The use of prophylactic percutaneous endoscopic gastrostomy and early enteral feeding in patients with advanced head and neck cancer-A prospective longitudinal study

Reducing outpatient gastrostomy tube complications

OBJECTIVE

To monitor the effectiveness of a multidisciplinary education protocol for gastrostomy tube (GT) use and care for patients to reduce complications postplacement.

METHODS

Baseline assessment included a preintervention/intervention design through quantitative measures to determine reduction in the number of GT complications postprocedure following implementation of a patient education protocol for 16 patients in the study.

INTERVENTION

A multidisciplinary approach was used in protocol development for standardizing patient education. Verbal, written, and hands-on demonstration methods for GT care were used to provide multiple education pathways to increase patient knowledge. Over the progression of 8 months (July 2019 to March 2020), patients with a new GT were followed postprocedure (1-2 weeks prior to starting radiation treatments) and throughout their course of radiation treatments (typically 6-7 weeks).

RESULTS

All 16 patients (100%) in the intervention group were included in the final analysis. GT complications were reduced from 91% in the preintervention group (n = 11) to 37% in the intervention group (n = 16). The most significant reduction occurred in technique issues, which decreased from 36% (n = 4) to 0%.

CONCLUSIONS

Implementation of a multidisciplinary approach with multiple educational sessions prior to GT placement and use led to increased patient knowledge and reduced GT complications.

Bioelectrical phase angle at diagnosis as a prognostic factor for survival in advanced head and neck cancer

Objective

Bioelectrical impedance analysis (BIA) is used to measure the patient’s body composition, fat-free mass, phase angle (PA), and standardized phase angle (SPA), which are affected by malnutrition. Low values of PA and SPA have been found to be negative prognostic factors for survival in different types of cancer and other severe diseases. The aim of the current study was to investigate whether PA and SPA can be used to predict survival in head and neck (HN) cancer.

Methods

One hundred twenty-eight patients with advanced HN cancer treated in Western Sweden 2002–2006 were examined with BIA at diagnosis, and PA and SPA were calculated. Patients’ age, gender, tumor site, TNM stage, and performance status were obtained, and weight, height, and BIA were measured. Survival up to 12 years was ascertained.

Results

The mean PA was 5.85° and the median was 5.91°. Lower PA and SPA values were significantly associated with shorter overall survival in univariate analyses, together with higher age, oral cancer, higher T class, worse performance status, more weight loss before diagnosis, lower: weight, height, BMI, and reactance. Age, performance status, T class, and PA were significant factors for the overall survival in the multivariable analysis. A PA cutoff value at 5.95° provided the best prediction of 5-year survival.

Conclusions

PA and SPA at diagnosis are significant factors for survival in patients with advanced HN cancer. They are promising prognostic tools to use in treatment planning; further studies are needed.

An exploration of factors predicting malnutrition in patients with advanced head and neck cancer

OBJECTIVES/HYPOTHESIS

Malnutrition is common among head and neck cancer patients and negatively impacts on survival and quality of life. This study aimed to identify predictors of malnutrition at time of diagnosis in order to identify patients at risk and enable early nutritional support and prevent malnutrition.

MATERIALS AND METHOD

A total of 134 patients with advanced oral and pharyngeal cancer were included in the study. Weight, body mass index (BMI), fat free mass (FFM), dysphagia, and quality of life were measured at diagnosis and after 6 months. Two definitions for malnutrition were applied: >10% weight loss and BMI <20 after 6 months.

RESULTS

Six months after diagnosis, 66% of the patients were malnourished as per the >10% weight loss definition, and 26% of the patients were malnourished as per the BMI < 20 weight loss definition. In multivariate analysis, low BMI followed by low FFM and dysphagia were the strongest predictors for malnutrition using BMI <20. Chemotherapy and high BMI at diagnosis were the strongest predictors of malnutrition using the 10% weight loss definition. For patients treated with chemotherapy, the risk for malnutrition was very high both for patients with normal BMI (67%) and for patients with BMI 30 (89%).

CONCLUSION

Unintended weight loss more than 10% seems to be the most reasonable definition of malnutrition for identifying predictors of this in head and neck cancer patients. The weight loss correlated significantly to a loss of FFM. Treatment with chemotherapy was a strong predictor, as was a high BMI at time of diagnosis. This is an important finding since overweight patients might not be considered at high risk for developing malnutrition, and consequently nutritional support for them might be delayed.