69120, Germany.,National Center for Tumor Diseases (NCT), University Hospital of Heidelberg, Heidelberg, Germany
| | - Ronald Koschny
- Department of Internal Medicine, University of Heidelberg, Heidelberg, Germany
| | - Nina Bougatf
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg 69120, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), University Hospital of Heidelberg, Heidelberg 69120, Germany.,National Center for Tumor Diseases (NCT), University Hospital of Heidelberg, Heidelberg, Germany.,Heidelberg Ion Therapy Center (HIT), University Hospital of Heidelberg, Heidelberg 69120, Germany
| | - Denise Bernhardt
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg 69120, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), University Hospital of Heidelberg, Heidelberg 69120, Germany.,National Center for Tumor Diseases (NCT), University Hospital of Heidelberg, Heidelberg, Germany.,Heidelberg Ion Therapy Center (HIT), University Hospital of Heidelberg, Heidelberg 69120, Germany
| | - Stefan E Welte
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg 69120, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), University Hospital of Heidelberg, Heidelberg 69120, Germany.,National Center for Tumor Diseases (NCT), University Hospital of Heidelberg, Heidelberg, Germany.,Heidelberg Ion Therapy Center (HIT), University Hospital of Heidelberg, Heidelberg 69120, Germany
| | - Sebastian Adeberg
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg 69120, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), University Hospital of Heidelberg, Heidelberg 69120, Germany.,National Center for Tumor Diseases (NCT), University Hospital of Heidelberg, Heidelberg, Germany.,Heidelberg Ion Therapy Center (HIT), University Hospital of Heidelberg, Heidelberg 69120, Germany
| | - Matthias Häfner
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg 69120, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), University Hospital of Heidelberg, Heidelberg 69120, Germany.,National Center for Tumor Diseases (NCT), University Hospital of Heidelberg, Heidelberg, Germany.,Heidelberg Ion Therapy Center (HIT), University Hospital of Heidelberg, Heidelberg 69120, Germany
| | - Steffen Kargus
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Heidelberg 69120, Germany
| | - Peter K Plinkert
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg 69120, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), University Hospital of Heidelberg, Heidelberg 69120, Germany.,National Center for Tumor Diseases (NCT), University Hospital of Heidelberg, Heidelberg, Germany.,Heidelberg Ion Therapy Center (HIT), University Hospital of Heidelberg, Heidelberg 69120, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg 69120, Germany
| | - Stefan Rieken
- Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg 69120, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), University Hospital of Heidelberg, Heidelberg 69120, Germany.,National Center for Tumor Diseases (NCT), University Hospital of Heidelberg, Heidelberg, Germany.,Heidelberg Ion Therapy Center (HIT), University Hospital of Heidelberg, Heidelberg 69120, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg 69120, Germany
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15
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Lazzari G, De Cillis MA, Buccoliero G, Silvano G. Competing Morbidities In Advanced Head And Neck Squamous Cell Carcinoma Concurrent Chemoradiotherapy: A Strong Implication Of A Multidisciplinary Team Approach. Cancer Manag Res 2019; 11:9771-9782. [PMID: 31819615 PMCID: PMC6875280 DOI: 10.2147/cmar.s229524] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 10/22/2019] [Indexed: 12/11/2022] Open
Abstract
Concurrent chemoradiotherapy (CCRT) is the standard approach for the treatment of locally advanced head and neck squamous cell carcinoma. Despite its undisputed advantages, CCRT is associated with acute and late toxicities, leading to unfavorable implications (eg, unplanned interruptions and noncancer-related mortality). The former prolongs the overall treatment time leading to a detrimental effect on tumor control. The latter consists of several noncancer morbidities arising from treatment-related toxicities, identifying a new pathway in cancer fate. This pathway has been termed noncancer mortality or competing mortality and consists of a series of treatment-competing morbidities, which nullify all therapeutic efforts aimed at curing these patients. The management of patients with head and neck squamous cell carcinoma who experience treatment-related toxicities is complex and requires expertise in oncological treatment as well as supportive care. The optimal management of these patients should start with knowledge regarding the most important competing morbidities developing during all phases of the disease (ie, from diagnosis to follow-up) to minimize treatment interruptions, ensure appropriate psychological support, and achieve the best oncological result. The purpose of the present review is to analyze the most important competing morbidities due to patient’s condition at baseline and CCRT, which could result in noncancer mortality. A multidisciplinary team approach is strongly required in the management of this disease.
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Affiliation(s)
- Grazia Lazzari
- Radiation Oncology Unit, S. Giuseppe Moscati Hospital, Taranto 74100, Italy
| | | | | | - Giovanni Silvano
- Radiation Oncology Unit, S. Giuseppe Moscati Hospital, Taranto 74100, Italy
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16
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Hazzard E, Walton K, McMahon A, Milosavljevic M, Tapsell L. Healthcare Professionals’ Perceptions of Feeding Tube Practices for Patients With Head and Neck Cancer Across 4 International Radiation Oncology Departments. JPEN J Parenter Enteral Nutr 2019; 44:796-805. [DOI: 10.1002/jpen.1699] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/16/2019] [Accepted: 08/17/2019] [Indexed: 01/02/2023]
Affiliation(s)
- Emily Hazzard
- Wollongong HospitalIllawarra Shoalhaven Local Health District Wollongong New South Wales Australia
- School of MedicineUniversity of Wollongong Wollongong New South Wales Australia
| | - Karen Walton
- School of MedicineUniversity of Wollongong Wollongong New South Wales Australia
- Illawarra Health and Medical Research InstituteUniversity of Wollongong Wollongong New South Wales Australia
| | | | - Marianna Milosavljevic
- Wollongong HospitalIllawarra Shoalhaven Local Health District Wollongong New South Wales Australia
| | - Linda Tapsell
- School of MedicineUniversity of Wollongong Wollongong New South Wales Australia
- Illawarra Health and Medical Research InstituteUniversity of Wollongong Wollongong New South Wales Australia
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17
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Li X, Zhou J, Chu C, You Q, Zhong R, Rao Z, Hu W. Home enteral nutrition may prevent myelosuppression of patients with nasopharyngeal carcinoma treated by concurrent chemoradiotherapy. Head Neck 2019; 41:3525-3534. [PMID: 31301097 DOI: 10.1002/hed.25861] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 05/16/2019] [Accepted: 06/18/2019] [Indexed: 02/05/2023] Open
Abstract
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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Affiliation(s)
- Xuemei Li
- Department of Clinical Nutrition, West China Hospital, Sichuan University, Chengdu, China
| | - Jidan Zhou
- Department of Radiotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Ci Chu
- Department of Clinical Nutrition, West China Hospital, Sichuan University, Chengdu, China
| | - Qian You
- Department of Clinical Nutrition, West China Hospital, Sichuan University, Chengdu, China
| | - Renming Zhong
- Department of Radiotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Zhiyong Rao
- Department of Clinical Nutrition, West China Hospital, Sichuan University, Chengdu, China
| | - Wen Hu
- Department of Clinical Nutrition, West China Hospital, Sichuan University, Chengdu, China
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18
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Enteral Nutrition in Pediatric High-risk Head and Neck Cancer Patients Receiving Proton Therapy: Identifying Risk Factors and Quality of Life Concerns to Optimize Care. J Pediatr Hematol Oncol 2019; 41:e247-e253. [PMID: 31026252 DOI: 10.1097/mph.0000000000001364] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Radiotherapy for pediatric head and neck tumors often results in mucositis and pain, limiting oral intake and compromising patients' nutrition. There are little pediatric data available regarding enteral tube use and risk factors. Our objective was to estimate nutrition needs, identify risk factors contributing to nutritional decline and explore quality of life measures regarding enteral nutrition during proton radiotherapy. PROCEDURE Nutritional metrics and status were collected throughout radiation treatment for 32 patients. We surveyed patients/caregivers about their perceptions of enteral nutrition. Risk factors for progression to non-oral nutrition or >5% weight loss were evaluated using univariate analysis. RESULTS Patients who received any esophageal radiation or >30 Gy mean dose to the pharyngeal constrictors were more likely to experience >5% weight loss. These patients, as well as those who received a mean dose >30 Gy to the oropharynx or concurrent chemotherapy, were also more likely to require non-oral supplementation. Patients expressed the importance of maximizing nutrition and feared pain associated with a tube placement. CONCLUSIONS Pediatric patients with head and neck cancer can be risk-stratified based on clinical and dosimetric factors. This data, combined with parent and patient perceptions, is key to the development of rational guidelines.
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19
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Badr H, Sobrero M, Chen J, Kotz T, Genden E, Sikora AG, Miles B. Associations between pre-, post-, and peri-operative variables and health resource use following surgery for head and neck cancer. Oral Oncol 2019; 90:102-108. [PMID: 30846167 DOI: 10.1016/j.oraloncology.2019.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 01/31/2019] [Accepted: 02/04/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE We examined associations between pre-, post-, and peri-operative variables and health resource use in head and neck cancer patients. METHODS Patients (N = 183) who were seen for a pre-surgical consult between January 2012 and December 2014 completed surveys that assessed medical history, a patient-reported outcome measure (PROM) of dysphagia, and quality of life (QOL). After surgery, peri-operative (e.g., tracheostomy, feeding tube) and post-operative (e.g., complications) variables were abstracted from patients' medical records. RESULTS Multivariate regression models using backward elimination showed that pre-surgical University of Washington Quality of Life (UW-QOL) Inventory and M.D. Anderson Dysphagia Inventory (MDADI) composite scores, documented surgical complications, and having a tracheostomy, were all significant predictors of hospital length of stay, explaining 57% of the total variance (F(5, 160) = 18.71, p < .001). Male gender, psychiatric history, and lower pre-surgical MDADI scores significantly predicted thirty-day unplanned readmissions (30dUR). Pre-surgical MDADI composite scores also significantly predicted emergencey department (ED) visits within 30 days of initial hospital discharge (p = .02). CONCLUSIONS Assessment of PROMs and QOL in the pre-surgical setting may assist providers in identifying patients at risk for prolonged LOS and increased health resource use after hospital discharge.
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Affiliation(s)
- Hoda Badr
- Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, TX, USA.
| | | | - Joshua Chen
- Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, TX, USA; Department of Psychology, University of St Thomas, Houston, TX, USA
| | - Tamar Kotz
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eric Genden
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrew G Sikora
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Brett Miles
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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20
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Vrolijk LB, de Roij van Zuijdewijn CLM, Slingerland M, Wiggenraad RGJ, Verschuur HP, Jeurissen FJF. PEG tube dependency after prophylactic placement in 209 head and neck cancer patients treated with chemoradiotherapy or radiation with cetuximab. Clin Otolaryngol 2019; 44:172-175. [PMID: 30615256 DOI: 10.1111/coa.13282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 09/05/2018] [Accepted: 10/08/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Lucia B Vrolijk
- Department of Internal Medicine, Haaglanden Medical Center, The Hague, The Netherlands
| | | | - Marije Slingerland
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Hendrik P Verschuur
- Department of Otolaryngology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Frank J F Jeurissen
- Department of Oncology, Haaglanden Medical Center, The Hague, The Netherlands
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21
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McClelland S, Andrews JZ, Chaudhry H, Teckie S, Goenka A. Prophylactic versus reactive gastrostomy tube placement in advanced head and neck cancer treated with definitive chemoradiotherapy: A systematic review. Oral Oncol 2018; 87:77-81. [PMID: 30527247 DOI: 10.1016/j.oraloncology.2018.10.028] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 10/19/2018] [Accepted: 10/21/2018] [Indexed: 01/25/2023]
Abstract
Although chemoradiotherapy (CRT) has improved disease outcomes in advanced head and neck cancer (aHNC), toxicity remains a major concern. Treatment interruptions and decreased quality of life (QOL) can occur due to malnutrition, secondary to mucositis, dysphagia and odynophagia. Gastrostomy tubes are used in many patients to improve nutrition during CRT. The optimal timing of PEG placement in patients with aHNC undergoing CRT remains controversial. Using the PubMed database, we performed a systematic review of published CRT series in aHNC to guide decision-making regarding optimal timing of percutaneous endoscopic gastrostomy (PEG) placement. We aimed to compare outcomes when patients are treated with prophylactic PEG (pPEG) versus reactive PEG (rPEG). Twenty-two studies examining the role of PEG placement in CRT for aHNC were reviewed. pPEG reduces the number of malnourished patients (defined as >10% of body weight), but average weight loss at various time points following treatment appears similar to patients with rPEG. pPEG is also associated with improved QOL at 6 months, and greater long term PEG dependence. Clinical and dosimetric parameters that correlate with malnutrition in patients without pPEG include advanced age, percent weight loss preceding treatment, and radiation dose to the pharyngeal constrictor muscles. Based on this evidence, our institutional strategy is to encourage pPEG in those patients deemed at greatest risk of becoming malnourished during the course of treatment, and to approach the remainder of patients with rPEG.
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Affiliation(s)
- Shearwood McClelland
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN, United States; Department of Radiation Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Janna Z Andrews
- Department of Radiation Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Huma Chaudhry
- Department of Radiation Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Sewit Teckie
- Department of Radiation Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Anuj Goenka
- Department of Radiation Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States.
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22
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Rose PM. Patients' characteristics informing practice: improving individualized nursing care in the radiation oncology setting. Support Care Cancer 2018; 26:3609-3618. [PMID: 29728842 DOI: 10.1007/s00520-018-4210-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 04/13/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE A large number of patients attend for radiotherapy daily. Primary nurses in the study settings aim to individualize care for their patients. The individual characteristics of patients may determine their perceptions of nursing care, and provide guidance in tailoring their care. This study aimed to assess patients' personal characteristics on their perceptions of individualized care (IC) provided by nurses during a course of radiotherapy, and to determine predictor variables that may inform nursing practice. METHODS This cross-sectional, exploratory study was conducted in three radiotherapy departments in Australia. Patients (n = 250) completed the Individualized Care Scale_Patient (ICS_P). Data were analyzed using descriptive and inferential statistics, univariate analysis, and multiple regression analysis. RESULTS Males reported significantly higher perceptions of IC than females in 7/9 subscales. Patients with head and neck and prostate cancer, as well as those requiring hospitalization during radiotherapy, scored significantly higher in 5/9 subscales. Courses > 30 days, those not receiving chemotherapy, and partnered patients reported greater IC across all subscales. Gender and hospitalization were the main predictor variables for IC. CONCLUSION Patients reported moderately high levels of IC during their radiotherapy; however, standard demographic information may provide limited insight into improving care for the individual. Patient characteristics routinely chosen, such as age, gender, and education may not predict how patients perceive their care or support the tailoring of interventions to improve IC. Researching a range of related patient characteristics may prove a more useful concept for future nursing studies aiming to predict outcomes to tailor nursing practice.
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Affiliation(s)
- Pauline M Rose
- Radiation Oncology, Princess Alexandra Hospital, Queensland Health, 31 Raymond Terrace, South Brisbane, Queensland, 4101, Australia.
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23
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Rendezvous endoscopic recanalization for complete esophageal obstruction. Surg Endosc 2018; 32:4256-4262. [DOI: 10.1007/s00464-018-6174-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 03/21/2018] [Indexed: 01/29/2023]
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24
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Vangelov B, Kotevski DP, Williams JR, Smee RI. The impact of HPV status on weight loss and feeding tube use in oropharyngeal carcinoma. Oral Oncol 2018; 79:33-39. [PMID: 29598948 DOI: 10.1016/j.oraloncology.2018.02.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/05/2018] [Accepted: 02/11/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES It has been well established that patients with oropharyngeal carcinoma are at high nutritional risk, with significant weight loss and tube feeding common. Human papillomavirus (HPV)-associated disease has led to a change in the "typical" presentation and nutritional profile of this population. The aim of our study was to determine whether the need for a feeding tube, and weight loss during radiotherapy (RT) in patients with oropharyngeal carcinoma differed with HPV status. MATERIALS AND METHODS Patients who received curative RT ± chemotherapy from January 2011 to January 2016 were included (n = 100). We retrospectively evaluated feeding tube use and timing of insertion (prophylactic vs reactive), percentage weight loss during RT and the prevalence of critical weight loss (CWL) ≥5%. RESULTS HPV-positive patients had significantly higher weight loss during RT compared to the rest of the cohort (8.4% vs 6.1%, 95%CI 0.8-3.9, p = 0.003). CWL was observed in 86% and in a higher proportion with HPV-positive disease (93%, p = 0.011). Conditional probability modelling analysis revealed, with 74% accuracy, concurrent chemoradiotherapy and HPV-positive status were predictors of CWL when comparing HPV-positive patients to HPV-negative (96%, p = 0.001 and 98%, p = 0.012 respectively). More HPV-positive patients required feeding tubes (n = 43, 63%, p = 0.05), most being reactive (n = 27, 63%). All patients with reactive tubes experienced CWL. CONCLUSION The high incidence of CWL in patients with HPV-positive oropharyngeal carcinoma is of concern. Tube feeding continues to be a necessary nutritional intervention in this population and predicting who will require a tube is challenging. Larger, prospective cohort studies are required.
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Affiliation(s)
- Belinda Vangelov
- Department of Radiation Oncology, The Nelune Comprehensive Cancer Centre, The Prince of Wales Hospital, Randwick, New South Wales, Australia.
| | - Damian P Kotevski
- Department of Radiation Oncology, The Nelune Comprehensive Cancer Centre, The Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Janet R Williams
- Department of Radiation Oncology, The Nelune Comprehensive Cancer Centre, The Prince of Wales Hospital, Randwick, New South Wales, Australia; University of New South Wales Clinical Teaching School, The Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Robert I Smee
- Department of Radiation Oncology, The Nelune Comprehensive Cancer Centre, The Prince of Wales Hospital, Randwick, New South Wales, Australia; University of New South Wales Clinical Teaching School, The Prince of Wales Hospital, Randwick, New South Wales, Australia; Department of Radiation Oncology, Tamworth Base Hospital, Tamworth, NSW, Australia
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25
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Wopken K, Bijl HP, Langendijk JA. Prognostic factors for tube feeding dependence after curative (chemo-) radiation in head and neck cancer: A systematic review of literature. Radiother Oncol 2018; 126:56-67. [DOI: 10.1016/j.radonc.2017.08.022] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 08/07/2017] [Accepted: 08/21/2017] [Indexed: 12/31/2022]
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26
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Hazzard E, Walton K, McMahon AT, Milosavljevic M, Tapsell LC. Nutrition-related hospital presentations and admissions among radiotherapy outpatients: a systematic literature review. J Hum Nutr Diet 2017; 31:357-369. [DOI: 10.1111/jhn.12505] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- E. Hazzard
- The Wollongong Hospital; Illawarra Shoalhaven Local Health District; Wollongong NSW Australia
| | - K. Walton
- Nutrition and Dietetics; School of Medicine; Illawarra Health and Medical Research Institute; University of Wollongong; Wollongong NSW Australia
| | - A.-T. McMahon
- Nutrition and Dietetics; School of Medicine; Illawarra Health and Medical Research Institute; University of Wollongong; Wollongong NSW Australia
| | - M. Milosavljevic
- The Wollongong Hospital; Illawarra Shoalhaven Local Health District; Wollongong NSW Australia
| | - L. C. Tapsell
- Nutrition and Dietetics; School of Medicine; Illawarra Health and Medical Research Institute; University of Wollongong; Wollongong NSW Australia
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Ruohoalho J, Aro K, Mäkitie AA, Atula T, Haapaniemi A, Keski-Säntti H, Kylänpää L, Takala A, Bäck LJ. Prospective experience of percutaneous endoscopic gastrostomy tubes placed by otorhinolaryngologist-head and neck surgeons: safe and efficacious. Eur Arch Otorhinolaryngol 2017; 274:3971-3976. [PMID: 28865046 DOI: 10.1007/s00405-017-4732-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 08/24/2017] [Indexed: 10/18/2022]
Abstract
Percutaneous endoscopic gastrostomy (PEG) is often the treatment of choice in head and neck cancer (HNC) patients needing long-term nutritional support. Prospective studies on PEG tube placement in an otorhinolaryngologist service are lacking. At our hospital, otolaryngologist-head and neck (ORL-HN) surgeons-have performed PEG insertions for HNC patients since 2008. We prospectively analyzed 127 consecutive HNC patients who received their PEG tubes at the Department of Otorhinolaryngology-head and neck surgery, and evaluated the outcome of PEG tube insertions performed by ORL-HN surgeons. To compare time delays before and after, PEG placement service was transferred from gastrointestinal surgeons to ORL-HN surgeons, and we retrospectively analyzed a separate group of 110 HNC patients who had earlier received PEG tubes at the Department of Gastrointestinal Surgery. ORL-HN surgeons' success rate in PEG insertion was 97.6%, leading to a final prospective study group of 124 patients. Major complications occurred in four (3.2%): two buried bumper syndromes, one subcutaneous hemorrhage leading to an abscess in the abdominal wall, and one metastasis at the PEG site. The most common minor complication was peristomal granulomatous tissue affecting 23 (18.5%) patients. After the change in practice, median time delay before PEG insertion decreased from 13 to 10 days (P < 0.005). The proportion of early PEG placements within 0-3 days increased from 3.6 to 14.6% (P < 0.005). PEG tube insertion seems to be a safe procedure in the hands of an ORL-HN surgeon. Independence from gastrointestinal surgeons' services reduced the time delay and improved the availability of urgent PEG insertions.
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Affiliation(s)
- Johanna Ruohoalho
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 263, 00029, Helsinki, Finland.
| | - Katri Aro
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 263, 00029, Helsinki, Finland
| | - Antti A Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 263, 00029, Helsinki, Finland.,Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Timo Atula
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 263, 00029, Helsinki, Finland
| | - Aaro Haapaniemi
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 263, 00029, Helsinki, Finland
| | - Harri Keski-Säntti
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 263, 00029, Helsinki, Finland
| | - Leena Kylänpää
- Department of Gastrointestinal and General Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 340, 00029, Helsinki, Finland
| | - Annika Takala
- Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, P.O. Box 263, 00029, Helsinki, Finland
| | - Leif J Bäck
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 263, 00029, Helsinki, Finland
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28
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Maggiore R, Zumsteg ZS, BrintzenhofeSzoc K, Trevino KM, Gajra A, Korc-Grodzicki B, Epstein JB, Bond SM, Parker I, Kish JA, Murphy BA, VanderWalde NA. The Older Adult With Locoregionally Advanced Head and Neck Squamous Cell Carcinoma: Knowledge Gaps and Future Direction in Assessment and Treatment. Int J Radiat Oncol Biol Phys 2017; 98:868-883. [PMID: 28602414 DOI: 10.1016/j.ijrobp.2017.02.022] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 01/23/2017] [Accepted: 02/13/2017] [Indexed: 02/06/2023]
Abstract
Older adults with head and neck squamous cell carcinoma (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 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 a higher risk of functional impairments remains challenging and is exacerbated by the paucity of studies involving older adults. The purpose of this article is to identify knowledge gaps in the evaluation and management of older adults with HNSCC-particularly those undergoing concurrent chemoradiation therapy-and their caregivers 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 locoregionally advanced HNSCC. On the basis of our findings, we prioritize 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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Affiliation(s)
- Ronald Maggiore
- Division of Hematology/Oncology, Department of Medicine, University of Rochester, Rochester, New York
| | - Zachary S Zumsteg
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Kelly M Trevino
- Department of Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
| | - Ajeet Gajra
- Division of Hematology/Oncology, Department of Medicine, SUNY Upstate Medical University Cancer Center, Syracuse, New York
| | | | - Joel B Epstein
- Department of Oral Medicine and Diagnostic Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Stewart M Bond
- Boston College William F. Connell School of Nursing, Chestnut Hill, Massachusetts
| | - Ira Parker
- University of California, San Diego School of Medicine, La Jolla, California
| | - Julie A Kish
- Division of Hematology/Oncology, Department of Medicine, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Barbara A Murphy
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Noam A VanderWalde
- Department of Radiation Oncology, University of Tennessee Health Science Center-West Cancer Center, Memphis, Tennessee.
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29
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Vangelov B, Smee RI. Clinical predictors for reactive tube feeding in patients with advanced oropharynx cancer receiving radiotherapy ± chemotherapy. Eur Arch Otorhinolaryngol 2017; 274:3741-3749. [PMID: 28748260 DOI: 10.1007/s00405-017-4681-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 07/19/2017] [Indexed: 11/30/2022]
Abstract
Enteral feeding is often required for nutrition support in head and neck cancer patients when oral intake is inadequate. When to initiate the insertion of a feeding tube continues to be a debated issue in our institution. We investigated the use of reactive feeding tubes (RFTs) in patients with advanced stage oropharynx cancer (OPC). Data were retrospectively collected on 131 patients who had radiotherapy (RT) ± chemotherapy from 2005 to 2015. Predictors for RFT insertion were investigated. Weight loss during RT was compared between those with RFT versus prophylactic tubes (PFTs) versus no tube, and survival outcomes evaluated. RFTs were more likely to be needed in patients who had bilateral neck node irradiation (p = 0.001) and concurrent chemoradiotherapy (CRT) (p = 0.038). Patients with RFTs had significantly higher mean percentage weight loss during RT (9.5 ± 3.4%) (p < 0.001) when compared to those with a PFT (5.2 ± 4.7%) and those with no tube (5.4 ± 3.1%). No difference was seen in 5-year survival rates in patients who did not have a feeding tube to those who required a RFT. RFT use is frequent in OPC, although difficult to predict. CRT and bilateral neck node irradiation were found to be associated with the need for the insertion of a feeding tube during RT. These patients also experience significantly higher weight loss, therefore, prophylactic tubes may need to be considered more often in this population.
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Affiliation(s)
- Belinda Vangelov
- Department of Radiation Oncology, Nelune Comprehensive Cancer Centre, The Prince of Wales Hospital and Community Health Services, Randwick, NSW, Australia. .,Department of Nutrition and Dietetics, The Prince of Wales Hospital, Randwick, NSW, Australia.
| | - Robert I Smee
- Department of Radiation Oncology, Nelune Comprehensive Cancer Centre, The Prince of Wales Hospital and Community Health Services, Randwick, NSW, Australia.,University of New South Wales Clinical Teaching School, Prince of Wales Hospital, Randwick, NSW, Australia.,Department of Radiation Oncology, Tamworth Base Hospital, Tamworth, NSW, Australia
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30
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Beadle BM, Liao KP, Giordano SH, Garden AS, Hutcheson KA, Lai SY, Guadagnolo BA. Reduced feeding tube duration with intensity-modulated radiation therapy for head and neck cancer: A Surveillance, Epidemiology, and End Results-Medicare Analysis. Cancer 2016; 123:283-293. [PMID: 27662641 DOI: 10.1002/cncr.30350] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 08/25/2016] [Accepted: 08/29/2016] [Indexed: 01/20/2023]
Abstract
BACKGROUND Intensity-modulated radiation therapy (IMRT) is a technologically advanced and resource-intensive method of delivering radiation therapy (RT) and is used to minimize toxicity for patients with head and neck cancer (HNC). Dependence on feeding tubes is a significant marker of toxicity of RT. The objective of this analysis was to compare the placement and duration of feeding tube use among patients with HNC from 1999 through 2011. METHODS The cohort, demographics, and cancer-related variables were determined using the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database, and claims data were used to analyze treatment details. RESULTS In total, 2993 patients were identified. At a median follow-up of 47 months, 54.4% of patients had ever had a feeding tube placed. The median duration from feeding tube placement to removal was 277 days. On zero-inflated negative binomial regression, patients who received IMRT and 3-dimensional RT (3DRT) (non-IMRT) had similar rates of feeding tube placement (odds ratio, 1.10; P = .35); however, patients who received 3DRT had a feeding tube in place 1.18 times longer than those who received IMRT (P = .03). The difference was only observed among patients who received definitive RT; patients who underwent surgery and also received adjuvant RT had no statistically significant difference in feeding tube placement or duration. CONCLUSIONS Patients with HNC who received definitive IMRT had a significantly shorter duration of feeding tube placement than those who received 3DRT. These data suggest that there may be significant quality-of-life benefits to IMRT with respect to long-term swallowing function in patients with HNC. Cancer 2017;123:283-293. © 2016 American Cancer Society.
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Affiliation(s)
- Beth M Beadle
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kai-Ping Liao
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sharon H Giordano
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Adam S Garden
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Katherine A Hutcheson
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen Y Lai
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - B Ashleigh Guadagnolo
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Swallowing assessment and management pre and post head and neck cancer treatment. Curr Opin Otolaryngol Head Neck Surg 2016; 23:440-7. [PMID: 26536335 DOI: 10.1097/moo.0000000000000205] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW Head and neck cancer (HNC) imposes significant structural, functional, and cosmetic burdens upon those affected. Although advances in multimodality organ preservation therapy have assisted in ameliorating a number of previous treatment-related sequelae, dysphagia remains a foremost concern for members of the multidisciplinary team. Given its acute and long-term impact on physical and psychological wellbeing, and subsequent bearing on delivery of treatment, treatment-related morbidity and overall mortality, prompt recognition, and accurate assessment and optimization of management are pivotal. RECENT FINDINGS Qualitative research has provided greater insight into the psychosocial burdens dysphagia imposes on HNC patients and carers, highlighting the need for holistic strategies of management. There is a growing body of evidence to support dietary alterations and preventive swallowing exercise regimens for maintenance of oral intake throughout and following HNC therapy. The role of prophylactic enteral feeding, however, remains uncertain, with conflicting institutional data and lack of high-quality prospective studies for meaningful systematic literature assessment. Endoscopic surgical techniques hold promise in relieving stricture-related dysphagia; however, multiple treatments are required and recurrence is common. SUMMARY Swallowing rehabilitation encompassing education, dietary modification, and swallowing exercises comprise the mainstay of current evidence-based dysphagia management in HNC patients.
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Zhang Z, Zhu Y, Ling Y, Zhang L, Wan H. Comparative effects of different enteral feeding methods in head and neck cancer patients receiving radiotherapy or chemoradiotherapy: a network meta-analysis. Onco Targets Ther 2016; 9:2897-909. [PMID: 27274283 PMCID: PMC4876095 DOI: 10.2147/ott.s101983] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Nasogastric tube (NGT) and percutaneous endoscopic gastrostomy were frequently used in the head and neck cancer patients when malnutrition was present. Nevertheless, the evidence was inclusive in terms of the choice and the time of tube placement. The aim of this network meta-analysis was to evaluate the comparative effects of prophylactic percutaneous endoscopic gastrostomy (pPEG), reactive percutaneous endoscopic gastrostomy (rPEG), and NGT in the head and neck cancer patients receiving radiotherapy or chemoradiotherapy. Databases of PubMed, Web of Science, and Elsevier were searched from inception to October 2015. Thirteen studies enrolling 1,631 participants were included in this network meta-analysis. The results indicated that both pPEG and NGT were superior to rPEG in the management of weight loss. pPEG was associated with the least rate of treatment interruption and nutrition-related hospital admission among pPEG, rPEG, and NGT. Meanwhile, there was no difference in tube-related complications. Our study suggested that pPEG might be a better choice in malnutrition management in the head and neck cancer patients undergoing radiotherapy or chemoradiotherapy. However, its effects need to be further investigated in more randomized controlled trials.
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Affiliation(s)
- Zhihong Zhang
- Department of Nursing, Shanghai Proton and Heavy Ion Center, Tongji University School of Medicine, Shanghai, People's Republic of China; Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Yu Zhu
- Department of Nursing, Shanghai Proton and Heavy Ion Center, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Yun Ling
- Department of Human Resource, Shanghai Proton and Heavy Ion Center, Shanghai, People's Republic of China
| | - Lijuan Zhang
- Department of Nursing, Shanghai Proton and Heavy Ion Center, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Hongwei Wan
- Department of Nursing, Shanghai Proton and Heavy Ion Center, Tongji University School of Medicine, Shanghai, People's Republic of China
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Pramyothin P, Manyanont S, Trakarnsanga A, Petsuksiri J, Ithimakin S. A prospective study comparing prophylactic gastrostomy to nutritional counselling with a therapeutic feeding tube if required in head and neck cancer patients undergoing chemoradiotherapy in Thai real-world practice. J Hum Nutr Diet 2016; 29:768-776. [DOI: 10.1111/jhn.12377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- P. Pramyothin
- Division of Nutrition; Department of Medicine; Siriraj Hospital; Mahidol University; Bangkok Thailand
| | - S. Manyanont
- Division of Medical Oncology; Department of Internal Medicine; Siriraj Hospital; Mahidol University; Bangkok Thailand
| | - A. Trakarnsanga
- Division of General Surgery; Department of Surgery; Siriraj Hospital; Mahidol University; Bangkok Thailand
| | - J. Petsuksiri
- Division of Radiation Oncology; Department of Radiology; Siriraj Hospital; Mahidol University; Bangkok Thailand
| | - S. Ithimakin
- Division of Medical Oncology; Department of Internal Medicine; Siriraj Hospital; Mahidol University; Bangkok Thailand
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McDonald MW, Liu Y, Moore MG, Johnstone PAS. Acute toxicity in comprehensive head and neck radiation for nasopharynx and paranasal sinus cancers: cohort comparison of 3D conformal proton therapy and intensity modulated radiation therapy. Radiat Oncol 2016; 11:32. [PMID: 26922239 PMCID: PMC4769827 DOI: 10.1186/s13014-016-0600-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 01/23/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND To evaluate acute toxicity endpoints in a cohort of patients receiving head and neck radiation with proton therapy or intensity modulated radiation therapy (IMRT). METHODS Forty patients received comprehensive head and neck radiation including bilateral cervical nodal radiation, given with or without chemotherapy, for tumors of the nasopharynx, nasal cavity or paranasal sinuses, any T stage, N0-2. Fourteen received comprehensive treatment with proton therapy, and 26 were treated with IMRT, either comprehensively or matched to proton therapy delivered to the primary tumor site. Toxicity endpoints assessed included g-tube dependence at the completion of radiation and at 3 months after radiation, opioid pain medication requirement compared to pretreatment normalized as equivalent morphine dose (EMD) at completion of treatment, and at 1 and 3 months after radiation. RESULTS In a multivariable model including confounding variables of concurrent chemotherapy and involved nodal disease, comprehensive head and neck radiation therapy using proton therapy was associated with a lower opioid pain requirement at the completion of radiation and a lower rate of gastrostomy tube dependence by the completion of radiation therapy and at 3 months after radiation compared to IMRT. Proton therapy was associated with statistically significant lower mean doses to the oral cavity, esophagus, larynx, and parotid glands. In subgroup analysis of 32 patients receiving concurrent chemotherapy, there was a statistically significant correlation with a greater opioid pain medication requirement at the completion of radiation and both increasing mean dose to the oral cavity and to the esophagus. CONCLUSIONS Proton therapy was associated with significantly reduced radiation dose to assessed non-target normal tissues and a reduced rate of gastrostomy tube dependence and opioid pain medication requirements. This warrants further evaluation in larger studies, ideally with patient-reported toxicity outcomes and quality of life endpoints.
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Affiliation(s)
- Mark W McDonald
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, 1365 Clifton Rd NE Suite A1300, Atlanta, GA, 30322, USA.
| | - Yuan Liu
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health of Emory University, Atlanta, GA, USA.
| | - Michael G Moore
- Department of Otolaryngology/Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Peter A S Johnstone
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA.
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35
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Validation of an updated evidence-based protocol for proactive gastrostomy tube insertion in patients with head and neck cancer. Eur J Clin Nutr 2016; 70:574-81. [DOI: 10.1038/ejcn.2015.230] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 12/11/2015] [Accepted: 12/19/2015] [Indexed: 12/11/2022]
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Gastrostomy in head and neck cancer: current literature, controversies and research. Curr Opin Otolaryngol Head Neck Surg 2015; 23:162-70. [PMID: 25692626 DOI: 10.1097/moo.0000000000000135] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW This article explores the literature on the role of gastrostomy tube feeding use in the management of head and neck cancer, with special attention to its indications, timing of insertion, advantages, complications and quality of life issues. RECENT FINDINGS The current guidelines in place across different countries and two ongoing randomized controlled trials are discussed in detail, and placed in the context of current evidence. SUMMARY There remains a lack of consensus about when and which enteral feeding routes (gastrostomy or nasogastric tube) should be used and controversy about the long-term effects on swallowing function as well as quality of life for patients. Local guidelines should be used or generated to guide practice or patients enrolled into existing trials until higher level evidence is generated.
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Bishop S, Reed WM. The provision of enteral nutritional support during definitive chemoradiotherapy in head and neck cancer patients. J Med Radiat Sci 2015; 62:267-76. [PMID: 27512573 PMCID: PMC4968562 DOI: 10.1002/jmrs.132] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 07/15/2015] [Accepted: 07/28/2015] [Indexed: 02/05/2023] Open
Abstract
Combination chemoradiation is the gold standard of management for locally advanced squamous cell carcinomas of the head and neck. One of the most significant advantages of this approach to treatment is organ preservation which may not be possible with radical surgery. Unfortunately, few treatments are without side-effects and the toxicity associated with combined modality treatment causes meaningful morbidity. Patients with head and neck cancer (HNC) may have difficulties meeting their nutritional requirements as a consequence of tumour location or size or because of the acute toxicity associated with treatment. In particular, severe mucositis, xerostomia, dysgeusia and nausea and vomiting limit intake. In addition to this, dysphagia is often present at diagnosis, with many patients experiencing silent aspiration. As such, many patients will require enteral nutrition in order to complete chemoradiotherapy (CRT). Feeding occurs via catheters placed transnasally (nasogastric tubes) or directly into the stomach through the anterior abdominal wall (percutaneous gastrostomy tubes). In the absence of clear evidence concerning the superiority of one method over another, the choice of feeding tube tends to be dependent on clinician and patient preference. This review examines key issues associated with the provision of enteral nutritional support during definitive CRT in HNC patients, including feeding methods, patient outcomes and timing of tube insertion and use.
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Affiliation(s)
- Sarah Bishop
- Illawarra Cancer Care CentreDepartment of Radiation Oncology, Wollongong HospitalWollongongNew South WalesAustralia
- Radiation Oncology DepartmentNelune Comprehensive Cancer CentrePrince of Wales HospitalRandwickNew South WalesAustralia
| | - Warren Michael Reed
- Medical Image Optimisation and Perception GroupDiscipline of Medical Radiation SciencesFaculty of Health SciencesThe University of SydneyLidcombeNew South WalesAustralia
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Khanh NT, Iyer NG. Management of post-operative fistula in head and neck surgery: Sweeping it under the carpet? World J Otorhinolaryngol 2015; 5:93-104. [DOI: 10.5319/wjo.v5.i4.93] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 07/19/2015] [Accepted: 09/28/2015] [Indexed: 02/06/2023] Open
Abstract
The most dreaded complication in head and neck surgery is the development of fistula. Fistulas are common and devastating. The prevalence and the risk factors that contribute to fistula formation after head and neck procedures were discussed briefly. The main goal of this manuscript is to discuss current management of head and neck fistula. We believed that the best management strategy for head and neck fistulas is prevention. We recommend a holistic preventive approach during the perioperative period. The roles of different types of wound products and hyperbaric oxygen therapy were also discussed and highlighted. We also discussed the operative repair of fistulas, which relies on the tenet of providing well-vascularized tissue to an area of poor wound healing. Most often, the surgeon’s preference and range of operative skills dictate the timing and the type of repair. We highlighted the use of the pectoralis major, a well-known flap, as well as a novel technique in the surgical repair of complex, difficult-to-heal head and neck fistula.
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39
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Lango MN, Galloway TJ, Mehra R, Ebersole B, Liu JCJ, Moran K, Ridge JA. Impact of baseline patient-reported dysphagia on acute gastrostomy placement in patients with head and neck squamous cell carcinoma undergoing definitive radiation. Head Neck 2015; 38 Suppl 1:E1318-24. [DOI: 10.1002/hed.24220] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 06/04/2015] [Accepted: 07/13/2015] [Indexed: 11/09/2022] Open
Affiliation(s)
- Miriam N. Lango
- Department of Surgical Oncology; Fox Chase Cancer Center, Temple Head and Neck Institute, Temple University Health System; Philadelphia Pennsylvania
| | - Thomas J. Galloway
- Department of Radiation Oncology; Fox Chase Cancer Center, Temple University Health System; Philadelphia Pennsylvania
| | - Ranee Mehra
- Department of Medical Oncology; Fox Chase Cancer Center, Temple University Health System; Philadelphia Pennsylvania
| | - Barbara Ebersole
- Department of Speech Pathology; Fox Chase Cancer Center, Temple Head and Neck Institute, Temple University Health System; Philadelphia PA
| | - Jeffrey Chang-Jen Liu
- Department of Surgical Oncology; Fox Chase Cancer Center, Temple Head and Neck Institute, Temple University Health System; Philadelphia Pennsylvania
| | - Kathleen Moran
- Department of Speech Pathology; Fox Chase Cancer Center, Temple Head and Neck Institute, Temple University Health System; Philadelphia PA
| | - John A. Ridge
- Department of Surgical Oncology; Fox Chase Cancer Center, Temple Head and Neck Institute, Temple University Health System; Philadelphia Pennsylvania
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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. Oral Oncol 2015; 51:622-8. [DOI: 10.1016/j.oraloncology.2015.03.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 03/14/2015] [Accepted: 03/18/2015] [Indexed: 11/30/2022]
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Zhang X, Falagas ME, Vardakas KZ, Wang R, Qin R, Wang J, Liu Y. Systematic review and meta-analysis of the efficacy and safety of therapy with linezolid containing regimens in the treatment of multidrug-resistant and extensively drug-resistant tuberculosis. J Thorac Dis 2015; 7:603-15. [PMID: 25973226 DOI: 10.3978/j.issn.2072-1439.2015.03.10] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 01/28/2015] [Indexed: 11/14/2022]
Abstract
BACKGROUND Linezolid containing regimens have been proposed as potentially valuable alternatives for the treatment of patients with multidrug-resistant tuberculosis (MDR-TB) or extensively drug-resistant TB (XDR-TB). METHODS A systematic review and meta-analysis was conducted to assess the efficacy, safety and tolerability of linezolid for drug-resistant TB (DR-TB) treatment. We searched the Cochrane Controlled Trial Registry, PubMed, Embase, Science Citation Index Expanded (SCI) and China National Knowledge Infrastructure (CNKI), database up to May 2014 to identify studies providing data of the use of linezolid for the treatment of DR-TB. RESULTS The search yielded 15 studies (367 patients) including one randomized controlled trial (RCT), covering 239 patients who could be evaluated for effectiveness; 83% [95% confidence interval (CI), 75-90%; I(2)=62.8%] had a favorable outcome, defined as either cure or treatment completion. The pooled rate of culture conversion was 89% (95% CI, 83-95%; I(2)=49.6%). Between the group receiving daily linezolid doses of ≤600 or >600 mg, the mortality was considerably lower in patients treated with less than 600 mg/day (P value <0.001). Of 367 patients for whom data on safety was available, peripheral neuropathy (31%, 95% CI, 19-42%; I(2)=81.7%) and anemia (25%, 95% CI, 15-34%; I(2)=76.6%) were the main adverse effects. Patients receiving less than 600 mg/day were more likely to experience nervous system adverse events (P value <0.01). CONCLUSIONS The available evidence suggests that linezolid could be considered as a promising option as treatment of MDR/XDR TB. Randomized trials are warranted to define the dose and frequency of administration.
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Affiliation(s)
- Xin Zhang
- 1 Department of Respiratory Medicine, General Hospital of Chinese People's Liberation Army, Beijing 100853, China ; 2 Outpatient Department of Navy Headquarters, Beijing 100841, China ; 3 Alfa Institute of Biomedical Sciences, Athens, Greece ; 4 Department of Clinical Pharmacology, General Hospital of Chinese People's Liberation Army, Beijing 100853, China
| | - Matthew E Falagas
- 1 Department of Respiratory Medicine, General Hospital of Chinese People's Liberation Army, Beijing 100853, China ; 2 Outpatient Department of Navy Headquarters, Beijing 100841, China ; 3 Alfa Institute of Biomedical Sciences, Athens, Greece ; 4 Department of Clinical Pharmacology, General Hospital of Chinese People's Liberation Army, Beijing 100853, China
| | - Konstantinos Z Vardakas
- 1 Department of Respiratory Medicine, General Hospital of Chinese People's Liberation Army, Beijing 100853, China ; 2 Outpatient Department of Navy Headquarters, Beijing 100841, China ; 3 Alfa Institute of Biomedical Sciences, Athens, Greece ; 4 Department of Clinical Pharmacology, General Hospital of Chinese People's Liberation Army, Beijing 100853, China
| | - Rui Wang
- 1 Department of Respiratory Medicine, General Hospital of Chinese People's Liberation Army, Beijing 100853, China ; 2 Outpatient Department of Navy Headquarters, Beijing 100841, China ; 3 Alfa Institute of Biomedical Sciences, Athens, Greece ; 4 Department of Clinical Pharmacology, General Hospital of Chinese People's Liberation Army, Beijing 100853, China
| | - Rong Qin
- 1 Department of Respiratory Medicine, General Hospital of Chinese People's Liberation Army, Beijing 100853, China ; 2 Outpatient Department of Navy Headquarters, Beijing 100841, China ; 3 Alfa Institute of Biomedical Sciences, Athens, Greece ; 4 Department of Clinical Pharmacology, General Hospital of Chinese People's Liberation Army, Beijing 100853, China
| | - Jin Wang
- 1 Department of Respiratory Medicine, General Hospital of Chinese People's Liberation Army, Beijing 100853, China ; 2 Outpatient Department of Navy Headquarters, Beijing 100841, China ; 3 Alfa Institute of Biomedical Sciences, Athens, Greece ; 4 Department of Clinical Pharmacology, General Hospital of Chinese People's Liberation Army, Beijing 100853, China
| | - Youning Liu
- 1 Department of Respiratory Medicine, General Hospital of Chinese People's Liberation Army, Beijing 100853, China ; 2 Outpatient Department of Navy Headquarters, Beijing 100841, China ; 3 Alfa Institute of Biomedical Sciences, Athens, Greece ; 4 Department of Clinical Pharmacology, General Hospital of Chinese People's Liberation Army, Beijing 100853, China
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Nutritional interventions in head and neck cancer patients undergoing chemoradiotherapy: a narrative review. Nutrients 2015; 7:265-76. [PMID: 25569622 PMCID: PMC4303838 DOI: 10.3390/nu7010265] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 12/24/2014] [Indexed: 11/29/2022] Open
Abstract
The present review aimed to define the role of nutritional interventions in the prevention and treatment of malnutrition in HNC patients undergoing CRT as well as their impact on CRT-related toxicity and survival. Head and neck cancer patients are frequently malnourished at the time of diagnosis and prior to the beginning of treatment. In addition, chemo-radiotherapy (CRT) causes or exacerbates symptoms, such as alteration or loss of taste, mucositis, xerostomia, fatigue, nausea and vomiting, with consequent worsening of malnutrition. Nutritional counseling (NC) and oral nutritional supplements (ONS) should be used to increase dietary intake and to prevent therapy-associated weight loss and interruption of radiation therapy. If obstructing cancer and/or mucositis interfere with swallowing, enteral nutrition should be delivered by tube. However, it seems that there is not sufficient evidence to determine the optimal method of enteral feeding. Prophylactic feeding through nasogastric tube or percutaneous gastrostomy to prevent weight loss, reduce dehydration and hospitalizations, and avoid treatment breaks has become relatively common. Compared to reactive feeding (patients are supported with oral nutritional supplements and when it is impossible to maintain nutritional requirements enteral feeding via a NGT or PEG is started), prophylactic feeding does not offer advantages in terms of nutritional outcomes, interruptions of radiotherapy and survival. Overall, it seems that further adequate prospective, randomized studies are needed to define the better nutritional intervention in head and neck cancer patients undergoing chemoradiotherapy.
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Rahnemai-Azar AA, Rahnemaiazar AA, Naghshizadian R, Kurtz A, Farkas DT. Percutaneous endoscopic gastrostomy: indications, technique, complications and management. World J Gastroenterol 2014; 20:7739-7751. [PMID: 24976711 PMCID: PMC4069302 DOI: 10.3748/wjg.v20.i24.7739] [Citation(s) in RCA: 333] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 02/26/2014] [Accepted: 04/08/2014] [Indexed: 02/06/2023] Open
Abstract
Percutaneous endoscopic gastrostomy (PEG) is the preferred route of feeding and nutritional support in patients with a functional gastrointestinal system who require long-term enteral nutrition. Besides its well-known advantages over parenteral nutrition, PEG offers superior access to the gastrointestinal system over surgical methods. Considering that nowadays PEG tube placement is one of the most common endoscopic procedures performed worldwide, knowing its indications and contraindications is of paramount importance in current medicine. PEG tubes are sometimes placed inappropriately in patients unable to tolerate adequate oral intake because of incorrect and unrealistic understanding of their indications and what they can accomplish. Broadly, the two main indications of PEG tube placement are enteral feeding and stomach decompression. On the other hand, distal enteral obstruction, severe uncorrectable coagulopathy and hemodynamic instability constitute the main absolute contraindications for PEG tube placement in hospitalized patients. Although generally considered to be a safe procedure, there is the potential for both minor and major complications. Awareness of these potential complications, as well as understanding routine aftercare of the catheter, can improve the quality of care for patients with a PEG tube. These complications can generally be classified into three major categories: endoscopic technical difficulties, PEG procedure-related complications and late complications associated with PEG tube use and wound care. In this review we describe a variety of minor and major tube-related complications as well as strategies for their management and avoidance. Different methods of percutaneous PEG tube placement into the stomach have been described in the literature with the "pull" technique being the most common method. In the last section of this review, the reader is presented with a brief discussion of these procedures, techniques and related issues. Despite the mentioned PEG tube placement complications, this procedure has gained worldwide popularity as a safe enteral access for nutrition in patients with a functional gastrointestinal system.
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Kramer S, Newcomb M, Hessler J, Siddiqui F. Prophylactic versus reactive PEG tube placement in head and neck cancer. Otolaryngol Head Neck Surg 2013; 150:407-12. [PMID: 24381015 DOI: 10.1177/0194599813517081] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To understand the impact of percutaneous endoscopic gastrostomy (PEG) tube placement timing on tube duration, weight loss, and disease control in patients with head and neck cancer (HNC). SETTING A tertiary academic center. STUDY DESIGN Historical cohort study. SUBJECTS AND METHODS Seventy-four patients with HNC were reviewed. Patients underwent cisplatinum-based chemoradiation therapy with or without surgical resection. They received a PEG tube either before radiation therapy began (prophylactic) or after (reactive). Patients were matched on the basis of age, gender, TNM stage, tumor subsite, human papillomavirus (HPV) status, and chemoradiation dose. RESULTS Patients receiving reactive PEG tubes had them in place for fewer days than those placed prophylactically (227 vs 139 days, P < .01). There was no difference in percentage weight loss at 2, 6, or 12 months. There was no difference in survival or disease control between the groups. CONCLUSIONS Reactive PEG tube placement may afford patients a shorter duration of usage without incurring greater weight loss or poorer oncologic outcomes.
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Affiliation(s)
- Scott Kramer
- College of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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