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Effect of prophylactic tube feeding in head and neck cancer patients with high Mallampati score undergoing definitive concurrent chemoradiotherapy

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Abstract

Purpose

There is no consensus on the selection of appropriate prophylactic tube feeding in patients with head and neck squamous cell carcinoma (HNSCC) undergoing concurrent chemoradiotherapy (CCRT). This study aimed to evaluate the effect of prophylactic tube feeding in patients with HNSCC who presented with a high Mallampati score and underwent CCRT.

Methods

We prospectively enrolled 185 consecutive patients with stage II to IVa HNSCC and a pre-treatment Mallampati score of 3 or 4 who received CCRT between August 2017 and December 2018 with follow-up data collected retrospectively. Patients were divided to either with or without prophylactic tube feeding group for comparison of treatment tolerance, toxicities, and quality of life(QOL). Propensity score matching (PSM) was used to achieve balanced covariates across the two groups.

Results

Of the cohort, 52 (28.1%) and 133 (71.9%) patients were allocated to the prophylactic and non-prophylactic tube feeding groups, respectively. Before and after PSM, patients in the tube feeding group had a significantly lower incidence of incomplete radiotherapy, incompletion of chemotherapy, emergency room visits, and grade 3 or higher infection, and improved symptoms of quality of life after CCRT than those in the non-tube feeding group.

Conclusion

Prophylactic tube feeding was associated with better treatment tolerance, safety profiles, and quality of life in patients with HNSCC and high Mallampati scores who underwent CCRT. Therefore, Mallampati score might serve as a clinical tool for proactive selection of patients receiving prophylactic tube feeding in HNSCC patients upon receiving CCRT.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

CCRT:

Concurrent chemoradiotherapy

HNSCC:

Head and neck squamous cell carcinoma

NGT:

Nasogastric tube

OS:

Overall survival

PEG:

Percutaneous endoscopic gastrostomy

PSM:

Propensity score matching

SAE:

Severe adverse events

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Acknowledgements

The authors gratefully acknowledge the assistance of the patients who participated in this study.

Funding

The authors disclosed that there is no funding for the research, authorship, and publication of this article.

Author information

Author notes

  1. Hung-Ming Wang

    Present address: Departments of Hematology-Oncology, and Radiation Oncology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan

  2. Shun-Wen Hsueh

    Present address: Departments of Hematology-Oncology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan

Authors and Affiliations

  1. Department of Hematology-Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan

    Chang-Hsien Lu

  2. College of Medicine, Chang Gung University, 5 Fu-Hsing Street, Kwei-Shan Shiang, Taoyuan, Taiwan

    Chang-Hsien Lu, Chih-Chung Hsu, Po-Hsu Su, Shinn-Yn Lin, Kun-Yun Yeh, Shun-Wen Hsueh, Joseph Tung-Chieh Chang, Hung-Ming Wang, Yu-Shin Hung & Wen-Chi Chou

  3. Departments of Hematology-Oncology, and Radiation Oncology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan

    Chih-Chung Hsu, Shinn-Yn Lin, Joseph Tung-Chieh Chang, Yu-Shin Hung & Wen-Chi Chou

  4. Departments of Hematology-Oncology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan

    Po-Hsu Su & Kun-Yun Yeh

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by LCH, HCC, SPH, and CWC. The first draft of the manuscript was written by LCH, HCC, SPH, CWC, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Wen-Chi Chou.

Ethics declarations

Ethics approval and consent to participate

This study was approved by the institutional review board of Chang Gung Memorial Hospital in September 2016 (ethic code: 201600916B0) and has been conducted in compliance with the Helsinki Declaration (1996). A written informed consent was obtained from all subjects.

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Not applicable.

Competing interest

The authors declare that there was no competing interests exist.regarding this study.

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Lu, CH., Hsu, CC., Su, PH. et al. Effect of prophylactic tube feeding in head and neck cancer patients with high Mallampati score undergoing definitive concurrent chemoradiotherapy. Support Care Cancer 31, 384 (2023). https://doi.org/10.1007/s00520-023-07859-4

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