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Santo B, Bertini N, Cattaneo CG, De Matteis S, De Franco P, Grassi R, Iorio GC, Longo S, Boldrini L, Piras A, Desideri I, De Felice F, Salvestrini V. Nutritional counselling for head and neck cancer patients treated with (chemo)radiation therapy: why, how, when, and what? Front Oncol 2024; 13:1240913. [PMID: 38264757 PMCID: PMC10803628 DOI: 10.3389/fonc.2023.1240913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 12/14/2023] [Indexed: 01/25/2024] Open
Affiliation(s)
- Bianca Santo
- Radiation Oncology Unit, Dipartimento di Oncoematologia, Ospedale “Vito Fazzi”, Lecce, Italy
| | - Niccolò Bertini
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Carlo Guglielmo Cattaneo
- Department of Radiotherapy, Policlinico Umberto I, Department of Radiological, Oncological and Pathological Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Sara De Matteis
- Radiation Oncology Unit, Dipartimento di Oncoematologia, Ospedale “Vito Fazzi”, Lecce, Italy
| | - Paola De Franco
- Radiation Oncology Unit, Dipartimento di Oncoematologia, Ospedale “Vito Fazzi”, Lecce, Italy
| | - Roberta Grassi
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, Naples, Italy
| | | | - Silvia Longo
- Unità Operativa Complessa (UOC) Radioterapia Oncologica, Fondazione Policlinico Universitario Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) “A. Gemelli”, Roma, Italy
| | - Luca Boldrini
- Unità Operativa Complessa (UOC) Radioterapia Oncologica, Fondazione Policlinico Universitario Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) “A. Gemelli”, Roma, Italy
| | - Antonio Piras
- Unità Operativa (UO) Radioterapia Oncologica, Villa Santa Teresa, Palermo, Italy
- Department of Biomedical Image Processing and Analysis, Ri.Med Foundation, Palermo, Italy
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Molecular and Clinical Medicine, University of Palermo, Palermo, Italy
| | - Isacco Desideri
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Francesca De Felice
- Department of Radiotherapy, Policlinico Umberto I, Department of Radiological, Oncological and Pathological Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Viola Salvestrini
- Radiation Oncology Unit, Centro Cyberknife, Istituto Fiorentino di Cura e Assistenza, Florence, Italy
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Sampieri C, Costantino A, Giordano GG, Dalè M, Marchi F, Iandelli A, Filauro M, Parrinello G, Pace GM, Festa BM, Spriano G, De Virgilio A, Peretti G. Predicting the need for prophylactic gastrostomy in major head and neck cancer surgery: The PEG score. Head Neck 2023; 45:3042-3052. [PMID: 37789705 DOI: 10.1002/hed.27532] [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: 05/30/2023] [Revised: 09/03/2023] [Accepted: 09/19/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND To elaborate a preoperative score to predict the necessity of enteral nutrition at 28 days postoperatively in patients undergoing head and neck surgery. METHODS A total of 424 patients with oral cavity, oropharyngeal, laryngeal, and hypopharyngeal carcinoma were retrospectively enrolled and analyzed to identify preoperative predictors of prolonged postsurgical enteral feeding which were used to create a prediction model with an easy-to-use nomogram. RESULTS Five preoperative variables (body mass index, previous radiotherapy, preoperative dysphagia, type of surgery, flap reconstruction) were found to be independent predictive factors and were used to create a prediction model named PEG score together with the related nomogram. Accuracy, F1, and the area under the curve (AUC) were 0.74, 0.83, and 0.74. Different decision thresholds can be used to vary the sensitivity and specificity. CONCLUSIONS The PEG score showed high prediction performances for modeling the need for enteral nutrition at 28 days postoperatively. Prospective studies are needed to define a personalized nutrition protocol.
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Affiliation(s)
- Claudio Sampieri
- Department of Medical Science (DIMES), University of Genoa, Genoa, Italy
- Otorhinolaryngology Department, Hospital Clínic, Barcelona, Spain
- Functional Unit of Head and Neck Tumors, Hospital Clínic, Barcelona, Spain
| | - Andrea Costantino
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Giorgio Gregory Giordano
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Michael Dalè
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Filippo Marchi
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea Iandelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Marta Filauro
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giampiero Parrinello
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Gian Marco Pace
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Bianca Maria Festa
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Giuseppe Spriano
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Armando De Virgilio
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Giorgio Peretti
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
- Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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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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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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Mellors K, Ye X, Van Den Brande J, Wai Ray Mak T, Brown T, Findlay M, Bauer J. Comparison of prophylactic percutaneous endoscopic gastrostomy with reactive enteral nutrition in patients with head and neck cancer undergoing radiotherapy or chemoradiotherapy: A systematic review. Clin Nutr ESPEN 2021; 46:87-98. [PMID: 34857252 DOI: 10.1016/j.clnesp.2021.09.724] [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: 04/05/2021] [Revised: 08/21/2021] [Accepted: 09/11/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND & AIMS Nutrition support is frequently indicated in patients with head and neck cancer (HNC). However, the optimal timing of enteral tube placement and feeding commencement is unknown. This review aims to compare the outcomes for patients with HNC undergoing curative intent radiotherapy (RT) or chemoradiotherapy (CRT) receiving either prophylactic percutaneous endoscopic gastrostomy (pPEG) tube placement/feeding or reactive enteral nutrition (rEN). METHODS A literature search was conducted in March 2020 across PubMed, CINAHL, Embase, Web of Science, and Scopus. Randomized controlled trials (RCTs) of patients (≥18 years) with HNC who had received either pPEG or rEN were included. Outcomes examined were weight change, nutritional status, body mass index, treatment interruptions, quality of life (QoL), disease-free survival and overall survival. Study quality and certainty of evidence were assessed using the Cochrane Risk-of-bias Tool for Randomized Trials Version 2 and the Grading of Recommendations Assessment, Development and Evaluation system, respectively. RESULTS Five studies (three RCTs) (n = 298) were included and definitions of pPEG and rEN were heterogenous. pPEG was associated with a clinically important reduction in short-term critical weight loss (>10% weight loss), and significantly improved short-term QoL in patients with HNC. The timing of nutrition support commencement had no effect on all other outcomes. The overall certainty of evidence was 'moderate' for: nutritional status; treatment interruptions; short-term QoL; disease-free survival; and 'low' for all other outcomes. CONCLUSIONS Patients with HNC undergoing RT or CRT receiving pPEG tube feeding/placement were less likely to experience short-term critical weight loss and have improved short-term QoL compared to rEN. Further well-designed RCTs with consistent definitions of tube feeding protocols and the use of validated tools to evaluate nutritional status, will assist to increase the certainty of evidence and confirm the beneficial effects observed.
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Affiliation(s)
- Kate Mellors
- School of Human Movement and Nutrition Sciences, University of Queensland, Queensland, Australia.
| | - Xiaodan Ye
- School of Human Movement and Nutrition Sciences, University of Queensland, Queensland, Australia.
| | - Jonathan Van Den Brande
- School of Human Movement and Nutrition Sciences, University of Queensland, Queensland, Australia.
| | - Tsz Wai Ray Mak
- School of Human Movement and Nutrition Sciences, University of Queensland, Queensland, Australia.
| | - Teresa Brown
- School of Human Movement and Nutrition Sciences, University of Queensland, Queensland, Australia; Nutrition & Dietetics, Royal Brisbane & Women's Hospital, Queensland, Australia.
| | - Merran Findlay
- Cancer Services, Royal Prince Alfred Hospital, New South Wales, Australia; Chris O'Brien Lifehouse, New South Wales, Australia.
| | - Judy Bauer
- School of Human Movement and Nutrition Sciences, University of Queensland, Queensland, Australia.
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Ferro A, Basyuni S, Bosley R, Santhanam V. A predictive model for swallowing dysfunction after oral cancer resection. Br J Oral Maxillofac Surg 2021; 59:1043-1049. [PMID: 34563355 DOI: 10.1016/j.bjoms.2021.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/22/2021] [Indexed: 12/24/2022]
Abstract
Aggressive therapy of oral cancers is associated with significant postoperative morbidity. Patients with feeding issues may require nutritional support. In our unit, patients identified as developing feeding issues are reactively referred for specialist input through a feeding issues multidisciplinary team meeting (FiMDT). Reactive feeding increases length of patient stay (LOS) and may contribute to patient morbidity. We aimed to develop a model to pre-emptively identify patients likely to develop feeding issues postoperatively, to facilitate the establishment of a preoperative referral pathway to increase patient flow. All referrals to a Head and Neck multidisciplinary team meeting over a five-year period were identified and preoperative factors were extracted. Linear regression was used to confirm that FiMDT was an independent predictor of LOS. Logistic regression was used to determine if referral to FiMDT could be predicted based on preoperative factors only. A total of 203 patients met inclusion criteria for analysis. Inpatient referral to FiMDT was an independent predictor of LOS. Significant predictors of inpatient FiMDT referral included tracheostomy, patient age, and alcohol intake. The resulting model was 90% sensitive and 93.8% specific with a threshold of 0.2. We have shown that inpatient FiMDT referral is an independent predictor of patient length of stay, and that the odds of referral can be robustly predicted. We aim to use this model in redirecting emphasis to a preoperative referral pathway for improved patient flow.
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Affiliation(s)
- A Ferro
- Department of Oral and Maxillofacial Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, United Kingdom.
| | - S Basyuni
- Department of Oral and Maxillofacial Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - R Bosley
- Department of Oral and Maxillofacial Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - V Santhanam
- Department of Oral and Maxillofacial Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, United Kingdom
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Ye X, Chang YC, Findlay M, Brown T, Bauer J. The effect of timing of enteral nutrition support on feeding outcomes and dysphagia in patients with head and neck cancer undergoing radiotherapy or chemoradiotherapy: A systematic review. Clin Nutr ESPEN 2021; 44:96-104. [PMID: 34330518 DOI: 10.1016/j.clnesp.2021.05.017] [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: 01/13/2021] [Revised: 05/11/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND & AIMS Patients with head and neck cancer (HNC) often require enteral nutrition (EN). This systematic review reports the effect of EN timing in patients with HNC undergoing curative-intent and definitive or adjuvant radiotherapy or chemoradiotherapy on tube feeding duration, tube-related complications and dysphagia. METHODS Randomised controlled trials (RCTs) published between January 2015-April 2020 were obtained from Medline, CINAHL and Embase. Study quality and certainty of evidence were assessed with Cochrane Risk-of-Bias and Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS Two RCTs (n = 265) in five manuscripts were included. The risk of bias was moderate in one RCT and low in the other RCT. Timing of EN (prophylactic vs. reactive) may have little or no effect on tube feeding duration or complications, however, the effect on dysphagia was uncertain. Certainty of evidence was low for short-term and moderate for long-term tube feeding duration, low for tube-related complications and very low for dysphagia. There was imprecision due to small sample sizes, heterogeneity in the definitions and protocols for prophylactic and reactive EN, variations in time points for outcome assessment and indirect dysphagia measures. CONCLUSION Larger well-designed trials are warranted to increase certainty of evidence regarding EN timing in patients with HNC.
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Affiliation(s)
- Xiaodan Ye
- School of Human Movement and Nutrition Sciences, University of Queensland, Queensland, Australia.
| | - Yuan-Chin Chang
- School of Human Movement and Nutrition Sciences, University of Queensland, Queensland, Australia.
| | - Merran Findlay
- Cancer Services, Royal Prince Alfred Hospital, New South Wales, Australia; Chris O'Brien Lifehouse, New South Wales, Australia.
| | - Teresa Brown
- School of Human Movement and Nutrition Sciences, University of Queensland, Queensland, Australia; Nutrition & Dietetics, Royal Brisbane & Women's Hospital, Queensland, Australia.
| | - Judy Bauer
- School of Human Movement and Nutrition Sciences, University of Queensland, Queensland, Australia.
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Vangelov B, Kotevski DP, Smee RI. The Impact of Critical Weight Loss and Reactive Feeding Tubes on Cancer-Specific Survival in Head and Neck Cancer. Nutr Cancer 2020; 73:262-272. [PMID: 32281392 DOI: 10.1080/01635581.2020.1750660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Critical weight loss (CWL) continues to be a major issue in head and neck cancer (HNC) and many patients require tube feeding. We investigated the use of reactive feeding tubes (RFTs), associated CWL, and the impact on cancer-specific survival (CSS). A single-institution, retrospective audit was conducted on 460 adult HNC patients who received radiotherapy ± chemotherapy between 2005 and 2017. CSS in patients with CWL and RFTs was compared to those with no tube. Prediction analysis for RFT insertion was also performed. CWL occurred in 53% of patients, and in 88% of those with a RFT (p < 0.001). In patients with CWL, those with a RFT had worse 5 and 10-year CSS compared to those with no tube (68% and 65% vs 83% and 80% respectively, p = 0.040) in multivariate Cox regression analysis. Concurrent chemoradiotherapy combined with CWL was the strongest predictor for RFT insertion (p = 0.003). CWL, combined with having a RFT, impacts negatively on CSS. CWL may be one of the triggers for RFT insertion, however those with no tube have better CSS. This may be due to higher weight loss levels seen in those who have a RFT, and earlier insertion to prevent such losses seems indicated.
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Affiliation(s)
- Belinda Vangelov
- Department of Radiation Oncology, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital and Community Health Service, Randwick, New South Wales, Australia
| | - Damian P Kotevski
- Department of Radiation Oncology, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital and Community Health Service, Randwick, New South Wales, Australia
| | - Robert I Smee
- Department of Radiation Oncology, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital and Community Health Service, Randwick, New South Wales, Australia.,Prince of Wales Clinical School, University of New South Wales, Randwick, New South Wales, Australia.,Department of Radiation Oncology, Tamworth Base Hospital, Tamworth, New South Wales, Australia
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Findlay M, Rankin NM, Bauer J, Collett G, Shaw T, White K. “Completely and utterly flummoxed and out of my depth”: patient and caregiver experiences during and after treatment for head and neck cancer—a qualitative evaluation of barriers and facilitators to best-practice nutrition care. Support Care Cancer 2020; 28:5771-5780. [DOI: 10.1007/s00520-020-05386-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/26/2020] [Indexed: 12/23/2022]
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10
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Hazzard E, Walton K, McMahon A, Milosavljevic M, Tapsell L. Healthcare Professionals’ Perceptions of Feeding Tube Practices for Patients With Head and Neck Cancer Across 4 International Radiation Oncology Departments. JPEN J Parenter Enteral Nutr 2019; 44:796-805. [DOI: 10.1002/jpen.1699] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/16/2019] [Accepted: 08/17/2019] [Indexed: 01/02/2023]
Affiliation(s)
- Emily Hazzard
- Wollongong HospitalIllawarra Shoalhaven Local Health District Wollongong New South Wales Australia
- School of MedicineUniversity of Wollongong Wollongong New South Wales Australia
| | - Karen Walton
- School of MedicineUniversity of Wollongong Wollongong New South Wales Australia
- Illawarra Health and Medical Research InstituteUniversity of Wollongong Wollongong New South Wales Australia
| | | | - Marianna Milosavljevic
- Wollongong HospitalIllawarra Shoalhaven Local Health District Wollongong New South Wales Australia
| | - Linda Tapsell
- School of MedicineUniversity of Wollongong Wollongong New South Wales Australia
- Illawarra Health and Medical Research InstituteUniversity of Wollongong Wollongong New South Wales Australia
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Abo Sharkh H, Madathil S, Al-Ghamdi O, Agnihotram RV, Sinha A, El-Hakim M, Nicolau B, Makhoul N. A Comprehensive Clinical Care Pathway for Microvascular Maxillofacial Reconstructive Surgery. J Oral Maxillofac Surg 2019; 77:2347-2354. [PMID: 31153941 DOI: 10.1016/j.joms.2019.04.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/26/2019] [Accepted: 04/27/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Clinical care pathways (CCPs) for major surgical procedures are less developed. We describe the development of a comprehensive microvascular maxillofacial reconstruction CCP and evaluate the impact. MATERIALS AND METHODS Our team developed a comprehensive CCP for patients undergoing microvascular free flap reconstruction for benign or malignant tumors. Patient data before (n = 48) and after (n = 47) implementation of the CCP were used to evaluate the impact. Bayesian negative binomial and logistic regression analyses were used to estimate the associations between the CCP and clinical outcomes (length of stay [LOS], readmission to the operating room, and readmission within 3 months of discharge). RESULTS The average total hospital LOS was high in the pre-CCP group (16.9 days) compared with the post-CCP group (9.8 days). Being in the post-CCP group reduced the LOS in the intensive care unit and surgical ward and reduced the risk of readmission to the operating room. CONCLUSION Our results underscore the importance of standardized evidence-based patient care through CCPs for complex patient populations.
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Affiliation(s)
- Haider Abo Sharkh
- Fellow in Maxillofacial Oncology and Microvascular Reconstruction, Department of Oral and Maxillofacial Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Sreenath Madathil
- Research Director, Department of Oral and Maxillofacial Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Osama Al-Ghamdi
- Previous Fellow in Maxillofacial Oncology and Microvascular Reconstruction, Department of Oral and Maxillofacial Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Ramanakumar V Agnihotram
- Adjunct Professor, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | - Avinash Sinha
- Assistant Professor, Department of Anesthesia, Montreal General Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Michel El-Hakim
- Assistant Professor, Department of Oral and Maxillofacial Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Belinda Nicolau
- Associate Professor, Division of Oral Health and Society, Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
| | - Nicholas Makhoul
- Director and Associate Professor, Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, McGill University, and Chief, Department of Dentistry and Oral and Maxillofacial Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
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Della Valle S, Colatruglio S, La Vela V, Tagliabue E, Mariani L, Gavazzi C. Nutritional intervention in head and neck cancer patients during chemo-radiotherapy. Nutrition 2018; 51-52:95-97. [DOI: 10.1016/j.nut.2017.12.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 11/06/2017] [Accepted: 12/17/2017] [Indexed: 11/28/2022]
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Brown T, Banks M, Hughes BG, Lin C, Kenny LM, Bauer JD. Impact of early prophylactic feeding on long term tube dependency outcomes in patients with head and neck cancer. Oral Oncol 2017; 72:17-25. [DOI: 10.1016/j.oraloncology.2017.06.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 06/24/2017] [Indexed: 12/28/2022]
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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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16
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Nutritional management in head and neck cancer: United Kingdom National Multidisciplinary Guidelines. The Journal of Laryngology & Otology 2017; 130:S32-S40. [PMID: 27841109 PMCID: PMC4873913 DOI: 10.1017/s0022215116000402] [Citation(s) in RCA: 159] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Nutritional support and intervention is an integral component of head and neck cancer management. Patients can be malnourished at presentation, and the majority of patients undergoing treatment for head and neck cancer will need nutritional support. This paper summarises aspects of nutritional considerations for this patient group and provides recommendations for the practising clinician.
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17
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Brown TE, Banks MD, Hughes BGM, Lin CY, Kenny LM, Bauer JD. Comparison of Nutritional and Clinical Outcomes in Patients with Head and Neck Cancer Undergoing Chemoradiotherapy Utilizing Prophylactic versus Reactive Nutrition Support Approaches. J Acad Nutr Diet 2016; 118:627-636. [PMID: 27986517 DOI: 10.1016/j.jand.2016.10.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 10/13/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND The optimal method of tube feeding for patients with head and neck cancer remains unclear. A validated protocol is available that identifies high-nutritional-risk patients who would benefit from prophylactic gastrostomy tube placement. Adherence to this protocol is ultimately determined by clinical team discretion or patient decision. OBJECTIVE The study aim was to compare outcomes after adherence and nonadherence to this validated protocol, thus comparing a prophylactic and reactive approach to nutrition support in this patient population. DESIGN We conducted a prospective comparative cohort study. Patients were observed during routine clinical practice over 2 years. PARTICIPANTS/SETTING Patients with head and neck cancer having curative-intent treatment between August 2012 and July 2014 at a tertiary hospital in Queensland, Australia, were included if assessed as high nutrition risk according to the validated protocol (n=130). Patients were grouped according to protocol adherence as to whether they received prophylactic gastrostomy (PEG) per protocol recommendation (prophylactic PEG group, n=69) or not (no PEG group, n=61). MAIN OUTCOME MEASURES Primary outcome was percentage weight change during treatment. Secondary outcomes were feeding tube use and hospital admissions. STATISTICAL ANALYSIS PERFORMED Fisher's exact, χ2, and two sample t tests were performed to determine differences between the groups. Linear and logistic regression were used to examine weight loss and unplanned admissions, respectively. RESULTS Patients were 88% male, median age was 59 years, with predominantly stage IV oropharyngeal cancer receiving definitive chemoradiotherapy. Statistically significantly less weight loss in the prophylactic PEG group (7.0% vs 9.0%; P=0.048) and more unplanned admissions in the no PEG group (82% vs 75%; P=0.029). In the no PEG group, 26 patients (43%) required a feeding tube or had ≥10% weight loss. CONCLUSIONS Prophylactic gastrostomy improved nutrition outcomes and reduced unplanned hospital admissions. Additional investigation of characteristics of patients with minimal weight loss or feeding tube use could help refine and improve the protocol.
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18
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Advances in understanding and improving gastrointestinal symptoms during supportive and palliative care: a decade of progress. Curr Opin Support Palliat Care 2016; 10:149-51. [PMID: 27054289 DOI: 10.1097/spc.0000000000000215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Squamous cell carcinoma of the lip: depth of invasion, local recurrence and regional metastases. Experience of a rural multidisciplinary head and neck unit. The Journal of Laryngology & Otology 2015; 130 Suppl 1:S32-7. [PMID: 26304159 DOI: 10.1017/s0022215115002212] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND The internationally recognised American Joint Committee on Cancer (tumour-node-metastasis) staging system utilises tumour size to determine stage. Other factors (i.e. tumour depth) may provide additional prognostic information. METHOD A thorough retrospective analysis was performed of 68 patients with primary lip squamous cell carcinoma operated on or discussed by the Darling Downs Health Service between 2005 and 2013. RESULTS Twelve patients developed lymphatic spread. There was a statistically significant increased risk of nodal metastasis in: patients with tumours of increased thickness (U = 103.50; degrees of freedom = 68; p < 0.001), those with a larger overall tumour size (U = 163.50; degrees of freedom = 68; p = 0.005) and patients living further from the treatment centre (U = 199.00; degrees of freedom = 68; p = 0.018). CONCLUSION It may be reasonable that other factors are considered for staging of lip squamous cell carcinomas, in combination with tumour-node-metastasis staging. Depth of invasion may have utility in prognosis and treatment; however, larger prospective analysis needs to be performed. Patients living in a more rural setting presented with more advanced disease, suggesting an ongoing rural-metropolitan gap in healthcare.
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20
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Brown TE, Crombie J, Spurgin AL, Tripcony L, Keller J, Hughes BGM, Dickie G, Kenny LM, Hodge RA. Improving guideline sensitivity and specificity for the identification of proactive gastrostomy placement in patients with head and neck cancer. Head Neck 2015; 38 Suppl 1:E1163-71. [DOI: 10.1002/hed.24184] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 03/02/2015] [Accepted: 07/03/2015] [Indexed: 01/28/2023] Open
Affiliation(s)
- Teresa E. Brown
- Department of Nutrition and Dietetics; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Jane Crombie
- Department of Speech Pathology; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Ann-Louise Spurgin
- Department of Speech Pathology; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Lee Tripcony
- Cancer Care Services, Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Jacqui Keller
- Cancer Care Services, Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Brett G. M. Hughes
- Cancer Care Services, Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
- School of Medicine, University of Queensland; Queensland Australia
| | - Graeme Dickie
- Cancer Care Services, Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Lizbeth Moira Kenny
- Cancer Care Services, Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Robert A. Hodge
- Department of ENT/Head and Neck Surgery; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
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21
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Feasibility and Safety of Overtubes for PEG-Tube Placement in Patients with Head and Neck Cancer. Gastroenterol Res Pract 2015; 2015:612610. [PMID: 25977688 PMCID: PMC4419231 DOI: 10.1155/2015/612610] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 03/24/2015] [Indexed: 01/16/2023] Open
Abstract
Background. Percutaneous endoscopic gastrostomy (PEG) placement using the “pull” technique is commonly utilized for providing nutritional support in head and neck cancer (HNC) patients, but it may be complicated by peristomal metastasis in up to 3% of patients. Overtube-assisted PEG placement might reduce this risk. However, this technique has not been systemically studied for this purpose to date. Methods. Retrospective analysis of consecutive patients with HNC who underwent overtube-assisted PEG placement at Westmead Hospital, Australia, between June 2011 and December 2013. Data were extracted from patients' endoscopy reports and case notes. We present our technique for PEG insertion and discuss the feasibility and safety of this method. Results. In all 53 patients studied, the PEG tubes were successfully placed using 25 cm long flexible overtubes, in 89% prophylactically (before commencing curative chemoradiotherapy), and in 11% reactively (for treatment of tumor related dysphagia or weight loss). During a median follow-up period of 16 months, 3 (5.7%) patients developed peristomal infection and 3 others developed self-limiting peristomal pain. There were no cases of overtube-related adverse events or overt cutaneous metastases observed. Conclusions. Overtube-assisted PEG placement in patients with HNC is a feasible, simple, and safe technique and might be effective for preventing cutaneous metastasis.
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22
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Harréus U. Surgical errors and risks - the head and neck cancer patient. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2013; 12:Doc04. [PMID: 24403972 PMCID: PMC3884539 DOI: 10.3205/cto000096] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Head and neck surgery is one of the basic principles of head and neck cancer therapy. Surgical errors and malpractice can have fatal consequences for the treated patients. It can lead to functional impairment and has impact in future chances for disease related survival. There are many risks for head and neck surgeons that can cause errors and malpractice. To avoid surgical mistakes, thorough preoperative management of patients is mandatory. As there are ensuring operability, cautious evaluation of preoperative diagnostics and operative planning. Moreover knowledge of anatomical structures of the head and neck, of the medical studies and data as well as qualification in modern surgical techniques and the surgeons ability for critical self assessment are basic and important prerequisites for head and neck surgeons in order to make out risks and to prevent from mistakes. Additionally it is important to have profound knowledge in nutrition management of cancer patients, wound healing and to realize and to be able to deal with complications, when they occur. Despite all precaution and surgical care, errors and mistakes cannot always be avoided. For that it is important to be able to deal with mistakes and to establish an appropriate and clear communication and management for such events. The manuscript comments on recognition and prevention of risks and mistakes in the preoperative, operative and postoperative phase of head and neck cancer surgery.
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Affiliation(s)
- Ulrich Harréus
- Department of Otolaryngology/Head and Neck Surgery, University Hospital Munich, Campus Grosshadern, Munich, Germany
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23
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Brown T, Findlay M, von Dincklage J, Davidson W, Hill J, Isenring E, Talwar B, Bell K, Kiss N, Kurmis R, Loeliger J, Sandison A, Taylor K, Bauer J. Using a wiki platform to promote guidelines internationally and maintain their currency: evidence-based guidelines for the nutritional management of adult patients with head and neck cancer. J Hum Nutr Diet 2013; 26:182-90. [DOI: 10.1111/jhn.12036] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- T. Brown
- Department of Nutrition and Dietetics; Royal Brisbane and Women's Hospital; Brisbane QLD Australia
- Clinical Oncological Society of Australia; Sydney NSW Australia
- School of Human Movement Studies; The University of Queensland; Brisbane QLD Australia
| | - M. Findlay
- Department of Nutrition and Dietetics; Royal Prince Alfred Hospital; Sydney NSW Australia
| | | | - W. Davidson
- Department of Nutrition and Dietetics; Princess Alexandra Hospital; Brisbane QLD Australia
| | - J. Hill
- Centre for Healthcare Improvement; Patient Safety and Quality Improvement Service; QLD Australia
| | - E. Isenring
- School of Human Movement Studies; The University of Queensland; Brisbane QLD Australia
- Department of Nutrition and Dietetics; Princess Alexandra Hospital; Brisbane QLD Australia
| | - B. Talwar
- Head and Neck Cancer Services; University College London Hospitals NHS Foundation Trust; London UK
| | - K. Bell
- Department of Nutrition and Dietetics; Liverpool Hospital; Sydney NSW Australia
| | - N. Kiss
- Department of Nutrition and Dietetics; Peter MacCallum Cancer Centre; Melbourne VIC Australia
| | - R. Kurmis
- Department of Clinical Dietetics; Royal Adelaide Hospital; Adelaide SA Australia
| | - J. Loeliger
- Department of Nutrition and Dietetics; Peter MacCallum Cancer Centre; Melbourne VIC Australia
| | - A. Sandison
- Department of Nutrition and Dietetics; Royal Melbourne Hospital; Melbourne VIC Australia
| | - K. Taylor
- Department of Nutrition and Dietetics; Fremantle Hospital; Fremantle WA Australia
| | - J. Bauer
- School of Human Movement Studies; The University of Queensland; Brisbane QLD Australia
- Department of Nutrition and Dietetics; The Wesley Hospital, Brisbane; QLD Australia
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24
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Martin L, Blomberg J, Lagergren P. Patients' perspectives of living with a percutaneous endoscopic gastrostomy (PEG). BMC Gastroenterol 2012; 12:126. [PMID: 22989321 PMCID: PMC3503865 DOI: 10.1186/1471-230x-12-126] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 08/27/2012] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Since enteral nutrition therapy is the preferred nutritional support for dysphagic patients with a range of diagnoses, PEG has become part of traditional care. However, enteral nutrition with PEG transfers treatment responsibility and activity to the patients and their carers, so the advantages should be discussed. The aim of this study was therefore to investigate patients' experience of living with a percutaneous endoscopic gastrostomy (PEG) in order to increase the understanding of patients' need for support. METHOD In a prospective study at Karolinska University Hospital in Sweden, data were collected consecutively at the time of PEG and two months later using a study-specific questionnaire about each patient's experience of living with a PEG. Fishers exact test was used to test for statistically significant difference at five per cent level. RESULTS There were 104 responders (response rate of 70%). Women felt more limited in daily activity compared to men (p = 0.004). Older patients experienced a more limited ability to influence the number of feeding times compared to younger (p = 0.026). Highly educated patients found feeding more time-consuming (p = 0.004). Patients with a cancer diagnosis reported that the PEG feeding interfered with their oral feeding more than patients with a neurological disease (p = 0.009). Patients mostly contacted the PEG outpatient clinic with problems regarding their PEG, and were mainly assisted by their spouse rather than district nurses. CONCLUSIONS PEG feeding is time-consuming and interferes with daily life. Although 73% was satisfied, patients' experiences of living with a PEG may be dependent on age, sex, education and diagnosis. Spouses are the main carers for PEG patients at home, and patients prefer to go to the PEG outpatient clinic for help if problems occur.
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Affiliation(s)
- Lena Martin
- Unit of Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
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