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Alami K, Willemse E, Quiriny M, Lipski S, Laurent C, Donquier V, Digonnet A. Evaluation of ChatGPT-4's Performance in Therapeutic Decision-Making During Multidisciplinary Oncology Meetings for Head and Neck Squamous Cell Carcinoma. Cureus 2024; 16:e68808. [PMID: 39376890 PMCID: PMC11456411 DOI: 10.7759/cureus.68808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2024] [Indexed: 10/09/2024] Open
Abstract
Objectives First reports suggest that artificial intelligence (AI) such as ChatGPT-4 (Open AI, ChatGPT-4, San Francisco, USA) might represent reliable tools for therapeutic decisions in some medical conditions. This study aims to assess the decisional capacity of ChatGPT-4 in patients with head and neck carcinomas, using the multidisciplinary oncology meeting (MOM) and the National Comprehensive Cancer Network (NCCN) decision as references. Methods This retrospective study included 263 patients with squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, and larynx who were followed at our institution between January 1, 2016, and December 31, 2021. The recommendation of GPT4 for the first- and second-line treatments was compared to the MOM decision and NCCN guidelines. The degrees of agreement were calculated using the Kappa method, which measures the degree of agreement between two evaluators. Results ChatGPT-4 demonstrated a moderate agreement in first-line treatment recommendations (Kappa = 0.48) and a substantial agreement (Kappa = 0.78) in second-line treatment recommendations compared to the decisions from MOM. A substantial agreement with the NCCN guidelines for both first- and second-line treatments was observed (Kappa = 0.72 and 0.66, respectively). The degree of agreement decreased when the decision included gastrostomy, patients over 70, and those with comorbidities. Conclusions The study illustrates that while ChatGPT-4 can significantly support clinical decision-making in oncology by aligning closely with expert recommendations and established guidelines, ongoing enhancements and training are crucial. The findings advocate for the continued evolution of AI tools to better handle the nuanced aspects of patient health profiles, thus broadening their applicability and reliability in clinical practice.
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Affiliation(s)
- Kenza Alami
- Otolaryngology, Jules Bordet Institute, Bruxelles, BEL
| | | | - Marie Quiriny
- Surgical Oncology, Jules Bordet Institute, Bruxelles, BEL
| | - Samuel Lipski
- Surgical Oncology, Jules Bordet Institute, Bruxelles, BEL
| | - Celine Laurent
- Otolaryngology - Head and Neck Surgery, Hôpital Ambroise-Paré, Mons, BEL
- Otolaryngology - Head and Neck Surgery, Hôpital Universitaire de Bruxelles (HUB) Erasme Hospital, Bruxelles, BEL
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Popa M, Young B, Rousseau N, Cherry MG, Jenkins I, Cloke J, Pettitt A, Jenkinson MD, Ahmed S, Pemberton AR, Sherratt FC. Consultations about randomised controlled trials are shorter and less in-depth for socioeconomically disadvantaged patients compared to socioeconomically advantaged patients: qualitative analysis across three trials. Trials 2024; 25:382. [PMID: 38872208 DOI: 10.1186/s13063-024-08216-4] [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: 08/04/2023] [Accepted: 05/31/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Patients from socioeconomically disadvantaged backgrounds are underserved in randomised controlled trials, yet they experience a much greater burden of disease compared with patients from socioeconomically advantaged areas. It is crucial to make trials more inclusive to ensure that treatments and interventions are safe and effective in real-world contexts. Improving how information about trials is verbally communicated is an unexplored strategy to make trials more inclusive. This study examined how trials are communicated verbally, comparing consultations involving patients from the most and least socioeconomically disadvantaged areas. METHODS Secondary qualitative analysis of 55 trial consultation transcripts from 41 patients, sampled from 3 qualitative studies embedded in their respective UK multi-site, cancer-related randomised controlled trials. Patients living in the most and least socioeconomically disadvantaged areas, defined using English Indices of Multiple Deprivation decile scores, were purposively sampled. Analysis was largely thematic and drew on the constant comparison method. RESULTS Recruiters communicated clinical uncertainty in a similar way for patients living in different socioeconomic areas. Consultations with disadvantaged patients were, on average, half the duration of those with advantaged patients, and tended to involve recruiters providing less in-depth explanations of trial concepts, used phrasing that softened trial arm risks, and described trial processes (e.g. randomisation) using informal or metaphorical phrasing. Disadvantaged and advantaged patients differed in the concerns they expressed; disadvantaged patients voiced fewer concerns and asked fewer questions but were also less likely to be invited to do so by recruiters. CONCLUSION Interactions about trials unfolded in different ways between patients living in different socioeconomic areas, likely due to both patient- and recruiter-related factors. We present considerations for recruiters when discussing trials with patients from socioeconomically disadvantaged backgrounds, aimed at enhancing trial communication. Future research should examine disadvantaged patients' and recruiters' experiences of verbal trial communication to inform guidance that addresses the needs and preferences of underserved groups.
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Affiliation(s)
- Mariana Popa
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Bridget Young
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Nikki Rousseau
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Mary G Cherry
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Isobel Jenkins
- School of Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Jane Cloke
- NIHR Applied Research Collaboration North West Coast, University of Liverpool, Liverpool, UK
| | - Andrew Pettitt
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | - Michael D Jenkinson
- Institute of Systems, Molecular and Integrative Biology, The University of Liverpool, Liverpool, UK
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Saiqa Ahmed
- NIHR Applied Research Collaboration North West Coast, University of Liverpool, Liverpool, UK
| | - Allan R Pemberton
- NIHR Applied Research Collaboration North West Coast, University of Liverpool, Liverpool, UK
| | - Frances C Sherratt
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK.
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Bischoff SC, Austin P, Bowykens K, Chourdakis M, de la Cuerda Compés C, Jonkers-Schuitema C, Lichota M, Nyulasi I, Schneider SM, Stanga Z, Pirone L, Cantón Blanco A. [ESPEN practical guideline: Home enteral nutrition]. NUTR HOSP 2023; 40:858-885. [PMID: 37409729 DOI: 10.20960/nh.04796] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
Introduction This ESPEN practical guideline will inform physicians, nurses, dieticians, pharmacists, caregivers and other home enteral nutrition (HEN) providers in a concise way about the indications and contraindications for HEN, as well as its implementation and monitoring. This guideline will also inform interested patients requiring HEN. Home parenteral nutrition is not included but will be addressed in a separate ESPEN guideline. The guideline is based on the ESPEN scientific guideline published before, which consists of 61 recommendations that have been reproduced and renumbered, along with the associated commentaries that have been shorted compared to the scientific guideline. Evidence grades and consensus levels are indicated. The guideline was commissioned and financially supported by ESPEN and the members of the guideline group were selected by ESPEN.
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Affiliation(s)
| | - Peter Austin
- Departamento de Farmacia. Oxford University Hospitals NHS Foundation Trust. University College London- School of Pharmacy
| | | | - Michael Chourdakis
- Escuela de Medicina. Facultad de Ciencias de la Salud. Universidad Aristóteles de Tesalónica
| | | | | | - Marek Lichota
- Asociación de pacientes con fallo intestinal "Appetite for Life"
| | - Ibolya Nyulasi
- Departamento de Nutrición. Departamento de Rehabilitación, Nutrición y Deporte. Universidad de Latrobe. Departamento de Medicina.Universidad de Monash
| | - Stéphane M Schneider
- Departamento de Gastroenterología y Nutrición. Centre Hospitalier Universitaire. Université Côte d'Azur
| | - Zeno Stanga
- Servicio de Diabetes, Endocrinología, Nutrición y Metabolismo. Hospital Universitario de Berna.Universidad de Berna
| | - Loris Pirone
- Departamento de Medicina y Cirugía. Alma Mater Studiorum - Universidad de Bolonia.Centro de Fallo Intestinal Crónico. Unidad de Nutrición Clínica y Metabolismo. IRCCS Azienda Ospedaliero. Universitaria di Bologna
| | - Ana Cantón Blanco
- Servicio de Endocrinología y Nutrición. Complejo Hospitalario Universitario de Santiago de Compostela (CHUS)
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Mudunov AM, Pak MB, Wolf LY. The role of nutritional support in treatment of head and neck tumors: clinical case. HEAD AND NECK TUMORS (HNT) 2022. [DOI: 10.17650/2222-1468-2022-12-3-86-94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The article presents a clinical observation of treatment of locally advanced squamous cell oropharyngeal carcinoma. The problems of nutritional support of patients during primary chemoradiation treatment are considered. The presented clinical case shows that use of sip feeds can significantly improve nutritional condition in patients with head and neck tumors and improve tolerability and results of antitumor treatment.
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Nugent M, Bryant V, Butcher C, Fisher H, Gill S, Goranova R, Hiu S, Lindley L, O'Hara J, Oluboyede Y, Patterson J, Rapley T, Robinson T, Rousseau N, Ryan V, Shanmugasundaram R, Sharp L, Smith Whelan R, Stocken DD, Ternent L, Wilson J, Walker J. Photobiomodulation in the management of oral mucositis for adult head and neck cancer patients receiving irradiation: the LiTEFORM RCT. Health Technol Assess 2022; 26:1-172. [PMID: 36484364 PMCID: PMC9761526 DOI: 10.3310/uwnb3375] [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] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Oral mucositis is a debilitating and painful complication of head and neck cancer irradiation that is characterised by inflammation of the mucous membranes, erythema and ulceration. Oral mucositis affects 6000 head and neck cancer patients per year in England and Wales. Current treatments have not proven to be effective. International studies suggest that low-level laser therapy may be an effective treatment. OBJECTIVES To assess the clinical effectiveness and cost-effectiveness of low-level laser therapy in the management of oral mucositis in head and neck cancer irradiation. To identify barriers to and facilitators of implementing low-level laser therapy in routine care. DESIGN Placebo-controlled, individually randomised, multicentre Phase III superiority trial, with an internal pilot and health economic and qualitative process evaluations. The participants, outcome assessors and therapists were blinded. SETTING Nine NHS head and neck cancer sites in England and Wales. PARTICIPANTS A total of 87 out of 380 participants were recruited who were aged ≥ 18 years and were undergoing head and neck cancer irradiation with ≥ 60 Gy. INTERVENTION Random allocation (1 : 1 ratio) to either low-level laser therapy or sham low-level laser therapy three times per week for the duration of irradiation. The diode laser had the following specifications: wavelength 660 nm, power output 75 mW, beam area 1.5 cm2, irradiance 50 mW/cm2, exposure time 60 seconds and fluence 3 J/cm2. There were 20-30 spots per session. Sham low-level laser therapy was delivered in an identical manner. MAIN OUTCOME MEASURE The mean Oral Mucositis Weekly Questionnaire-Head and Neck Cancer score at 6 weeks following the start of irradiation. Higher scores indicate a worse outcome. RESULTS A total of 231 patients were screened and, of these, 87 were randomised (low-level laser therapy arm, n = 44; sham arm, n = 43). The mean age was 59.4 years (standard deviation 8.8 years) and 69 participants (79%) were male. The mean Oral Mucositis Weekly Questionnaire-Head and Neck Cancer score at 6 weeks was 33.2 (standard deviation 10) in the low-level laser therapy arm and 27.4 (standard deviation 13.8) in the sham arm. LIMITATIONS The trial lacked statistical power because it did not meet the recruitment target. Staff and patients willingly participated in the trial and worked hard to make the LiTEFORM trial succeed. However, the task of introducing, embedding and sustaining new low-level laser therapy services into a complex care pathway proved challenging. Sites could deliver low-level laser therapy to only a small number of patients at a time. The administration of low-level laser therapy was viewed as straightforward, but also time-consuming and sometimes uncomfortable for both patients and staff, particularly those staff who were not used to working in a patient's mouth. CONCLUSIONS This trial had a robust design but lacked power to be definitive. Low-level laser therapy is relatively inexpensive. In contrast with previous trials, some patients found low-level laser therapy sessions to be difficult. The duration of low-level laser therapy sessions is, therefore, an important consideration. Clinicians experienced in oral cavity work most readily adapt to delivering low-level laser therapy, although other allied health professionals can be trained. Blinding the clinicians delivering low-level laser therapy is feasible. There are important human resource, real estate and logistical considerations for those setting up low-level laser therapy services. FUTURE WORK Further well-designed randomised controlled trials investigating low-level laser therapy in head and neck cancer irradiation are needed, with similar powered recruitment targets but addressing the recruitment challenges and logistical findings from this research. TRIAL REGISTRATION This trial is registered as ISRCTN14224600. FUNDING This project was funded by the National Institute for Health and Care Research ( NIHR ) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 46. See the NIHR Journals Library website for further project information.
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Malnutrition, nutrition support and dietary intervention: the role of the dietitian supporting patients with head and neck cancer. Br Dent J 2022; 233:757-764. [DOI: 10.1038/s41415-022-5107-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022]
Abstract
AbstractMalnutrition is prevalent in patients with head and neck cancer (HNC) at diagnosis but can occur at any stage of the treatment pathway. The impact of disease burden and treatment side effects can lead to altered anatomy, compromised quality and quantity of saliva and impaired swallowing function, which can result in deleterious effects on nutritional status. Optimising nutrition status is critical, as malnutrition is adversely associated with treatment tolerance and outcomes, wound healing, morbidity, mortality, quality of life and survival. Dietitians are integral members of the HNC multidisciplinary team and are uniquely qualified in the assessment, management and optimisation of nutritional status across the care pathway. This includes providing informational counselling to patients and carers on the short- and long-term nutritional impact of planned treatments alongside multidisciplinary members. Dietitians lead on the recommendation, provision and monitoring of nutrition support, which can be via the oral, enteral or parenteral route. Oral nutrition support includes dietary counselling, nourishing dietary, food fortification advice and high energy/protein oral nutritional supplements. Enteral nutrition support, or tube feeding, can be required on a short- and/or long-term basis and dietitians support appropriate decision-making for the type of tube and timing of placement across the care pathway.
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Bora H, Bhattacharyya M, Kalita AK, Medhi PP, Sarma G, Nath J, Kalita M, Ingtipi D, Sarma B. Subjective Global Assessment of Nutritional Status in Head and Neck Cancer Patients Treated with Radiotherapy - A Prospective Observational Study from North East India. Nutr Cancer 2022; 75:357-367. [PMID: 36052999 DOI: 10.1080/01635581.2022.2118323] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Head and neck cancer (HNC) patients undergoing curative radiotherapy (RT) are at risk of malnutrition due to disease process as well as effects of therapy. Identifying the nutritional status of these patients at the earliest, helps to introduce adequate and timely interventions that can improve compliance and outcomes of treatment. Various tools for nutritional assessment in cancer patients have been proposed. In this prospective observational study we used the Subjective Global Assessment (SGA) questionnaire in a cohort of HNC patients receiving definitive RT at a regional cancer center of North East India. Recording of data was done at baseline, at two weekly intervals during treatment, at end of radiotherapy (EORT) and at follow-up upto 6 months. We observed that despite proper nutrition counseling, our patients suffered from malnutrition throughout their course of RT, which was at its peak by EORT but gradually improved over six months of follow-up. Pain on eating and swallowing were the most debilitating symptoms which caused significant decline of nutrient intake, body fat and muscle mass among patients together with deteriorating SGA ratings. Our results will hopefully help us design better strategies for nutrition management while delivering curative (chemo)radiotherapy for HNC patients of this region- which has one of the highest incidences of HNC in the world.
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Affiliation(s)
- Hima Bora
- Department of Radiation Oncology, Dr Bhubaneswar Borooah Cancer Institute, Guwahati, India
| | | | - Apurba Kumar Kalita
- Department of Radiation Oncology, Dr Bhubaneswar Borooah Cancer Institute, Guwahati, India
| | - Partha Pratim Medhi
- Department of Radiation Oncology, Dr Bhubaneswar Borooah Cancer Institute, Guwahati, India
| | - Gautam Sarma
- Department of Radiation Oncology, Dr Bhubaneswar Borooah Cancer Institute, Guwahati, India
| | - Jyotiman Nath
- Department of Radiation Oncology, Dr Bhubaneswar Borooah Cancer Institute, Guwahati, India
| | - Manoj Kalita
- Department of Cancer Registry and Biostatistics, Dr Bhubaneswar Borooah Cancer Institute, Guwahati, India
| | - Dimi Ingtipi
- Consultant Dietician, Dr Bhubaneswar Borooah Cancer Institute, Guwahati, India
| | - Biswajit Sarma
- Department of Radiation Oncology, Dr Bhubaneswar Borooah Cancer Institute, Guwahati, India
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Edwards A, Brown T, Hughes BGM, Bauer J. The changing face of head and neck cancer: are patients with human papillomavirus-positive disease at greater nutritional risk? A systematic review. Support Care Cancer 2022; 30:7191-7204. [PMID: 35477809 PMCID: PMC9385807 DOI: 10.1007/s00520-022-07056-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 04/11/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE Human papillomavirus (HPV) is now the primary cause of oropharyngeal head and neck cancer (OPC) worldwide; yet limited research has examined the effect of HPV-positive status (OPC+) on nutrition outcomes. This study aims to determine the impact of HPV status on nutritional outcomes for adult patients with OPC undergoing any treatment modality. METHODS A systematic literature review was conducted up to and including July 2021 of PubMed, Embase, CENTRAL, CINAHL, and Web of Science to identify studies conducted in adults (>18 years) with known OPC reporting on any outcome(s) related to nutrition, according to HPV status (OPC+ versus OPC-). Bias was assessed using QUIPS tool, with certainty of evidence assessed using GRADE system. RESULTS Six studies (total n = 635) all at moderate-high risk of bias were included. Three studies reported on weight change (n = 255), three feeding tube dependency (n = 380), three feeding tube timing of placement (prophylactic or reactive) and/or utilisation (n = 255), two nutritional (energy and/or protein) intake (n = 230), and one nutritional status (n = 83). Patients with OPC+ may experience greater weight loss, may have higher utilisation of reactive feeding tubes (both GRADE low certainty, downgraded due to serious bias and imprecision), and may have lower feeding tube dependency rates (GRADE low certainty, downgraded due to serious bias and inconsistency) versus OPC- . It is uncertain whether nutritional intake and nutritional status differed between populations (GRADE very low certainty, downgraded due to serious bias and very serious imprecision). CONCLUSION Further, high-quality research is needed to understand optimal nutritional care practices for patients with OPC + to achieve positive health outcomes into survivorship.
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Affiliation(s)
- Anna Edwards
- School of Human Movements and Nutrition Sciences, University of Queensland, Brisbane, QLD, Australia.
- Nutrition & Dietetics, Toowoomba Hospital, Darling Downs Health, Toowoomba, QLD, Australia.
- Nutrition & Dietetics, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, QLD, Australia.
| | - Teresa Brown
- School of Human Movements and Nutrition Sciences, University of Queensland, Brisbane, QLD, Australia
- Nutrition & Dietetics, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | - Brett G M Hughes
- Cancer Care Services, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, QLD, Australia
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Judy Bauer
- School of Human Movements and Nutrition Sciences, University of Queensland, Brisbane, QLD, Australia
- Nutrition, Dietetics & Food, School of Clinical Sciences, Monash Health, Monash University, Victoria, Australia
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9
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The Outcomes of Nutritional Support Techniques in Patients with Gastrointestinal Cancers. GASTROENTEROLOGY INSIGHTS 2022. [DOI: 10.3390/gastroent13030025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Gastrointestinal cancers represent a major cause of morbidity and mortality worldwide. A significant issue regarding the therapeutic management of these patients consists of metabolic disturbances and malnutrition. Nutritional deficiencies have a negative impact on both the death rates of these patients and the results of surgical or oncological treatments. Thus, current guidelines recommend the inclusion of a nutritional profile in the therapeutic management of patients with gastrointestinal cancers. The development of digestive endoscopy techniques has led to the possibility of ensuring the enteral nutrition of cancer patients without oral feeding through minimally invasive techniques and the avoidance of surgeries, which involve more risks. The enteral nutrition modalities consist of endoscopy-guided nasoenteric tube (ENET), percutaneous endoscopic gastrostomy (PEG), percutaneous endoscopic gastrostomy with jejunal tube extension (PEG-J), direct percutaneous endoscopic jejunostomy (DPEJ) or endoscopic ultrasound (EUS)-guided gastroenterostomy.
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10
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Effect of prophylactic gastrostomy on nutritional and clinical outcomes in patients with head and neck cancer. Eur J Clin Nutr 2022; 76:1536-1541. [PMID: 35534701 DOI: 10.1038/s41430-022-01154-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 04/20/2022] [Accepted: 04/26/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND We aimed to identify which enteral feeding method was most beneficial for patients and compare clinical outcomes, quality of life, and complication rates by assessing patients who underwent prophylactic percutaneous endoscopic gastrostomy (pPEG) tube, reactive percutaneous endoscopic gastrostomy (rPEG) tube or reactive nasogastric tube (rNGT) insertion. METHODS Patients with head and neck cancers (HNCs) were enrolled between April 1, 2013 and April 17, 2019 (n = 335; 296 males, 39 females). Data concerning patient characteristics and treatment modalities were extracted from the medical records. Comparisons between enteral feeding methods were made by univariate and multivariate analysis. Overall survival (OS) outcomes were analyzed by the log rank test using the Kaplan-Meier method. RESULTS A total of 335 patients were included. The median follow-up time was 29.5 months. There were forty-six patients in the pPEG tube group, 23 patients in the rPEG tube group, and 266 patients in the rNGT group. pPEG, increased body-mass index (BMI), and N0-1 category were significantly associated with less weight loss in the multivariate analysis (all P < 0.05). pPEG decreased the rate of radiotherapy delay compared with that of reactive interventions (23.1% vs. 47.1%, P = 0.007). In terms of quality of life, global health status, role functioning, emotional functioning, cognitive functioning, pain, and dyspnea were significantly improved in the pPEG tube group (all P < 0.05). BMI and weight loss were independent prognostic factors for clinical survival outcomes (all P < 0.05). CONCLUSIONS pPEG could improve nutrition outcomes, reduce treatment delay, and maintain quality of life.
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Bischoff SC, Austin P, Boeykens K, Chourdakis M, Cuerda C, Jonkers-Schuitema C, Lichota M, Nyulasi I, Schneider SM, Stanga Z, Pironi L. ESPEN practical guideline: Home enteral nutrition. Clin Nutr 2021; 41:468-488. [PMID: 35007816 DOI: 10.1016/j.clnu.2021.10.018] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 10/25/2021] [Indexed: 01/12/2023]
Abstract
This ESPEN practical guideline will inform physicians, nurses, dieticians, pharmacists, caregivers and other home enteral nutrition (HEN) providers in a concise way about the indications and contraindications for HEN, as well as its implementation and monitoring. This guideline will also inform interested patients requiring HEN. Home parenteral nutrition is not included but will be addressed in a separate ESPEN guideline. The guideline is based on the ESPEN scientific guideline published before, which consists of 61 recommendations that have been reproduced and renumbered, along with the associated commentaries that have been shorted compared to the scientific guideline. Evidence grades and consensus levels are indicated. The guideline was commissioned and financially supported by ESPEN and the members of the guideline group were selected by ESPEN.
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Affiliation(s)
- Stephan C Bischoff
- University of Hohenheim, Institute of Nutritional Medicine, Stuttgart, Germany.
| | - Peter Austin
- Pharmacy Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK, University College London School of Pharmacy, London, UK
| | - Kurt Boeykens
- AZ Nikolaas Hospital, Nutrition Support Team, Sint-Niklaas, Belgium
| | - Michael Chourdakis
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Cristina Cuerda
- Hospital General Universitario Gregorio Marañón, Nutrition Unit, Madrid, Spain
| | | | - Marek Lichota
- Intestinal Failure Patients Association "Appetite for Life", Cracow, Poland
| | - Ibolya Nyulasi
- Department of Nutrition, Department of Rehabilitation, Nutrition and Sport, Latrobe University, Department of Medicine, Monash University, Australia
| | - Stéphane M Schneider
- Gastroenterology and Nutrition, Centre Hospitalier Universitaire, Université Côte d'Azur, Nice, France
| | - Zeno Stanga
- Division of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital and University of Bern, Switzerland
| | - Loris Pironi
- Alma Mater Studiorum -University of Bologna, Department of Medical and Surgical Sciences, Italy; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Centre for Chronic Intestinal Failure, Clinical Nutrition and Metabolism Unit, Italy
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Vasiliadou I, Noble D, Hartley A, Moleron R, Sanghera P, Urbano TG, Schipani S, Gujral D, Foran B, Bhide S, Haridass A, Nathan K, Michaelidou A, Sen M, Geropantas K, Joseph M, O'Toole L, Griffin M, Pettit L, Chambers J, Jankowska P, De Winton E, Goranova R, Singh N, Shah K, Kong Conceptualisation A. A multi-centre survey reveals variations in the standard treatments and treatment modifications for head and neck cancer patients during Covid-19 pandemic. Clin Transl Radiat Oncol 2021; 30:50-59. [PMID: 34226880 PMCID: PMC8242198 DOI: 10.1016/j.ctro.2021.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 06/15/2021] [Accepted: 06/23/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The onset of the COVID-19 pandemic necessitated rapid changes to the practice of head and neck oncology in UK. There was a delay between the onset of the pandemic and the release of guidelines from cancer societies and networks, leading to a variable response of individual centres. This survey was conducted to assess the pre-Covid-19 pandemic standard of practice for head and neck oncology patients and the treatment modifications introduced during the first wave of the pandemic in UK. METHODOLOGY The UK National Cancer Research Institute (NCRI) Head and Neck Clinical Studies Group initiated a multi-centre survey using questionnaire to investigate the effect on feeding tube practice, radiotherapy (RT) fractionation and volumes, use of chemotherapy in the neo-adjuvant, concurrent and palliative setting, the use of immunotherapy in the palliative setting, access to radiology and histopathology services, and availability of surgical procedures. RESULTS 30 centres were approached across UK; 23 (76.7%) centres responded and were included in the survey. There were differences in the standard practices in feeding tube policy, RT dose and fractionation as well as concurrent chemotherapy use. 21 (91%) participating centres had at least one treatment modification. 15 (65%) centres initiated a change in radical RT; changing to either a hypofractionation or acceleration schedule. For post-operative RT 10 centres (43.5%) changed to a hypofractionation schedule. 12 (52.2%) centres stopped neo-adjuvant chemotherapy for all patients; 13 (56.5%) centres followed selective omission of chemotherapy in concurrent chemo-radiotherapy patients, 17 (73.9%) centres changed first-line chemotherapy treatment to pembrolizumab (following NHS England's interim guidance) and 8 (34.8%) centres stopped the treatment early or offered delays for patients that have been already on systemic treatment. The majority of centres did not have significant changes associated with surgery, radiology, histopathology and dental screening. CONCLUSION There are variations in the standard of practice and treatment modifications for head and neck cancer patients during Covid-19 pandemic. A timely initiative is required to form a consensus on head and neck cancer management in the UK and other countries.
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Affiliation(s)
| | - David Noble
- Edinburgh Cancer Centre, Edinburgh, United Kingdom
| | - Andrew Hartley
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | | | - Paul Sanghera
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | | | | | - Dorothy Gujral
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Bernie Foran
- Weston Park Cancer Centre, Sheffield, United Kingdom
| | - Shree Bhide
- Royal Marsden NHS Foundation Trust, London and Sutton, United Kingdom
| | | | - Kannon Nathan
- Kent Oncology Centre, Maidstone and Canterbury, United Kingdom
| | | | - Mehmet Sen
- Leeds Cancer Centre, Leeds, United Kingdom
| | | | - Mano Joseph
- The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | | | | | - Laura Pettit
- Lingen Davie Cancer Centre, Shrewsbury, United Kingdom
| | | | | | | | | | | | - Ketan Shah
- Oxford University Hospitals, Oxford, United Kingdom
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13
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Baijens LWJ, Walshe M, Aaltonen LM, Arens C, Cordier R, Cras P, Crevier-Buchman L, Curtis C, Golusinski W, Govender R, Eriksen JG, Hansen K, Heathcote K, Hess MM, Hosal S, Klussmann JP, Leemans CR, MacCarthy D, Manduchi B, Marie JP, Nouraei R, Parkes C, Pflug C, Pilz W, Regan J, Rommel N, Schindler A, Schols AMWJ, Speyer R, Succo G, Wessel I, Willemsen ACH, Yilmaz T, Clavé P. European white paper: oropharyngeal dysphagia in head and neck cancer. Eur Arch Otorhinolaryngol 2021; 278:577-616. [PMID: 33341909 PMCID: PMC7826315 DOI: 10.1007/s00405-020-06507-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 11/17/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE To develop a European White Paper document on oropharyngeal dysphagia (OD) in head and neck cancer (HNC). There are wide variations in the management of OD associated with HNC across Europe. METHODS Experts in the management of specific aspects of OD in HNC across Europe were delegated by their professional medical and multidisciplinary societies to contribute to this document. Evidence is based on systematic reviews, consensus-based position statements, and expert opinion. RESULTS Twenty-four sections on HNC-specific OD topics. CONCLUSION This European White Paper summarizes current best practice on management of OD in HNC, providing recommendations to support patients and health professionals. The body of literature and its level of evidence on diagnostics and treatment for OD in HNC remain poor. This is in the context of an expected increase in the prevalence of OD due to HNC in the near future. Contributing factors to increased prevalence include aging of our European population (including HNC patients) and an increase in human papillomavirus (HPV) related cancer, despite the introduction of HPV vaccination in various countries. We recommend timely implementation of OD screening in HNC patients while emphasizing the need for robust scientific research on the treatment of OD in HNC. Meanwhile, its management remains a challenge for European professional associations and policymakers.
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Affiliation(s)
- Laura W J Baijens
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Leena-Maija Aaltonen
- Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Christoph Arens
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Magdeburg, Otto-von-Guericke University, Magdeburg, Germany
| | - Reinie Cordier
- Department of Special Needs Education, University of Oslo, Oslo, Norway
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
| | - Patrick Cras
- Department of Neurology, Born Bunge Institute, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Lise Crevier-Buchman
- Voice, Speech, Swallowing Lab, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital UVSQ and Research lab CNRS-UMR7018, Hôpital Foch, Suresnes, France
| | - Chris Curtis
- Swallows Head and Neck Cancer Charity, Blackpool, UK
| | - Wojciech Golusinski
- Department of Head and Neck Surgery, The Greater Poland Cancer Centre, Poznan University of Medical Sciences, Poznan, Poland
| | - Roganie Govender
- Head and Neck Cancer Centre, University College London Hospital, London, UK
| | - Jesper Grau Eriksen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Kevin Hansen
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - Kate Heathcote
- Robert White Centre for Airway, Voice and Swallow, Poole Hospital NHS Foundation Trust, Dorset, UK
| | - Markus M Hess
- Deutsche Stimmklinik, Hamburg, Germany
- Departement of Voice, Speech and Hearing Disorders, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sefik Hosal
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Atılım University, Medicana International Ankara, Ankara, Turkey
| | - Jens Peter Klussmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - C René Leemans
- Department of Otolaryngology, Head and Neck Surgery, Amsterdam University Medical Centres, Vrije Universiteit, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam University Medical Centres, Vrije Universiteit, Amsterdam, The Netherlands
| | - Denise MacCarthy
- Division of Restorative Dentistry and Periodontology, Faculty of Health Sciences, Trinity College Dublin, Dublin Dental University Hospital, Dublin, Ireland
| | - Beatrice Manduchi
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Jean-Paul Marie
- Department of Otorhinolaryngology, Head and Neck Surgery, Rouen University Hospital, Rouen, France
| | - Reza Nouraei
- Department of Ear Nose and Throat Surgery, The Robert White Centre for Airway Voice and Swallowing, Poole Hospital NHS Foundation Trust, University of Southampton, Southampton, UK
| | - Claire Parkes
- Department of Speech and Language Therapy, St. James's Hospital, Dublin, Ireland
| | - Christina Pflug
- Departement of Voice, Speech and Hearing Disorders, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Walmari Pilz
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- MHeNs School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Julie Regan
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Nathalie Rommel
- Department Neurosciences, Experimental Otorhinolaryngology, Deglutology, University of Leuven, Leuven, Belgium
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Annemie M W J Schols
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Renee Speyer
- Department of Special Needs Education, University of Oslo, Oslo, Norway
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, Leiden, The Netherlands
- Faculty of Health, School of Health and Social Development, Victoria, Australia
| | - Giovanni Succo
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO - IRCCS, Candiolo, TO, Italy
- Department of Oncology, University of Turin, Orbassano, TO, Italy
| | - Irene Wessel
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anna C H Willemsen
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
- Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Taner Yilmaz
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
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Cotogni P, Stragliotto S, Ossola M, Collo A, Riso S. The Role of Nutritional Support for Cancer Patients in Palliative Care. Nutrients 2021; 13:306. [PMID: 33498997 PMCID: PMC7911232 DOI: 10.3390/nu13020306] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/11/2021] [Accepted: 01/19/2021] [Indexed: 02/07/2023] Open
Abstract
The role of nutritional support for cancer patients in palliative care is still a controversial topic, in part because there is no consensus on the definition of a palliative care patient because of ambiguity in the common medical use of the adjective palliative. Nonetheless, guidelines recommend assessing nutritional deficiencies in all such patients because, regardless of whether they are still on anticancer treatments or not, malnutrition leads to low performance status, impaired quality of life (QoL), unplanned hospitalizations, and reduced survival. Because nutritional interventions tailored to individual needs may be beneficial, guidelines recommend that if oral food intake remains inadequate despite counseling and oral nutritional supplements, home enteral nutrition or, if this is not sufficient or feasible, home parenteral nutrition (supplemental or total) should be considered in suitable patients. The purpose of this narrative review is to identify in these cancer patients the area of overlapping between the two therapeutic approaches consisting of nutritional support and palliative care in light of the variables that determine its identification (guidelines, evidence, ethics, and law). However, nutritional support for cancer patients in palliative care may be more likely to contribute to improving their QoL when part of a comprehensive early palliative care approach.
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Affiliation(s)
- Paolo Cotogni
- Department of Anesthesia, Pain Management and Palliative Care, Intensive Care and Emergency, Molinette Hospital, University of Turin, 10126 Turin, Italy
| | - Silvia Stragliotto
- Medical Oncology 1, Veneto Institute of Oncology-IRCCS, 35128 Padova, Italy;
| | - Marta Ossola
- Clinical Nutrition and Dietetics Unit, Department of Internal Medicine, Molinette Hospital, 10126 Turin, Italy;
| | - Alessandro Collo
- Clinical Nutrition and Dietetics Unit, Maggiore della Carità Hospital, University of Eastern Piedmont, 28100 Novara, Italy; (S.R.); (A.C.)
| | - Sergio Riso
- Clinical Nutrition and Dietetics Unit, Maggiore della Carità Hospital, University of Eastern Piedmont, 28100 Novara, Italy; (S.R.); (A.C.)
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Arvanitakis M, Gkolfakis P, Despott EJ, Ballarin A, Beyna T, Boeykens K, Elbe P, Gisbertz I, Hoyois A, Mosteanu O, Sanders DS, Schmidt PT, Schneider SM, van Hooft JE. Endoscopic management of enteral tubes in adult patients - Part 1: Definitions and indications. European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2021; 53:81-92. [PMID: 33260229 DOI: 10.1055/a-1303-7449] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
ESGE recommends considering the following indications for enteral tube insertion: (i) clinical conditions that make oral intake impossible (neurological conditions, obstructive causes); (ii) acute and/or chronic diseases that result in a catabolic state where oral intake becomes insufficient; and (iii) chronic small-bowel obstruction requiring a decompression gastrostomy.Strong recommendation, low quality evidence.ESGE recommends the use of temporary feeding tubes placed through a natural orifice (either nostril) in patients expected to require enteral nutrition (EN) for less than 4 weeks. If it is anticipated that EN will be required for more than 4 weeks, percutaneous access should be considered, depending on the clinical setting.Strong recommendation, low quality evidence.ESGE recommends the gastric route as the primary option in patients in need of EN support. Only in patients with altered/unfavorable gastric anatomy (e. g. after previous surgery), impaired gastric emptying, intolerance to gastric feeding, or with a high risk of aspiration, should the jejunal route be chosen.Strong recommendation, moderate quality evidence.ESGE suggests that recent gastrointestinal (GI) bleeding due to peptic ulcer disease with risk of rebleeding should be considered to be a relative contraindication to percutaneous enteral access procedures, as should hemodynamic or respiratory instability.Weak recommendation, low quality evidence.ESGE suggests that the presence of ascites and ventriculoperitoneal shunts should be considered to be additional risk factors for infection and, therefore, further preventive precautions must be taken in these cases.Weak recommendation, low quality evidence.ESGE recommends that percutaneous tube placement (percutaneous endoscopic gastrostomy [PEG], percutaneous endoscopic gastrostomy with jejunal extension [PEG-J], or direct percutaneous endoscopic jejunostomy [D-PEJ]) should be considered to be a procedure with high hemorrhagic risk, and that in order to reduce this risk, specific guidelines for antiplatelet or anticoagulant use should be followed strictly.Strong recommendation, low quality evidence.ESGE recommends refraining from PEG placement in patients with advanced dementia.Strong recommendation, low quality evidence.ESGE recommends refraining from PEG placement in patients with a life expectancy shorter than 30 days.Strong recommendation, low quality evidence*.
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Affiliation(s)
- Marianna Arvanitakis
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Paraskevas Gkolfakis
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Edward J Despott
- Royal Free Unit for Endoscopy and Centre for Gastroenterology, UCL Institute for Liver and Digestive Health, The Royal Free Hospital, London, United Kingdom
| | - Asuncion Ballarin
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Torsten Beyna
- Department of Gastroenterology and Therapeutic Endoscopy, Evangelisches Krankenhaus Düsseldorf, Germany
| | - Kurt Boeykens
- Nutrition Support Team, AZ Nikolaas Hospital, Sint-Niklaas, Belgium
| | - Peter Elbe
- Department of Upper Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.,Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Ingrid Gisbertz
- Department of Gastroenterology, Bernhoven Hospital, Uden, The Netherlands
| | - Alice Hoyois
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Ofelia Mosteanu
- Department of Gastroenterology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - David S Sanders
- Academic Unit of Gastroenterology, Royal Hallamshire Hospital and University of Sheffield, United Kingdom
| | - Peter T Schmidt
- Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden.,Department of Medicine, Ersta Hospital, Stockholm, Sweden
| | - Stéphane M Schneider
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Gastroentérologie et Nutrition, Nice, France
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
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16
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Nutritional Support in Head and Neck Radiotherapy Patients Considering HPV Status. Nutrients 2020; 13:nu13010057. [PMID: 33375430 PMCID: PMC7823874 DOI: 10.3390/nu13010057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 12/21/2020] [Accepted: 12/23/2020] [Indexed: 02/07/2023] Open
Abstract
Malnutrition is a common problem in patients with head and neck cancer (HNC), including oropharyngeal cancer (OPC). It is caused by insufficient food intake due to dysphagia, odynophagia, and a lack of appetite caused by the tumor. It is also secondary to the oncological treatment of the basic disease, such as radiotherapy (RT) and chemoradiotherapy (CRT), as a consequence of mucositis with the dry mouth, loss of taste, and dysphagia. The severe dysphagia leads to a definitive total impossibility of eating through the mouth in 20–30% of patients. These patients usually require enteral nutritional support. Feeding tubes are a commonly used nutritional intervention during radiotherapy, most frequently percutaneous gastrostomy tube. Recently, a novel HPV-related type of OPC has been described. Patients with HPV-associated OPC are different from the HPV− ones. Typical HPV− OPC is associated with smoking and alcohol abuse. Patients with HPV+ OPC are younger and healthy (without comorbidities) at diagnosis compared to HPV− ones. Patients with OPC are at high nutritional risk, and therefore, they require nutritional support in order to improve the treatment results and quality of life. Some authors noted the high incidence of critical weight loss (CWL) in patients with HPV-related OPC. Other authors have observed the increased acute toxicities during oncological treatment in HPV+ OPC patients compared to HPV− ones. The aim of this paper is to review and discuss the indications for nutritional support and the kinds of nutrition, including immunonutrition (IN), in HNC, particularly OPC patients, undergoing RT/CRT, considering HPV status.
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17
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Bojaxhiu B, Shrestha BK, Luterbacher P, Elicin O, Shelan M, Macpherson AJS, Heimgartner B, Giger R, Aebersold DM, Zaugg K. Unplanned hospitalizations in patients with locoregionally advanced head and neck cancer treated with (chemo)radiotherapy with and without prophylactic percutaneous endoscopic gastrostomy. Radiat Oncol 2020; 15:281. [PMID: 33317602 PMCID: PMC7737384 DOI: 10.1186/s13014-020-01727-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/06/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Current studies about percutaneous endoscopic gastrostomy (PEG) tube placement report equivalent patient outcomes with prophylactic PEG tubes (pPEGs) versus common nutritional support. Unreported was if omitting a pPEG is associated with an increased risk of complications leading to a treatment-related unplanned hospitalization (TRUH). METHODS TRUHs were retrospectively analyzed in patients with advanced head and neck squamous cell carcinoma (n = 310) undergoing (chemo)radiotherapy with (pPEG) or without PEG (nPEG). RESULTS In 88 patients (28%), TRUH was reported. One of the leading causes of TRUH in nPEG patients was inadequate oral intake (n = 16, 13%), and in pPEG patients, complications after PEG tube insertion (n = 12, 10%). Risk factors for TRUH were poor performance status, tobacco use, and surgical procedures. CONCLUSIONS Omitting pPEG tube placement without increasing the risk of an unplanned hospitalization due to dysphagia, dehydration or malnutrition, is an option in patients being carefully monitored. Patients aged > 60 years with hypopharyngeal carcinoma, tobacco consumption, and poor performance status appear at risk of PEG tube-related complications leading to an unplanned hospitalization.
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Affiliation(s)
- Beat Bojaxhiu
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Radiation Oncology, Stadtspital Triemli, Birmensdorferstrasse 497, 8063, Zurich, Switzerland
| | - Binaya K Shrestha
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Pascal Luterbacher
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mohamed Shelan
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrew J S Macpherson
- Department of Visceral Surgery and Medicine, Division of Gastroenterology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Benjamin Heimgartner
- Department of Visceral Surgery and Medicine, Division of Gastroenterology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roland Giger
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel M Aebersold
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kathrin Zaugg
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. .,Department of Radiation Oncology, Stadtspital Triemli, Birmensdorferstrasse 497, 8063, Zurich, Switzerland.
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Ang SY, Lim ML, Ong HS, Chong JNC, Ng XP, Lam M, Chan MM, Lopez V, Lim SH. A Descriptive Study of enteral tube feeding among adults in an acute care tertiary hospital-patient selection, characteristics and complications. Clin Nutr ESPEN 2020; 37:58-64. [DOI: 10.1016/j.clnesp.2020.03.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/17/2020] [Accepted: 03/25/2020] [Indexed: 10/24/2022]
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Hardman J, Sharma N, Smith J, Nankivell P. Conservative management of oesophageal soft food bolus impaction. Cochrane Database Syst Rev 2020; 5:CD007352. [PMID: 32391954 PMCID: PMC7389440 DOI: 10.1002/14651858.cd007352.pub3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Impaction of a soft food bolus in the oesophagus causes dysphagia and regurgitation. If the bolus does not pass spontaneously, then the patient is at risk of aspiration, dehydration, perforation, and death. Definitive management is with endoscopic intervention, recommended within 24 hours. Prior to endoscopy, many patients undergo a period of observation, awaiting spontaneous disimpaction, or may undergo enteral or parenteral treatments to attempt to dislodge the bolus. There is little consensus as to which of these conservative strategies is safe and effective to be used in this initial period, before resorting to definitive endoscopic management for persistent impaction. OBJECTIVES To evaluate the efficacy of non-endoscopic conservative treatments in the management of soft food boluses impacted within the oesophagus. SEARCH METHODS We searched the following databases, using relevant search terms: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and CINAHL. The date of the search was 18 August 2019. We screened the reference lists of relevant studies and reviews on the topic to identify any additional studies. SELECTION CRITERIA We included randomised controlled trials of the management of acute oesophageal soft food bolus impaction, in adults and children, reporting the incidence of disimpaction (confirmed radiologically or clinically by return to oral diet) without the need for endoscopic intervention. We did not include studies focusing on sharp or solid object impaction. DATA COLLECTION AND ANALYSIS We used standard methodological procedures recommended by Cochrane. MAIN RESULTS We identified 890 unique records through the electronic searches. We excluded 809 clearly irrelevant records and retrieved 81 records for further assessment. We subsequently included one randomised controlled trial that met the eligibility criteria, which was conducted in four Swedish centres and randomised 43 participants to receive either intravenous diazepam followed by glucagon, or intravenous placebos. The effect of the active substances compared with placebo on rates of disimpaction without intervention is uncertain, as the numbers from this single study were small, and the rates were similar (38% versus 32%; risk ratio 1.19, 95% confidence interval 0.51 to 2.75, P = 0.69). The certainty of the evidence using GRADE for this outcome is low. Data on adverse events were lacking. AUTHORS' CONCLUSIONS There is currently inadequate data to recommend the use of any enteral or parenteral treatments in the management of acute oesophageal soft food bolus impaction. There is also inadequate data regarding potential adverse events from the use of these treatments, or from potential delays in definitive endoscopic management. Caution should be exercised when using any conservative management strategies in these patients.
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Affiliation(s)
- John Hardman
- Head and Neck Unit, The Royal Marsden Hospital, London, UK
| | - Neil Sharma
- Department of Otolaryngology, Head and Neck Surgery, University Hospitals Birmingham, Birmingham, UK
- Institute of Cancer and Genomic Studies, University of Birmingham, Birmingham, UK
| | - Joel Smith
- Department of Otolaryngology, Head and Neck Surgery, Royal Devon and Exeter Hospital, Exeter, UK
| | - Paul Nankivell
- Department of Otolaryngology, Head and Neck Surgery, Queen Elizabeth Hospital, Birmingham, UK
- Institute of Head and Neck Studies and Education, Institute of Cancer and Genomic Studies, University of Birmingham, Birmingham, UK
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20
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Nunes G, Fonseca J, Barata AT, Dinis-Ribeiro M, Pimentel-Nunes P. Nutritional Support of Cancer Patients without Oral Feeding: How to Select the Most Effective Technique? GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2020; 27:172-184. [PMID: 32509923 PMCID: PMC7250336 DOI: 10.1159/000502981] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/27/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Digestive tumours are among the leading causes of morbidity and mortality. Many cancer patients cannot maintain oral feeding and develop malnutrition. The authors aim to: review the endoscopic, radiologic and surgical techniques for nutritional support in cancer patients; address the strategies for nutritional intervention according to the selected technique; and establish a decision-making algorithm to define the best approach in a specific tumour setting. SUMMARY This is a narrative non-systematic review based on an electronic search through the medical literature using PubMed and UpToDate. The impossibility of maintaining oral feeding is a major cause of malnutrition in head and neck (H&N) cancer, oesophageal tumours and malignant gastric outlet obstruction. Tube feeding, endoscopic stents and gastrojejunostomy are the three main nutritional options. Nasal tubes are indicated for short-term enteral feeding. Percutaneous endoscopic gastrostomy (PEG) is the gold standard when enteral nutrition is expected for more than 3-4 weeks, especially in H&N tumour and oesophageal cancer patients undergoing definite chemoradiotherapy. A gastropexy push system may be considered to avoid cancer seeding. Radiologic and surgical gastrostomy are alternatives when an endoscopic approach is not feasible. Postpyloric nutrition is indicated for patients intolerant to gastric feeding and may be achieved through nasoenteric tubes, PEG with jejunal extension, percutaneous endoscopic jejunostomy and surgical jejunostomy. Oesophageal and enteric stents are palliative techniques that allow oral feeding and improve quality of life. Surgical or EUS-guided gastrojejunostomy is recommended when enteric stents fail or prolonged survival is expected. Nutritional intervention is dependent on the technique chosen. Institutional protocols and decision algorithms should be developed on a multidisciplinary basis to optimize nutritional care. CONCLUSIONS Gastroenterologists play a central role in the nutritional support of cancer patients performing endoscopic techniques that maintain oral or enteral feeding. The selection of the most effective technique must consider the cancer type, the oncologic therapeutic program, nutritional aims and expected patient survival.
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Affiliation(s)
- Gonçalo Nunes
- Gastroenterology Department, GENE − Artificial Feeding Team, Hospital Garcia de Orta, Almada, Portugal
| | - Jorge Fonseca
- Gastroenterology Department, GENE − Artificial Feeding Team, Hospital Garcia de Orta, Almada, Portugal
- CiiEM − Center for Interdisciplinary Research Egas Moniz, Monte da Caparica, Portugal
| | - Ana Teresa Barata
- Gastroenterology Department, GENE − Artificial Feeding Team, Hospital Garcia de Orta, Almada, Portugal
| | - Mário Dinis-Ribeiro
- Gastroenterology Department, Instituto Português de Oncologia Francisco Gentil, Porto, Portugal
- Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Pedro Pimentel-Nunes
- Gastroenterology Department, Instituto Português de Oncologia Francisco Gentil, Porto, Portugal
- Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
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Bischoff SC, Austin P, Boeykens K, Chourdakis M, Cuerda C, Jonkers-Schuitema C, Lichota M, Nyulasi I, Schneider SM, Stanga Z, Pironi L. ESPEN guideline on home enteral nutrition. Clin Nutr 2020; 39:5-22. [DOI: 10.1016/j.clnu.2019.04.022] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 04/19/2019] [Indexed: 02/07/2023]
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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: 1.0] [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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Beacher NG, Sweeney MP. The dental management of a mouth cancer patient. Br Dent J 2019; 225:855-864. [PMID: 30412520 DOI: 10.1038/sj.bdj.2018.932] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2018] [Indexed: 12/17/2022]
Abstract
Dentists and dental care professionals have a key role to play in the journey of the mouth cancer patient. Involved in the prevention, diagnosis and delivery of oral healthcare before, during and following mouth cancer treatment, dental professionals are essential to the delivery of patient care. This article will explore and consider the priorities of dental pre-assessment and the subsequent delivery of oral healthcare in the context of the different oncology treatment strategies utilised and in end-of-life care. The significant side effects of radiotherapy will be reviewed and clinical dental considerations presented using the existing evidence base and available guidelines. Ensuring mouth cancer does not result in dental disease is an important role for all members of the dental community.
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Affiliation(s)
- N G Beacher
- University of Glasgow Dental School, School of Medicine, College of Medical, Veterinary & Life Sciences, Glasgow, UK
| | - M P Sweeney
- University of Glasgow Dental School, School of Medicine, College of Medical, Veterinary & Life Sciences, Glasgow, UK
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Sanz-Paris A, Martinez-García M, Martinez-Trufero J, Lambea-Sorrosal J, Calvo-Gracia F, López-Alaminos ME. Oligomeric Enteral Nutrition in Undernutrition, due to Oncology Treatment-Related Diarrhea. Systematic Review and Proposal of An Algorithm of Action. Nutrients 2019; 11:nu11081888. [PMID: 31412681 PMCID: PMC6722903 DOI: 10.3390/nu11081888] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/09/2019] [Accepted: 08/09/2019] [Indexed: 12/19/2022] Open
Abstract
Oncology treatment-related diarrhea and malnutrition appear together in oncological patients because of the disease itself, or the treatments that are administered for it. Therefore it is essential to carry out a nutritional treatment. Enteral nutrition formulas, containing peptides and medium chain triglycerides, can facilitate absorption in cases of malabsorption. There are few references to the use of enteral nutrition in the clinical society guidelines of patient management with oncology treatment-related diarrhea (OTRD). A bibliographic review of the studies with oligomeric enteral nutrition in OTRD found only nine studies with chemotherapy (all with the same oligomeric formula in which oral mucositis improves, while the rest of the outcomes show different results), and eight studies with radiotherapy (with different products and very heterogeneous results). We hereby present our action algorithm to supplement the diet of OTRD patients with an oligomeric enteral nutrition formula. The first step is the nutritional assessment, followed by the assessment of the functional capacity of the patient’s intestine. With these two aspects evaluated, the therapeutic possibilities available vary in degrees of complexity: These will range from the usual dietary recommendations, to supplementation with oral oligomeric enteral nutrition, along with complete enteral nutrition with oligomeric formula, and up to potentially total parenteral nutrition.
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Affiliation(s)
- Alejandro Sanz-Paris
- Department of Endocrinology and Nutrition, Miguel Servet Hospital, 50009 Zaragoza, Spain.
- Instituto de Investigación Sanitaria Aragón (IIS Aragon), 50009 Zaragoza, Spain.
| | - María Martinez-García
- Department of Endocrinology and Nutrition, Miguel Servet Hospital, 50009 Zaragoza, Spain
| | | | | | - Fernando Calvo-Gracia
- Department of Endocrinology and Nutrition, University Clinic Hospital, 50009 Zaragoza, Spain
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Nutritional parameters associated with hospital admissions in patients being treated for head and neck cancer. Support Care Cancer 2019; 28:341-349. [PMID: 31044309 DOI: 10.1007/s00520-019-04826-w] [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] [Received: 06/15/2018] [Accepted: 04/23/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE This study analysed nutritional parameters (baseline body mass index (BMI), weight changes and enteral nutrition (EN) use, and their association with hospital admissions during radiotherapy in patients with head and neck cancer (HNC)). METHODS A retrospective review of patients diagnosed with HNC and treated with radiotherapy between October 2012 and April 2014 was conducted. Data on each subject's diagnosis, age, sex, chemotherapy, previous surgery, EN use, weight changes, and BMI were examined for their association with hospital admissions during treatment. RESULTS Eighty-three patients were included, mean age (±standard deviation) = 61 (± 11 years). Thirty-four percent had self-reported weight loss at diagnosis, and mean BMI was 26.2 ± 5.3 kg/m2. Mean weight change during treatment was - 5.1 ± 6.2%. Ten patients used EN, with mean weight stabilisation during EN use (0.3 ± 5.1%). Higher presenting BMI, younger age, and definitive radiotherapy ± chemotherapy predicted greater weight loss (p < 0.05). Critical weight loss ≥ 5% was associated with a higher number of hospital admissions for nutrition reasons (n = 10) (p = 0.011) compared with those without critical weight loss (n = 2). EN use was associated with a higher number of nutrition-related admissions; however, it did not predict length of stay among those admitted. CONCLUSION Critical weight loss during radiotherapy was associated with unplanned nutrition-related hospital admissions. Higher BMI was associated with greater weight loss during radiotherapy, whilst EN use assisted in weight preservation. Further research around patient selection for nutritional interventions aimed at preventing critical weight loss and unplanned hospital admissions is needed.
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de las Peñas R, Majem M, Perez-Altozano J, Virizuela JA, Cancer E, Diz P, Donnay O, Hurtado A, Jimenez-Fonseca P, Ocon MJ. SEOM clinical guidelines on nutrition in cancer patients (2018). Clin Transl Oncol 2019; 21:87-93. [PMID: 30617923 PMCID: PMC6339658 DOI: 10.1007/s12094-018-02009-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 12/05/2018] [Indexed: 12/11/2022]
Abstract
Nutritional deficiency is a common medical problem that affects 15-40% of cancer patients. It negatively impacts their quality of life and can compromise treatment completion. Oncological therapies, such as surgery, radiation therapy, and drug therapies are improving survival rates. However, all these treatments can play a role in the development of malnutrition and/or metabolic alterations in cancer patients, induced by the tumor or by its treatment. Nutritional assessment of cancer patients is necessary at the time of diagnosis and throughout treatment, so as to detect nutritional deficiencies. The Patient-Generated Subjective Global Assessment method is the most widely used tool that also evaluates nutritional requirements. In this guideline, we will review the indications of nutritional interventions as well as artificial nutrition in general and according to the type of treatment (radiotherapy, surgery, or systemic therapy), or palliative care. Likewise, pharmacological agents and pharmaconutrients will be reviewed in addition to the role of regular physical activity.
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Affiliation(s)
- R. de las Peñas
- Medical Oncology Department, Consorcio Hospital Provincial de Castellón, Av. Doctor Clara, 19, 12002 Castellón de la Plana, Spain
| | - M. Majem
- Medical Oncology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - J. Perez-Altozano
- Medical Oncology Department, Hospital Virgen de los Lirios, Alcoy, Spain
| | - J. A. Virizuela
- Medical Oncology Department, Hospital Virgen Macarena, Sevilla, Spain
| | - E. Cancer
- Endocrinology and Nutrition Department, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - P. Diz
- Medical Oncology Department, Hospital de León, León, Spain
| | - O. Donnay
- Medical Oncology Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - A. Hurtado
- Medical Oncology Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - P. Jimenez-Fonseca
- Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - M. J. Ocon
- Endocrinology and Nutrition Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
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Grote M, Maihöfer C, Weigl M, Davies-Knorr P, Belka C. Progressive resistance training in cachectic head and neck cancer patients undergoing radiotherapy: a randomized controlled pilot feasibility trial. Radiat Oncol 2018; 13:215. [PMID: 30400971 PMCID: PMC6219249 DOI: 10.1186/s13014-018-1157-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 10/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cancer cachexia is a prevalent symptom of head and neck neoplasms. The reduction in skeletal muscle mass is one of the main characteristics which can lead to poor physical functioning. The purposes of this pilot randomized controlled trial were to determine the feasibility of progressive resistance training in cachectic head and neck cancer patients during radiotherapy and to explore possible risks and benefits. METHODS Twenty cachectic participants with head and neck cancer receiving radiation were randomized to obtain either a machine supported progressive resistance training (n = 10) or usual care (n = 10). The training took place 3 times weekly for 30 min. Intervention included 3 exercises for major muscle groups with 8-12 repetition maximum for 3 sets each. Bioelectrical impedance analysis, hand-held dynamometry, Six-Minute Walk Test and standardized questionnaires for fatigue and quality of life were used for evaluating outcomes at baseline before radiotherapy (t1), after 7 weeks of radiotherapy (t2) and 8 weeks after the end of radiotherapy (t3). RESULTS All participants (n = 20) completed the trial. No serious adverse events occurred. At the initial assessment the cachectic patients had already lost 7.1 ± 5.2% of their body weight. General fatigue (score 10.7 ± 3.3) and reduced quality of life (score 71.3 ± 20.6) were prevalent in cachectic head and neck cancer patients even before radiotherapy. An average improvement of weight loading for leg press (+ 19.0%), chest press (+ 29.8%) and latissimus pull-down (+ 22.8%) was possible in the intervention group. Participants had at least 13 training sessions. The outcome measures showed nonsignificant changes at t2 and t3, but a trend for a better course of general fatigue and quality of life at t2 in the intervention group. CONCLUSIONS Despite advanced tumor stage and burdensome treatment the intervention adherence is excellent. Progressive resistance training in cachectic head and neck cancer patients during radiotherapy seems to be safe and feasible and may have beneficial effects of general fatigue and quality of life. TRIAL REGISTRATION ClinicalTrials.gov, NCT03524755 . Registered 15 May 2018 - Retrospectively registered.
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Affiliation(s)
- Manuel Grote
- Department of Radiation Oncology, University Hospital, LMU Munich, 81377, Munich, Germany. .,Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, 81377, Munich, Germany. .,Present Address: Department of Health Promotion/Occupational Health Management, AOK Baden-Württemberg, 70191, Stuttgart, Germany.
| | - Cornelius Maihöfer
- Department of Radiation Oncology, University Hospital, LMU Munich, 81377, Munich, Germany.,Clinical Cooperation Group 'Personalized Radiotherapy in Head and Neck Cancer' Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, 85764, Neuherberg, Germany
| | - Martin Weigl
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, 81377, Munich, Germany
| | - Patricia Davies-Knorr
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, 81377, Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, 81377, Munich, Germany.,Clinical Cooperation Group 'Personalized Radiotherapy in Head and Neck Cancer' Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, 85764, Neuherberg, Germany
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Long term patient reported swallowing function following chemoradiotherapy for oropharyngeal carcinoma. Radiother Oncol 2018; 128:452-458. [DOI: 10.1016/j.radonc.2018.06.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 05/30/2018] [Accepted: 06/08/2018] [Indexed: 01/30/2023]
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Takahashi M, Kosaka N, Wakui E, Iwaki S, Nishii M, Teshima M, Shinomiya H, Morimoto K, Kiyota N, Sasaki R, Usami M, Otsuki N, Nibu KI. Role of intensive nutrition support and prophylactic percutaneous endoscopic gastrostomy during concomitant chemoradiotherapy for oropharyngeal cancer. Int J Clin Oncol 2018; 23:1023-1028. [PMID: 30121869 DOI: 10.1007/s10147-018-1328-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 07/31/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Concomitant chemoradiotherapy (CCRT) produces severe mucositis and swallowing dysfunction, often resulting in malnutrition. Intensive nutrition support (INS) in addition to percutaneous endoscopic gastrostomy (PEG) is reported to decrease adverse effects during CCRT. PATIENTS AND METHODS Fifty-eight patients with oropharyngeal cancer treated by CDDP-based CCRT were retrospectively analyzed. Twenty-nine patients treated with INS in addition to PEG were classified as INS group, and other 29 patients treated with PEG but without INS were classified as control group. RESULTS INS in addition to PEG significantly increased calorie intake in the second half of CCRT and reduced adverse events including mucositis (p = 0.0019), leukopenia (p = 0.04), and renal function (p = 0.006). Moreover, 21 out of 29 patients had successfully administration of 200 mg/m2 or more of CDDP, while only 10 out of 29 patients had enough amount of CDDP in control group. CONCLUSIONS These results suggest that INS in addition to prophylactic PEG not only decreases adverse effects but also may potentially improve oncological outcome of the patients with oropharyngeal cancer treated by CCRT.
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Affiliation(s)
- Miki Takahashi
- Department of Rehabilitation, Kobe University Hospital, Kobe, Japan
| | - Nana Kosaka
- Division of Nutrition and Metabolism, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Emi Wakui
- Department of Rehabilitation, Kobe University Hospital, Kobe, Japan
| | - Shinobu Iwaki
- Department of Rehabilitation, Kobe University Hospital, Kobe, Japan
| | - Mika Nishii
- Department of Rehabilitation, Kobe University Hospital, Kobe, Japan
| | - Masanori Teshima
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Hospital, Kobe, Japan
| | - Hirotaka Shinomiya
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Hospital, Kobe, Japan
| | - Koichi Morimoto
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Hospital, Kobe, Japan
| | - Naomi Kiyota
- Department of Medical Oncology and Hematology, Kobe University Hospital, Kobe, Japan
| | - Ryohei Sasaki
- Department of Radiation Oncology, Kobe University Hospital, Kobe, Japan
| | - Makoto Usami
- Division of Nutrition and Metabolism, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Naoki Otsuki
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Hospital, Kobe, Japan.
| | - Ken-Ichi Nibu
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Hospital, Kobe, Japan
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Hofto S, Abbott J, Jackson JE, Isenring E. Investigating adherence to Australian nutritional care guidelines in patients with head and neck cancer. CANCERS OF THE HEAD & NECK 2018; 3:6. [PMID: 31093359 PMCID: PMC6460524 DOI: 10.1186/s41199-018-0033-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 07/12/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Significant weight loss and malnutrition are common in patients with head and neck cancer, despite advances in treatment and development of evidenced-based guidelines. The aim of this study was to assess adherence to evidenced-based guidelines and investigate nutrition outcomes during and post radiation treatment in head and neck cancer patients. METHODS This was a two-year retrospective cohort study of 209 head and neck cancer patients (85% male) treated with ≥20 fractions of radiation (mean dose = 64.8 Gy delivered over 31.9 fractions) at an Australian tertiary hospital. RESULTS Regarding guideline adherences, 80% of patients were seen by a dietitian weekly during treatment and 62% of patients were seen bi-weekly for six-weeks post-treatment. Average weight loss was 6.7% during treatment and 10.3% three-months post treatment. At the end of treatment, oropharyngeal and oral cavity patients had lost the most weight (8.8, 10.9%), with skin cancer and laryngeal patients losing the least weight (4.8, 2.9%). Gastrostomy patients (n = 60) had their tube in-situ for an average of 150 days and lost an average of 7.7 kg (9.4%) during treatment and 11.5 kg (13.5%) from baseline to three-months post treatment. The number of malnourished patients increased from 15% at baseline to 56% at the end of treatment, decreasing to 30% three-months post treatment. CONCLUSIONS Despite high adherence to evidenced-based guidelines, large discrepancies in weight loss and nutritional status between tumor sites was seen. This highlights the opportunity for further investigation of the relationship between tumor site, nutritional status and nutrition interventions, which may then influence future evidenced-based guidelines.
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Affiliation(s)
- Sophie Hofto
- Faculty of Health Sciences and Medicine, Bond University, 2 Promethean Way, Robina, QLD 4226 Australia
| | - Jessica Abbott
- Gold Coast University Hospital, Southport, QLD Australia
| | - James E. Jackson
- Faculty of Health Sciences and Medicine, Bond University, 2 Promethean Way, Robina, QLD 4226 Australia
- Radiation Oncology Centres, Gold Coast University Hospital, Southport, QLD Australia
| | - Elisabeth Isenring
- Faculty of Health Sciences and Medicine, Bond University, 2 Promethean Way, Robina, QLD 4226 Australia
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Indications and benefits of intraoperative esophagogastroduodenoscopy. Wideochir Inne Tech Maloinwazyjne 2018; 13:164-175. [PMID: 30002748 PMCID: PMC6041574 DOI: 10.5114/wiitm.2018.72740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 10/16/2017] [Indexed: 11/29/2022] Open
Abstract
Introduction Intraoperative esophagogastroduodenoscopy (IOG) is a diagnostic and therapeutic method for a variety of special conditions in upper gastrointestinal (UGI) pathology. The indication remains individual due to insufficient evidence and limited training of surgeons in digestive endoscopy. Aim To evaluate the indications, benefits and risks of IOG. Material and methods A single-center retrospective study of 110 consecutive IOGs in 104 patients was performed. The preoperative plan, the timing of IOG, preoperative evaluation, intraoperative finding, localization of the pathology, type of the procedure, change of expected therapy and complications were assessed. Results The cohort comprised 29 esophageal tumors, 5 tumors of the cardia, 36 gastric tumors, gastrointestinal bleeding (8), esophageal diverticula (3), perforations (3), GERD (5), mediastinal pathology (3), fistula (4), assessment of nutrition (10), duodenal adenoma (2), ulcer disease, esophageal stenosis and gastric volvulus. The indication for IOG was established preoperatively in 79% and intraoperatively in 21%. The lesion was localized in 96.4%. The therapy was altered to a wider resection (11), smaller resection (5), localization and surgical therapy of bleeding (8) or allowed minimally invasive surgery (25). A total of 3 postoperative complications included gastric perforation and positivity of resection line (following EMR/ESD) and recurrent bleeding. The 30-day mortality reached 3.6% without a specific cause in IOG. Conclusions The IOG is a complementary method in the diagnosis and treatment of UGI pathology. It enables minimally invasive finalization of the procedures and individualization of the therapy.
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Nutritional status in patients with head and neck cancer undergoing radiotherapy: a longitudinal study. Support Care Cancer 2018; 27:239-247. [PMID: 29938330 DOI: 10.1007/s00520-018-4319-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 06/13/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Patients with head and neck cancers are susceptible to malnutrition during radiotherapy. This study aimed to determine the changes in the nutritional status and its determinants in patients with head and neck cancer during radiotherapy. METHODS This prospective observational study was performed in an outpatient Radiation Oncology clinic with a sample of 54 patients. An interview form (including anthropometric and laboratory parameters), the Patient-Generated Subjective Global Assessment to assess nutritional status, quality of life scales, and toxicity criteria were used for data collection at the baseline, the end of radiotherapy and 1 and 3 months after radiotherapy. RESULTS While the majority of the patients (90%) were well nourished at baseline, most of the patients (74%) were malnourished at the end of radiotherapy (p < 0.001). During radiotherapy, patients developed malnutrition, reflected in a decrease in food intake, approximately 5% loss of body weight, a reduction in mid-arm upper circumference and mid-arm muscle mass, and reduced serum protein and albumin levels. The nutritional status was worse in oropharyngeal cancers (p = 0.021), advanced stage (p = 0.004), use of concomitant chemotherapy (p = 0.041), and worse toxicity (p < 0.001). Furthermore, the nutritional status was strongly associated with the quality of life. CONCLUSIONS This study demonstrated negative impact of radiotherapy on the nutritional status of patients with head and neck cancer. The study also showed the association of the nutritional status and the quality of life. The nutritional status should be assessed during different periods in the trajectory of treatment due to its significant contribution to the quality of life.
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De la Garza-Ramos R, Goodwin CR, Abu-Bonsrah N, Jain A, Passias PG, Neuman BJ, Sciubba DM. Predictive Factors for Percutaneous Endoscopic Gastrostomy Tube Placement After Anterior Cervical Fusion. Global Spine J 2018; 8:260-265. [PMID: 29796374 PMCID: PMC5958480 DOI: 10.1177/2192568217713010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
STUDY DESIGN Retrospective case-control study. OBJECTIVES To identify incidence and risk factors for percutaneous endoscopic gastrostomy (PEG) tube placement after anterior cervical fusion (ACF). METHODS Adult patients undergoing elective ACF with/without corpectomy for spondylosis from 2002 to 2011 were identified using the Nationwide Inpatient Sample database. The primary outcome measure was PEG tube placement; secondary outcomes included in-hospital mortality, total hospital charges, and discharge disposition. Multiple regression analyses were conducted to identify independent predictors of PEG tube placement. RESULTS Of 164 097 patients, 217 (0.13%) required a PEG tube. Patients needing PEG tube placement were older (69 vs 52 years; P < .001) and more likely to be male (65% vs 46.6%; P < .001) when compared with control patients. After regression analysis, age over 65 year (odds ratio [OR] = 4.16; P < .001) was the strongest independent predictor for PEG tube placement; other associated factors included male gender (OR = 2.14; P < .001), congestive heart failure (OR = 4.11; P < .001), anemia (OR = 3.52; P < .001), alcohol abuse (OR = 2.80; P = .009), renal failure (OR = 2.25; P = .003), chronic lung disease (OR = 1.78; P < .001), corpectomy (OR = 2.16; P < .001), and fusion of ≥3 segments (OR = 1.74; P < .001). Mortality rate for patients requiring PEG tube placement was 5.1% versus 0.05% for controls (P < .001); average hospital charges were $134 379 versus $39 519 (P < .001), and nonroutine discharges were seen in 89.3% versus only 6.4% for controls (P < .001). CONCLUSIONS The incidence of PEG tube placement after ACF was 0.13% in this study. Identified risk factors included age >65, corpectomy, fusion of ≥3 segments, and various comorbidities. Additionally, there may be increased risk of in-hospital mortality, hospital charges, and nonroutine discharges among these patients.
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Affiliation(s)
| | | | | | - Amit Jain
- Johns Hopkins University, Baltimore, MD, USA
| | - Peter G. Passias
- NYU Medical Center-Hospital for Joint Diseases, New York, NY, USA
| | | | - Daniel M. Sciubba
- Johns Hopkins University, Baltimore, MD, USA,Daniel M. Sciubba, Department of Neurosurgery, The Johns Hopkins Hospital, 600 North Wolfe Street, Meyer 5-185, Baltimore, MD 21287, USA.
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The impact of dietary regimen compliance on outcomes for HNSCC patients treated with radiation therapy. Support Care Cancer 2018; 26:3307-3313. [PMID: 29671062 DOI: 10.1007/s00520-018-4198-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 04/09/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To analyze nutritional factors and compliance with dietary recommendations for associations with overall survival (OS) and progression-free survival (PFS) in patients receiving definitive RT for laryngeal and oropharyngeal cancers. MATERIALS/METHODS We identified 352 patients with non-metastatic laryngeal (146) and oropharyngeal (206) cancer treated with definitive RT between 2004 and 2013. Disease and patient characteristics, treatment information, sarcopenia based on muscle areas at L3 level on CT, compliance with the nutritional program, and clinical outcomes data were tabulated. Descriptive statistics, Kaplan-Meier survival analysis, and log rank tests were performed, and Cox regression models were used to examine predictors of OS and PFS. RESULTS The median follow-up for the entire cohort was 22.86 months. The actuarial rates for OS were 91, 86, and 73% at years 1, 2, and 5, respectively. Of patients with abdominal CT prior to starting RT, 70.9% (112/158) were sarcopenic with a median muscle mass index of 48.2 (range 30.4-70.9) for males and 35.9 (range 24.6-53.2) for females. The majority (85.8%) of patients met with a dietitian during their course of RT and 62.6% of these patients were compliant with the nutritional program. Compliance with the nutritional program resulted in 27% (HR 0.73, 95% CI 0.43-1.26) protection from death (did not reach significance) and 31% (HR 0.69, 95% CI 0.50-0.94) significant protection from disease progression. Higher pretreatment BMI was associated with a lower risk of death (HR 0.94, 95% CI 0.90-0.99) and disease progression (HR 0.96, 95% CI 0.93-0.99). CONCLUSION Laryngeal and oropharyngeal cancer patients treated with definitive RT who are compliant with regular dietetic counseling and contact appear to have improved outcomes. TRIAL REGISTRATION Not applicable.
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Lin MC, Shueng PW, Chang WK, Mu-Hsin Chang P, Feng HC, Yang MH, Lou PJ. Consensus and clinical recommendations for nutritional intervention for head and neck cancer patients undergoing chemoradiotherapy in Taiwan. Oral Oncol 2018; 81:16-21. [PMID: 29884409 DOI: 10.1016/j.oraloncology.2018.03.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 03/25/2018] [Accepted: 03/26/2018] [Indexed: 01/10/2023]
Abstract
Because of the anatomical location, patients with head and neck cancer (HNC) frequently experience dysphagia and malnutrition at the time of diagnosis and these conditions are often exacerbated after chemoradiotherapy. There is an emerging medical need to establish a consensus on nutritional intervention for these patients. A panel of 30 senior physicians and experts from multidisciplinary teams drafted clinical recommendations to improve the management of nutritional interventions in Taiwan and to provide updated treatment strategy recommendations in hope of improving the nutritional status of patients with HNC. This clinical review describes the resulting consensus document, including the impact of malnutrition on clinical outcomes, the role of prophylactic tube feeding, the choice of tube feeding, and the benefit of oral nutritional supplements in patients with HNC undergoing chemoradiotherapy. The outcomes of this review will support clinicians in their efforts to improve the nutritional status of patients with HNC.
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Affiliation(s)
- Mei-Chun Lin
- Department of Otolaryngology, National Taiwan University Hsin-Chu Branch, Hsin-Chu City, Taiwan
| | - Pei-Wei Shueng
- Division of Radiation Oncology, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Peter Mu-Hsin Chang
- Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsin-Chun Feng
- Department of Dietetics and Nutrition, National Taiwan University Hospital, Taipei, Taiwan
| | - Muh-Hwa Yang
- Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Pei-Jen Lou
- Department of Otolaryngology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
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Shamim F, Rashid S, Khan M, Khan R. Palliative surgical gastrostomy under ultrasound-guided bilateral rectus sheath blocks in a head and neck cancer patient. Saudi J Anaesth 2018; 12:371-373. [PMID: 29628869 PMCID: PMC5875247 DOI: 10.4103/sja.sja_770_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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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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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: 1.3] [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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Nesemeier R, Dunlap N, McClave SA, Tennant P. Evidence-Based Support for Nutrition Therapy in Head and Neck Cancer. CURRENT SURGERY REPORTS 2017; 5:18. [PMID: 32288971 PMCID: PMC7102400 DOI: 10.1007/s40137-017-0179-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW Patients diagnosed with head and neck (H&N) cancer often present in a malnourished state for varied reasons; nutritional optimization is therefore critical to the success of treatment for these complex patients. This article aims to review the current nutrition literature pertaining to H&N cancer patients and to present evidence-based strategies for nutritional support specific to this population. RECENT FINDINGS Aggressive nutritional intervention is frequently required in the H&N cancer patient population. Rehabilitating nutrition during operative and nonoperative treatment improves compliance with treatment, quality of life, and clinical outcomes. When and whether to establishing alternative enteral access are points of controversy, although recent evidence suggests prophylactic enteral feeding tube placement should not be universally applied. Perioperative nutritional optimization including preoperative carbohydrate loading and provision of arginine-supplemented immunonutrition has been shown to benefit at-risk H&N cancer patients. SUMMARY With multidisciplinary collaboration, H&N cancer patients can receive individualized nutritional support to withstand difficult cancer treatment regimens and return to acceptable states of nutritional health.
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Affiliation(s)
- Ryan Nesemeier
- Department of Otolaryngology-Head and Neck Surgery, University of Louisville, 529 S Jackson St., 3rd Floor, Louisville, KY 40202 USA
| | - Neal Dunlap
- Department of Radiation Oncology, University of Louisville, Louisville, KY USA
| | - Stephen A. McClave
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville School of Medicine, University of Louisville, Louisville, KY USA
| | - Paul Tennant
- Department of Otolaryngology-Head and Neck Surgery, University of Louisville, 529 S Jackson St., 3rd Floor, Louisville, KY 40202 USA
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Randomised controlled trial of early prophylactic feeding vs standard care in patients with head and neck cancer. Br J Cancer 2017; 117:15-24. [PMID: 28535154 PMCID: PMC5520203 DOI: 10.1038/bjc.2017.138] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 04/21/2017] [Accepted: 04/24/2017] [Indexed: 02/08/2023] Open
Abstract
Background: Weight loss remains significant in patients with head and neck cancer, despite prophylactic gastrostomy and intensive dietary counseling. The aim of this study was to improve outcomes utilising an early nutrition intervention. Methods: Patients with head and neck cancer at a tertiary hospital in Australia referred for prophylactic gastrostomy prior to curative intent treatment were eligible for this single centre randomised controlled trial. Exclusions included severe malnutrition or dysphagia. Patients were assigned following computer-generated randomisation sequence with allocation concealment to either intervention or standard care. The intervention group commenced supplementary tube feeding immediately following tube placement. Primary outcome measure was percentage weight loss at three months post treatment. Results: Recruitment completed June 2015 with 70 patients randomised to standard care (66 complete cases) and 61 to intervention (56 complete cases). Following intention-to-treat analysis, linear regression found no effect of the intervention on weight loss (10.9±6.6% standard care vs 10.8±5.6% intervention, P=0.930) and this remained non-significant on multivariable analysis (P=0.624). No other differences were found for quality of life or clinical outcomes. No serious adverse events were reported. Conclusions: The early intervention did not improve outcomes, but poor adherence to nutrition recommendations impacted on potential outcomes.
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Lawson N, Krisciunas GP, Langmore SE, Castellano K, Sokoloff W, Hayatbakhsh R. Comparing dysphagia therapy in head and neck cancer patients in Australia with international healthcare systems. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2017; 19:128-138. [PMID: 27093099 DOI: 10.3109/17549507.2016.1159334] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 02/24/2016] [Indexed: 06/05/2023]
Abstract
PURPOSE The Australian healthcare system has invested heavily in multidisciplinary cancer care teams. Despite such investments, guidelines that clearly delineate standard of care dysphagia treatment are lacking and services provided to Head and Neck Cancer (HNC) patients are not always consistent. There is little consensus regarding the frequency and intensity of dysphagia therapy. This is largely due to a lack of well-designed clinical trials that establish the efficacy of any dysphagia therapy in this patient population. The aim of this study was to evaluate HNC dysphagia therapy patterns among Australian speech-language pathologists (SLPs). METHOD A 22 question internet-based survey was administered to a web-based professional interest group. Results were analysed by institution type and individual clinical experience. RESULT A response rate of 46% was achieved (67 out of 144 surveyed). This survey identified several aspects of dysphagia management that were provided uniformly in addition to many aspects of care that showed a lack of consensus. CONCLUSION By comparing the results of this survey with existing international best-evidence treatment guidelines, the development of uniform Australian guidelines may be facilitated. However, more authoritative data on dysphagia treatment efficacy is needed to provide uniform evidence-based HNC dysphagia treatment guidelines.
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Affiliation(s)
- Nadine Lawson
- a Princess Alexandra Hospital - Speech Pathology , Woolloongabba , Queensland , Australia
| | | | - Susan E Langmore
- b Boston University Medical Centre - Otolaryngology , Boston , MA , USA
- c Boston University - Speech Language Hearing Science , Boston , MA , USA , and
| | - Kerlly Castellano
- b Boston University Medical Centre - Otolaryngology , Boston , MA , USA
| | - William Sokoloff
- b Boston University Medical Centre - Otolaryngology , Boston , MA , USA
| | - Reza Hayatbakhsh
- d University of Queensland - School of Population Health, University of Queensland , Herston , Queensland , Australia
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Abstract
Malnutrition can adversely affect physical and psychological function, influencing both morbidity and mortality. Despite the prevalence of malnutrition and its associated health and economic costs, malnutrition remains under-detected and under-treated in differing healthcare settings. For a subgroup of malnourished individuals, a gastrostomy (a feeding tube placed directly into the stomach) may be required to provide long-term nutritional support. In this review we explore the spectrum and consequences of malnutrition in differing healthcare settings. We then specifically review gastrostomies as a method of providing nutritional support. The review highlights the origins of gastrostomies, and discusses how endoscopic and radiological advances have culminated in an increased demand and placement of gastrostomy feeding tubes. Several studies have raised concerns about the benefits derived following this intervention and also about the patients selected to undergo this procedure. These studies are discussed in detail in this review, alongside suggestions for future research to help better delineate those who will benefit most from this intervention, and improve understanding about how gastrostomies influence nutritional outcomes.
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Fang CY, Heckman CJ. Informational and Support Needs of Patients with Head and Neck Cancer: Current Status and Emerging Issues. CANCERS OF THE HEAD & NECK 2016; 1. [PMID: 28670482 PMCID: PMC5488795 DOI: 10.1186/s41199-016-0017-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The objective of this article is to review and summarize the extant literature on head and neck cancer (HNC) patients’ informational needs and to characterize emerging issues in this patient population in order to define priorities for future research. HNC patients may undergo challenging treatment regimens and experience treatment-related alterations in primary daily functions such as speech and eating. These changes often persist following treatment and may lead to significant deficits in quality of life and interpersonal relations. Despite empirical evidence demonstrating that receipt of adequate information and support is predictive of improved outcomes post-treatment, relatively limited attention has been paid to the informational and support needs of HNC patients. This review focuses primarily on three topic domains: (1) managing treatment-related side effects; (2) addressing alcohol and tobacco dependence; and (3) informational needs in the areas of human papillomavirus (HPV) and clinical trials. While there is increasing awareness of the rehabilitation and survivorship needs in this patient population, patients note that the impact of treatment on social activities and interactions is under-discussed and of key concern. In addition, there is a significant gap in addressing communication and informational needs of caregivers and family members who are integral for promoting healthy behaviors and self-care post-treatment. Greater integration of programs that address tobacco or alcohol dependency within a comprehensive treatment and support plan may increase patient motivation to seek help and enhance patient success in maintaining long-term abstinence. Finally, emerging patient-provider communication needs, particularly in the context of decision making about clinical trials or surrounding an HPV-related diagnosis, have been noted among both patients and healthcare providers. Future research on the development of novel programs that offer feasible and acceptable methods for addressing unmet informational and support needs is warranted and may yield benefit for improving patient-reported outcomes.
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Affiliation(s)
- Carolyn Y Fang
- Fox Chase Cancer Center, 333 Cottman Ave., Philadelphia, PA
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Władysiuk MS, Mlak R, Morshed K, Surtel W, Brzozowska A, Małecka-Massalska T. Bioelectrical impedance phase angle as a prognostic indicator of survival in head-and-neck cancer. ACTA ACUST UNITED AC 2016; 23:e481-e487. [PMID: 27803609 DOI: 10.3747/co.23.3181] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Phase angle could be an alternative to subjective global assessment for the assessment of nutrition status in patients with head-and-neck cancer. METHODS We prospectively evaluated a cohort of 75 stage iiib and iv head-and-neck patients treated at the Otolaryngology Department, Head and Neck Surgery, Medical University of Lublin, Poland. Bioelectrical impedance analysis was performed in all patients using an analyzer that operated at 50 kHz. The phase angle was calculated as reactance divided by resistance (Xc/R) and expressed in degrees. The Kaplan-Meier method was used to calculate survival. RESULTS Median overall survival in the cohort was 32.0 months. At the time of analysis, 47 deaths had been recorded in the cohort (62.7%). The risk of shortened overall survival was significantly higher in patients whose phase angle was less than 4.733 degrees than in the remaining patients (19.6 months vs. 45 months, p = 0.0489; chi-square: 3.88; hazard ratio: 1.8856; 95% confidence interval: 1.0031 to 3.5446). CONCLUSIONS Phase angle might be prognostic of survival in patients with advanced head-and-neck cancer. Further investigation in a larger population is required to confirm our results.
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Affiliation(s)
- M S Władysiuk
- HTA Consulting, Cracow, Medical University of Lublin, Lublin, Poland
| | - R Mlak
- Human Physiology Department, Medical University of Lublin, Lublin, Poland
| | - K Morshed
- Epidemiology Department, Medical University of Lublin, Poland
| | - W Surtel
- Electronics Department, Lublin University of Technology, Lublin, Poland
| | - A Brzozowska
- Oncology Department, Medical University of Lublin, Lublin, Poland
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Lim JH, Choi SH, Lee C, Seo JY, Kang HY, Yang JI, Chung SJ, Kim JS. Thirty-day mortality after percutaneous gastrostomy by endoscopic versus radiologic placement: a systematic review and meta-analysis. Intest Res 2016; 14:333-342. [PMID: 27799884 PMCID: PMC5083262 DOI: 10.5217/ir.2016.14.4.333] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 02/10/2016] [Accepted: 02/22/2016] [Indexed: 02/07/2023] Open
Abstract
Background/Aims A percutaneous gastrostomy can be placed either endoscopically (percutaneous endoscopic gastrostomy, PEG) or radiologically (radiologically-inserted gastrostomy, RIG). However, there is no consistent evidence of the safety and efficacy of PEG compared to RIG. Recently, 30-day mortality has become considered as the most important surrogate index for evaluating the safety and efficacy of percutaneous gastrostomy. The aim of this meta-analysis was to compare the 30-day mortality rates between PEG and RIG. Methods Major electronic databases (MEDLINE, Embase, Scopus, and Cochrane library) were queried for comparative studies on the two insertion techniques of gastrostomy among adults with swallowing disturbance. The primary outcome was the 30-day mortality rate after gastrostomy insertion. Forest and funnel plots were generated for outcomes using STATA version 14.0. Results Fifteen studies (n=2,183) met the inclusion criteria. PEG was associated with a lower risk of 30-day mortality after tube placement compared with RIG (odds ratio, 0.60; 95% confidence interval [CI], 0.38–0.94; P=0.026). The pooled prevalence of 30-day mortality of PEG was 5.5% (95% CI, 4.0%–6.9%) and that of RIG was 10.5% (95% CI, 6.8%–14.3%). No publication bias was noted. Conclusions The present meta-analysis demonstrated that PEG is associated with a lower probability of 30-day mortality compared to RIG, suggesting that PEG should be considered as the first choice for long-term enteral tube feeding. Further prospective randomized studies are needed to evaluate and compare the safety of these two different methods of gastrostomy.
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Affiliation(s)
- Joo Hyun Lim
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Seung Ho Choi
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Changhyun Lee
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Ji Yeon Seo
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Hae Yeon Kang
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Jong In Yang
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Su Jin Chung
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Joo Sung Kim
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
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Predictive Factors for Prophylactic Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement and Use in Head and Neck Patients Following Intensity-Modulated Radiation Therapy (IMRT) Treatment: Concordance, Discrepancies, and the Role of Gabapentin. Dysphagia 2016; 31:206-13. [PMID: 26753929 DOI: 10.1007/s00455-015-9679-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 12/09/2015] [Indexed: 10/22/2022]
Abstract
The prophylactic placement of a percutaneous endoscopic gastrostomy (PEG) tube in the head and neck cancer (HNC) patient is controversial. We sought to identify factors associated with prophylactic PEG placement and actual PEG use. Since 2010, data regarding PEG placement and use were prospectively recorded in a departmental database from January 2010 to December 2012. HNC patients treated with intensity-modulated radiation therapy (IMRT) were retrospectively evaluated from 2010 to 2012. Variables potentially associated with patient post-radiation dysphagia from previous literature, and our experience was evaluated. We performed multivariate logistic regression on these variables with PEG placement and PEG use, respectively, to compare the difference of association between the two arms. We identified 192 HNC patients treated with IMRT. Prophylactic PEG placement occurred in 121 (63.0 %) patients, with PEG use in 97 (80.2 %) patients. PEG placement was associated with male gender (p < .01), N stage ≥ N2 (p < .05), pretreatment swallowing difficulties (p < .01), concurrent chemotherapy (p < .01), pretreatment KPS ≥80 (p = .01), and previous surgery (p = .02). Concurrent chemotherapy (p = .03) was positively associated with the use of PEG feeding by the patient, whereas pretreatment KPS ≥80 (p = .03) and prophylactic gabapentin use (p < .01) were negatively associated with PEG use. The analysis suggests there were discrepancies between prophylactic PEG tube placement and actual use. Favorable pretreatment KPS, no pretreatment dysphagia, no concurrent chemotherapy, and the use of gabapentin were significantly associated with reduced PEG use. This analysis may help refine the indications for prophylactic PEG placement.
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Dysphagia and Head and Neck Cancer. Dysphagia 2016. [DOI: 10.1016/b978-0-323-18701-5.00004-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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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: 1.9] [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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Anker SD, Morley JE. Cachexia: a nutritional syndrome? J Cachexia Sarcopenia Muscle 2015; 6:269-71. [PMID: 26675043 PMCID: PMC4670732 DOI: 10.1002/jcsm.12088] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 10/02/2015] [Indexed: 12/16/2022] Open
Abstract
Cachexia leads to nutritional deficits including anorexia and loss of fat and muscle mass. In persons with precachexia or early cachexia, for example, old persons with weight loss and chronic obstructive pulmonary disease, there is strong evidence that nutritional support improves outcomes. Limited evidence suggests that this may be true for heart failure and chronic kidney disease. The evidence for nutritional support in refractory cachexia is, not surprisingly, less dramatic. It would appear that early in the cachectic process, nutrition, coupled with exercise, may be an important therapeutic approach.
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Affiliation(s)
- Stefan D Anker
- Applied Cachexia Research, Department of Cardiology, Charité Medical School Campus Virchow-Klinikum, Berlin, Germany ; Department of Innovative Clinical Trials, University Medical Centre Göttingen Göttingen, Germany
| | - John E Morley
- Divisions of Geriatric Medicine and Endocrinology, Saint Louis University School of Medicine St. Louis, MO, USA
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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: 5] [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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