Skip to main content
SpringerLink
Log in

Population-based comparison of two feeding tube approaches for head and neck cancer patients receiving concurrent systemic–radiation therapy: is a prophylactic feeding tube approach harmful or helpful?

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study is to compare patient outcomes between a therapeutic versus a prophylactic gastrostomy tube (GT) placement approach in patients treated with concurrent systemic and radiation (SRT) therapy for head and neck cancer (HNC).

Methods

Outcomes were compared between all HNC patients treated with concurrent SRT from January 2001 to June 2009 from a center that only places GTs therapeutically when clinically necessary (center A) versus a center that generally places them prophylactically (center B).

Results

A total of 445 patients with HNC were identified, with 63 % from center A. As anticipated, GTs were placed less commonly in center A compared to B (31 versus 88 %; p < 0.001). Center B had a significantly higher number of GT complications (p < 0.001), including infection (16 versus 5 %), leakage (10 versus 2 %), and blockage (3 versus 1 %). Conversely, center A had a higher admission rate (27 versus 13 %, p = 0.001), most prominent for GT-related issues (15 versus 6 %). Center B had higher GT dependence at 90 days post-radiation therapy (34 versus 12 %; p < 0.001), but not at 1 year (11 versus 10 %; p = 0.74). There was no significant difference in the proportion of head and neck patients who had a 10 % weight loss at 1 year (compared to baseline) between centers A and B (42 versus 53 %, p = 0.07). There was no significant difference in the overall survival (A versus B, HR = 0.99; p = 0.96).

Conclusion

A prophylactic GT approach results in exposing higher number of patients to GT complications. The higher rate of hospitalizations using a therapeutic approach suggests that patients are sicker when GTs are required. Given the similar weight loss and survival, a therapeutic approach at an earlier stage of need may be a preferable approach, when access to prompt GT placement is available.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Pignon JP, le Maitre A, Maillard E et al (2009) Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): an update on 93 randomised trials and 17,346 patients. Radiother Oncol 92:4–14

    Article  PubMed  Google Scholar 

  2. Clavel S, Fortin B, Despres P et al (2011) Enteral feeding during chemoradiotherapy for advanced head-and-neck cancer: a single-institution experience using a therapeutic approach. Int J Radiat Oncol Biol Phys 79:763–769

    Article  PubMed  Google Scholar 

  3. Nugent B, Parker MJ, McIntyre IA (2010) Nasogastric tube feeding and percutaneous endoscopic gastrostomy tube feeding in patients with head and neck cancer. J Hum Nutr Diet 23:277–284

    Article  PubMed  CAS  Google Scholar 

  4. Koyfman SA, Adelstein DJ (2012) Enteral feeding tubes in patients undergoing definitive chemoradiation therapy for head-and-neck cancer: a critical review. Int J Radiat Oncol Biol Phys 84:581–589

    Article  PubMed  Google Scholar 

  5. Chen AM, Li BQ, Lau DH et al (2010) Evaluating the role of prophylactic gastrostomy tube placement prior to definitive chemoradiotherapy for head and neck cancer. Int J Radiat Oncol Biol Phys 78:1026–1032

    Article  PubMed  Google Scholar 

  6. Beaver ME, Matheny KE, Roberts DB et al (2001) Predictors of weight loss during radiation therapy. Otolaryngol Head Neck Surg 125:645–648

    Article  PubMed  CAS  Google Scholar 

  7. Lee JH, Machtay M, Unger LD et al (1998) Prophylactic gastrostomy tubes in patients undergoing intensive irradiation for cancer of the head and neck. Arch Otolaryngol Head Neck Surg 124:871–875

    Article  PubMed  CAS  Google Scholar 

  8. Piquet MA, Ozsahin M, Larpin I et al (2002) Early nutritional intervention in oropharyngeal cancer patients undergoing radiotherapy. Support Care Cancer 10:502–504

    Article  PubMed  Google Scholar 

  9. Salas S, Baumstarck-Barrau K, Alfonsi M et al (2009) Impact of the prophylactic gastrostomy for unresectable squamous cell head and neck carcinomas treated with radio-chemotherapy on quality of life: prospective randomized trial. Radiother Oncol 93:503–509

    Article  PubMed  Google Scholar 

  10. Grant DG, Bradley PT, Pothier DD et al (2009) Complications following gastrostomy tube insertion in patients with head and neck cancer: a prospective multi-institution study, systematic review and meta-analysis. Clin Otolaryngol 34:103–112

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

There are no conflicts of interest for any of the authors.

Author information

Authors and Affiliations

  1. Radiation Therapy Program, BC Cancer Agency - Vancouver Centre, 600 West 10th Ave, Vancouver, V5Z4E6, BC, Canada

    Robert Olson, Irene Karam & Angela Bowman

  2. University of British Columbia, Vancouver, BC, Canada

    Robert Olson, Irene Karam, Gavin Wilson, Christopher Lee & Frances Wong

  3. Radiation Therapy Program, BC Cancer Agency - Centre for the North, 1215 Lethbridge Street, Prince George, V2M 7E9, BC, Canada

    Robert Olson

  4. Systemic Therapy Program, BC Cancer Agency - Fraser Valley Centre, 13750 96th Avenue, Surrey, V3V1Z2, BC, Canada

    Christopher Lee

  5. Radiation Therapy Program, BC Cancer Agency - Fraser Valley Centre, 13750 96th Avenue, Surrey, V3V1Z2, BC, Canada

    Frances Wong

Authors
  1. Robert Olson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Irene Karam
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gavin Wilson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Angela Bowman
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christopher Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Frances Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Robert Olson.

Electronic supplementary material

Below is the link to the electronic supplementary material.

ESM 1

(DOC 35 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Olson, R., Karam, I., Wilson, G. et al. Population-based comparison of two feeding tube approaches for head and neck cancer patients receiving concurrent systemic–radiation therapy: is a prophylactic feeding tube approach harmful or helpful?. Support Care Cancer 21, 3433–3439 (2013). https://doi.org/10.1007/s00520-013-1936-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-013-1936-y

Keywords

Search

Navigation