Impact of prophylactic gastrostomy or reactive NG tube upon patient-reported long term swallow function following chemoradiotherapy for oropharyngeal carcinoma: A matched pair analysis.
Summary Objectives The purpose of this matched pair analysis is to assess patient-reported long term swallow function following chemoradiotherapy for locally advanced oropharyngeal cancer in relation to the use of a prophylactic gastrostomy or reactive nasogastric (NG) tube. Materials and methods The MD Anderson Dysphagia Inventory (MDADI) was posted to 68 consecutive patients with stage III/IV oropharyngeal squamous cell carcinoma who had completed parotid sparing intensity modulated radiotherapy with concurrent chemotherapy between 2010 and 2012, had not required therapeutic enteral feeding prior to treatment, minimum 2 years follow up post treatment, and who were disease free. 59/68 replies were received, and a matched pair analysis (matching for T and N stage) was performed for 52 patients, 26 managed with a prophylactic gastrostomy and 26 with an approach of an NG tube as needed. Results There were no significant differences in patient demographics, pre-treatment diet and treatment factors between the two groups. Patient-reported swallowing function measured using the MDADI was superior for patients managed with an NG tube as required compared with a prophylactic gastrostomy: overall composite score 68.1 versus 59.4 ( p = 0.04), global score 67.7 versus 60 ( p = 0.04), emotional subscale 73.5 versus 60.4 ( p p p = 0.38). Conclusions Compared with an approach of an NG tube as required, the use of a prophylactic gastrostomy was associated with inferior long term patient-reported long term swallow outcomes.
Background Severe late dysphagia is common after chemoradiotherapy for cancers of the larynx and oropharynx. Options for reduction of severe late dysphagia are limited for human papillomavirus (HPV)-negative patients. In this study, the role of feeding tube choice in severe late dysphagia is investigated. Methods Patients disease-free after chemoradiotherapy for HPV-negative cancers of the laryngopharynx who received a feeding tube on-treatment were identified. The incidence of severe late dysph...
Last. Rosemary Martino(U of T: University of Toronto)H-Index: 25
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Patients undergoing radiotherapy for head and neck cancer (HNC) often experience malnutrition and dehydration during treatment. As a result, some centres place PEG tubes prophylactically (pPEG) to prevent these negative consequences. However, recent research has suggested that pPEG use may negatively affect swallowing physiology, function and/or quality of life, especially in the long term. The purpose of this study was to systematically review the literature on pPEG use in HNC patients undergoi...
Objectives: Swallowing can be significantly affected during and following radiotherapy for head and neck cancer (HNC). The purpose of this study was to understand: (1) the trajectory of swallowing recovery following parotid-sparing intensity-modulated radiotherapy (IMRT) and (2) overall physical and social-emotional wellbeing and how patients prioritise swallowing following treatment. Materials and methods: Sixty-one HNC patients completed questionnaires as part of a prospective study exploring ...
Abstract Aims To determine the pattern of disease recurrence in non-nasopharyngeal head and neck squamous cell carcinoma (HNSCC) patients treated with radical intensity-modulated radiotherapy (IMRT) with or without chemotherapy, and to correlate the sites of locoregional recurrence with radiotherapy target volumes. Materials and methods In total, 136 patients treated with radical IMRT with or without chemotherapy between 2008 and 2011 for non-nasopharyngeal HNSCC were retrospectively identified....
Background: Swallowing dysfunction following chemoradiation for head and neck cancer is a major cause of morbidity and reduced quality of life. This review discusses 3 strategies that may improve posttreatment swallowing function. Methods: The literature was assessed by a multiauthor team that produced evidence-based recommendations. Results: (1) Prospective and randomized studies with small cohorts show a trend toward benefits for a preventative exercise program addressing oral and pharyngeal s...
Last. Allen M. Chen(UC Davis: University of California, Davis)H-Index: 36
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Data have emerged that the addition of concurrent chemotherapy to radiation can lead to swallowing dysfunction that may have an impact on patient quality of life and lead to significant morbidities such as poor nutritional status, enteral feeding tube dependence, and aspiration pneumonia. Although intensity-modulated radiation therapy (IMRT) for head and neck cancer was initially developed to spare the parotid gland to reduce xerostomia, attention has recently focused on its utility to selective...
Abstract Aims Two contrasting approaches of a prophylactic gastrostomy or a nasogastric tube as needed are widely used to support patients receiving chemoradiotherapy for head and neck cancer. The influence of the type and timing of enteral feeding tube support upon long-term swallowing is uncertain. This study analysed the patients' perspective on long-term swallowing, comparing two groups of patients who received chemoradiotherapy for oropharyngeal cancer managed with the two approaches. Mater...
Definitive chemoradiation therapy has evolved as the preferred organ preservation strategy in the treatment of locally advanced head-and-neck cancer (LA-HNC). Dry mouth and dysphagia are among the most common and most debilitating treatment-related toxicities that frequently necessitate the placement of enteral feeding tubes (FT) in these patients to help them meet their nutritional requirements. The use of either a percutaneous endoscopic gastrostomy tube or a nasogastric tube, the choice of us...
Summary To determine the outcomes of patients managed with different routes of enteral feeding during chemoradiotherapy for oropharynx cancer. The hospital and dietetic records of consecutive patients with oropharynx squamous cell carcinoma treated between January 2007 and June 2009 with concurrent chemoradiotherapy were reviewed retrospectively. One hundred and four patients were analysed. Seventy-one received a prophylactic gastrostomy, 21 were managed with a strategy of NG tube as required an...
#1Ewa Silander(Sahlgrenska University Hospital)H-Index: 11
#2Jan Nyman(Sahlgrenska University Hospital)H-Index: 27
Last. Eva Hammerlid(Sahlgrenska University Hospital)H-Index: 34
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Background. The purpose of this randomized study was to examine if a prophylactic percutaneous endo- scopic gastrostomy (PEG) for enteral nutrition could prevent malnutrition, reduce hospital stay, and improve health-related quality of life (HRQOL). Methods. One hundred thirty-four patients with advanced head and neck cancer were randomized to either prophylactic PEG (study group) or clinical praxis (control group). Patients' weight, body mass index (BMI), need for hospitalization, and HRQOL wer...
#1Ramez Philips(Thomas Jefferson University)H-Index: 6
#2Michael C. Topf(VUMC: Vanderbilt University Medical Center)H-Index: 8
Last. David Cognetti(Thomas Jefferson University)H-Index: 20
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Abstract null null Objectives null To determine the rate of gastrostomy tube dependence after transoral robotic surgery (TORS), and to determine which patient or surgical factors increase the likelihood of gastrostomy tube dependence. null null null Methods null Retrospective chart review of all patients who underwent TORS for oropharyngeal squamous cell carcinoma (OPSCC) at a single institution from January 2011 through July 2016. Patients who underwent TORS for recurrent OPSCC were excluded. P...
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...
Last. Dirk Van Gestel(ULB: Université libre de Bruxelles)H-Index: 11
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BACKGROUND Nutritional complications in patients with locally advanced head and neck cancer (LA-HNC) treated by concurrent chemoradiotherapy (CCRT) often lead to placement of a prophylactic gastrostomy (PG) tube, while indication lacks harmonization. Our aim was to explore the current PG tube utilization among Belgian radiation oncology centers. METHODS A survey was distributed to all 24 Belgian Radiation oncology departments, with questions about the number of patient treated per year, whether ...
Abstract Objective: To review special considerations of treating head and neck cancer in the elderly population. Finding: The number of adults aged 65 years and older projected to reach 90 million by 2050. The fastest growing age group, adults 85 years and older, is projected to triple by 2060. Determining the optimal treatment plan for elderly patients can be difficult for numerous reasons, including multiple medical co-morbidities, mental and physical disabilities, polypharmacy, cognitive stat...
Last. Ann Hoeben(UM: Maastricht University)H-Index: 16
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Summary Background and aims Chemoradiation and bioradiation (CRT/BRT) for locally advanced head and neck squamous cell carcinoma (LAHNSCC) often comes with high toxicity rates, interfering with oral intake and leading to temporary tube feeding (TF) dependency. High-quality scientific evidence for indicators of prophylactic gastrostomy insertion is not available. The aim of this retrospective cohort study was to develop a prediction model to identify patients who need prophylactic gastrostomy ins...
BACKGROUND: Limited data exist regarding which head and head and neck cancer (HNC) survivors will suffer from long-term dysphagia. METHODS: From a population-based cohort of 1901 Utah residents with HNC and >/=3 years follow-up, we determined hazard ratio for dysphagia, aspiration pneumonia, or gastrostomy associated with various risk factors. We tested prediction models with combinations of factors and then assessed discrimination of our final model. RESULTS: Cancer site in the hypopharynx, adv...
BACKGROUND: Chemoradiation or bioradiation treatment (CRT/BRT) of locally advanced head and neck squamous cell carcinoma (LAHNSCC) comes with high toxicity rates, often leading to temporary tube feeding (TF) dependency. Cachexia is a common problem in LAHNSCC. Yet changes in body composition and muscle weakness during CRT/BRT are underexplored. Strong evidence on the effect of TF on body composition during treatment is lacking. The aim of this cohort study was to assess (i) the relationship of f...
ObjectiveTo estimate long-term prevalence of new dysphagia-related diagnoses in a large cohort of head and neck cancer survivors.Study DesignRetrospective cohort.SettingPopulation based.Subjects an...
Summary Background & aims Enteral feeding is commonly required during radiotherapy treatment for head and neck cancer. Only limited qualitative research into head and neck cancer patients' experiences of enteral tube feeding has been undertaken. The aim of this qualitative study was to evaluate patients' experiences of EF and the surrounding decision making process. Methods Semi-structured, face-to face interviews were conducted with ten patients who had completed (chemo)radiotherapy/radiotherap...
AbstractBackground: Prior reports have raised concerns that a prophylactic gastrostomy may be detrimental to long-term swallow function. This study evaluates patient-reported swallow function follo...
