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Culié D, Schiappa R, Pace-Loscos T, Guelfucci B, Vergez S, Garrel R, Fakhry N, Dassonville O, Poissonnet G, Lallemant B, Sudaka A, Saada-Bouzid E, Benezery K, Temam S, Gorphe P, Chamorey E, Bozec A. Enteral Nutrition during Radiotherapy for Oropharyngeal Cancers: Prevalence and Prognostic Factors Based on HPV Status (A GETTEC Study). J Clin Med 2023; 12:jcm12093169. [PMID: 37176609 PMCID: PMC10179627 DOI: 10.3390/jcm12093169] [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: 03/23/2023] [Revised: 04/19/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
Nutritional support during radiotherapy is crucial to tolerating and completing oropharyngeal squamous cell carcinoma (OPSCC) treatment. The impact of HPV status on nutritional support is debated. The objective was to evaluate the rate of Reactive Feeding Tube (RFT) use and determine its prognostic factors during definitive radiotherapy for OPSCC. All OPSCC patients treated from 2009 to 2014 were included in this multicentric retrospective study. The impact of tumor p16 status on the risk of RFT was assessed through multivariate analyses. Among the 543 patients, 103 patients required an RFT (19.0%). The use of RFT differed between centers (5% to 32.4%). In multivariate analysis, only tongue base involvement and concurrent chemotherapy were significantly associated with RFT (OR = 2.18 and 3.7, respectively). Tongue base involvement and concomitant chemotherapy were prognostic factors for RFT. HPV status was not a prognostic factor for enteral nutrition during radiotherapy for OPSCC.
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Affiliation(s)
- Dorian Culié
- Antoine Lacassagne Centre, University Institute of the Face and Neck, Côte d'Azur University, 06000 Nice, France
- Antoine Lacassagne Centre, Department of Epidemiology, Biostatistics and Health Data, Côte d'Azur University, 06000 Nice, France
| | - Renaud Schiappa
- Antoine Lacassagne Centre, Department of Epidemiology, Biostatistics and Health Data, Côte d'Azur University, 06000 Nice, France
| | - Tanguy Pace-Loscos
- Antoine Lacassagne Centre, Department of Epidemiology, Biostatistics and Health Data, Côte d'Azur University, 06000 Nice, France
| | - Bruno Guelfucci
- Department of Otorhinolaryngology and Head and Neck Surgery, Sainte Musse Hospital, 83100 Toulon, France
| | - Sebastien Vergez
- Department of Otorhinolaryngology and Head and Neck Surgery, Cancer University Institute of Toulouse, 31100 Toulouse, France
| | - Renaud Garrel
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Montpellier, 34295 Montpellier, France
| | - Nicolas Fakhry
- Department of Otorhinolaryngology and Head and Neck Surgery, Public Assistance-Hospitals of Marseille, 13005 Marseille, France
| | - Olivier Dassonville
- Antoine Lacassagne Centre, University Institute of the Face and Neck, Côte d'Azur University, 06000 Nice, France
| | - Gilles Poissonnet
- Antoine Lacassagne Centre, University Institute of the Face and Neck, Côte d'Azur University, 06000 Nice, France
| | - Benjamin Lallemant
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Nîmes, 30900 Nîmes, France
| | - Anne Sudaka
- Antoine Lacassagne Centre, Department of Pathology, Côte d'Azur University, 06000 Nice, France
| | - Esma Saada-Bouzid
- Antoine Lacassagne Centre, Department of Medical Oncology, Côte d'Azur University, 06000 Nice, France
| | - Karen Benezery
- Antoine Lacassagne Centre, Department of Radiotherapy, Côte d'Azur University, 06000 Nice, France
| | - Stephane Temam
- Department of Otorhinolaryngology and Head and Neck Surgery, Gustave Roussy Institute, 94805 Villejuif, France
| | - Phillipe Gorphe
- Department of Otorhinolaryngology and Head and Neck Surgery, Gustave Roussy Institute, 94805 Villejuif, France
| | - Emmanuel Chamorey
- Antoine Lacassagne Centre, Department of Epidemiology, Biostatistics and Health Data, Côte d'Azur University, 06000 Nice, France
| | - Alexandre Bozec
- Antoine Lacassagne Centre, University Institute of the Face and Neck, Côte d'Azur University, 06000 Nice, France
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Xu Y, Peng H, Guo Q, Guo L, Peng X, Lin S. Effect of Percutaneous Endoscopic Gastrostomy on Quality of Life after Chemoradiation for Locally Advanced Nasopharyngeal Carcinoma: A Cross-Sectional Study. Curr Oncol 2023; 30:1000-1009. [PMID: 36661725 PMCID: PMC9857610 DOI: 10.3390/curroncol30010076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/25/2022] [Accepted: 01/03/2023] [Indexed: 01/13/2023] Open
Abstract
(1) Background: Prophylactic percutaneous endoscopic gastrostomy (PEG) maintained nutritional status and improved survival of patients with locally advanced nasopharyngeal carcinoma (LA-NPC). However, the role of PEG in patients’ quality of life (QoL) is still controversial. We aimed to investigate the effect of PEG on the QoL of patients with LA-NPC without progression. (2) Methods: Patients with LA-NPC between 1 June 2010 and 30 June 2014 in Fujian Cancer Hospital were divided into PEG and non-PEG groups. The QoL Questionnaire core 30 (QLQ-C30), incidence of adverse effects, weight, and xerostomia recovery were compared between the two groups of patients without progression as of 30 June 2020. (3) Results: No statistically significant difference in the scores of each QLQ-C30 scale between the two groups (p > 0.05). The incidence of xerostomia was higher in the PEG group than in the non-PEG group (p = 0.044), but the association was not seen after adjusting for gender, age, T, and N stage (OR: 0.902, 95%CI: 0.485−1.680). No significant difference in the incidence of other adverse effects as well as in weight and dry mouth recovery (p > 0.05). (4) Conclusion: PEG seems not to have a detrimental effect on long-term Qol, including the self-reported swallowing function of NPC patients without progressive disease.
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Affiliation(s)
- Yun Xu
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou 350000, China
| | - Hewei Peng
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou 350000, China
| | - Qiaojuan Guo
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou 350000, China
- Fujian Key Laboratory of Translational Cancer Medicine, Fuzhou 350000, China
| | - Lanyan Guo
- School of Medical Imaging, Fujian Medical University, Fuzhou 350000, China
| | - Xiane Peng
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou 350000, China
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou 350000, China
| | - Shaojun Lin
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou 350000, China
- Fujian Key Laboratory of Translational Cancer Medicine, Fuzhou 350000, China
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3
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Choi IH, Cho YK. Percutaneous Endoscopic Gastrostomy: Procedure, Complications and Management. BRAIN & NEUROREHABILITATION 2022; 15:e2. [PMID: 36743844 PMCID: PMC9833457 DOI: 10.12786/bn.2022.15.e2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 03/11/2022] [Indexed: 11/08/2022] Open
Abstract
Percutaneous endoscopic gastrostomy (PEG) is considered in patients with insufficient oral intake who need enteral feeding or therapeutic gastric decompression. PEG tube feeding is generally superior to nasogastric tube feeding in terms of patients' comfort, long-term use, and feeding efficiency. Patient selection for PEG, the proper endoscopic insertion technique, early recognition of complications, and appropriate management are important for patient care. During preparation, adequate management of anticoagulation and antithrombotic agents are important to prevent bleeding, and prophylactic antibiotics prevent wound infection. Most complications are minor; however, major complications that require surgical correction or are life-threatening may occur, such as wound infection, bleeding, buried bumper syndrome, colocutaneous fistula, perforation, volvulus, and injuries to other organs. This review presents practical guidelines for the selection and preparation of patients, endoscopic insertion methods, and complication management strategies.
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Affiliation(s)
- In Hyoung Choi
- Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Yu Kyung Cho
- Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Korea
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Spurlock AY, Johnson TW, Pritchett A, Pierce L, Hussey J, Johnson K, Carter H, Davidson SL, Mundi MS, Epp L, Hurt RT. Blenderized food tube feeding in patients with head and neck cancer. Nutr Clin Pract 2021; 37:615-624. [PMID: 34462968 PMCID: PMC9292291 DOI: 10.1002/ncp.10760] [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] [Indexed: 12/13/2022] Open
Abstract
Background Patients with headand neck cancer (HNC) are at high risk for malnutrition before and during chemoradiation treatment. Many will also require tube feeding to address declines in energy intake, weight, and quality of life (QOL) caused by the impact of treatment on gastrointestinal (GI) symptoms. Blenderized tube feeding (BTF) may ameliorate these adverse conditions. Methods In this open‐label, prospective pilot study, 30 patients with HNC who required feeding tube placement were recruited to switch from standard commercial formula after 2 weeks to a commercially prepared BTF formula. Weight, body mass index (BMI), GI symptoms, and QOL scores were tracked for 6 weeks from the first week of feeding tube placement. Results Of the 16 patients who completed the 6‐week assessment period, weights and BMI scores for 15 patients trended upward. For most patients, QOL and oral intake increased and GI symptoms decreased over the 6‐week period, particularly during weeks 3 and 4, when the impact of treatment is particularly exacting on patients with HNC. Conclusion BTF effectively mitigated weight loss, GI symptoms, QOL scores, and total energy intake in this group of patients with HNC who received tube feeding for 6 weeks.
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Affiliation(s)
| | - Teresa W Johnson
- College of Health and Human Services, Troy University, Troy, Alabama, USA
| | | | - Leah Pierce
- Montgomery Cancer Center, Montgomery, Alabama, USA
| | - Jenna Hussey
- School of Nursing, Troy University, Troy, Alabama, USA
| | - Kelly Johnson
- School of Nursing, Troy University, Troy, Alabama, USA
| | - Holly Carter
- School of Nursing, Troy University, Troy, Alabama, USA
| | - Stephen L Davidson
- Alabama Oncology Hematology Associates at The Montgomery Cancer Center, Montgomery, Alabama, USA
| | - Manpreet S Mundi
- Division of Endocrinology, Mayo Clinic, Rochester, Minnesota, USA
| | - Lisa Epp
- Endocrinology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Ryan T Hurt
- Medicine, Mayo Clinic, Rochester, Minnesota, USA
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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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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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8
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Pfister DG, Spencer S, Adelstein D, Adkins D, Anzai Y, Brizel DM, Bruce JY, Busse PM, Caudell JJ, Cmelak AJ, Colevas AD, Eisele DW, Fenton M, Foote RL, Galloway T, Gillison ML, Haddad RI, Hicks WL, Hitchcock YJ, Jimeno A, Leizman D, Maghami E, Mell LK, Mittal BB, Pinto HA, Ridge JA, Rocco JW, Rodriguez CP, Shah JP, Weber RS, Weinstein G, Witek M, Worden F, Yom SS, Zhen W, Burns JL, Darlow SD. Head and Neck Cancers, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2020; 18:873-898. [DOI: 10.6004/jnccn.2020.0031] [Citation(s) in RCA: 313] [Impact Index Per Article: 78.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Treatment is complex for patients with head and neck (H&N) cancers with specific site of disease, stage, and pathologic findings guiding treatment decision-making. Treatment planning for H&N cancers involves a multidisciplinary team of experts. This article describes supportive care recommendations in the NCCN Guidelines for Head and Neck Cancers, as well as the rationale supporting a new section on imaging recommendations for patients with H&N cancers. This article also describes updates to treatment recommendations for patients with very advanced H&N cancers and salivary gland tumors, specifically systemic therapy recommendations.
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Affiliation(s)
| | | | - David Adelstein
- 3Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Douglas Adkins
- 4Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | - Yoshimi Anzai
- 5Huntsman Cancer Institute at the University of Utah
| | | | | | | | | | | | | | - David W. Eisele
- 12The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | - Moon Fenton
- 13The University of Tennessee Health Science Center
| | | | | | | | | | | | | | | | - Debra Leizman
- 3Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | - Bharat B. Mittal
- 22Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | - James W. Rocco
- 23The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | | | | | | | | | - Sue S. Yom
- 27UCSF Helen Diller Family Comprehensive Cancer Center
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9
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Chang A, Watcharamon C, Rattanasupa A, Thongsonkleeb K, Chowdok B, Khaimook A, Ovartlarnporn B, Prachayakul V. Comparison of Clinical Outcomes Between Surgical Gastrostomy and Percutaneous Endoscopic Gastrostomy with Introducer Technique in Patients with Upper Aerodigestive Malignancies: A Single-Center Analysis. World J Surg 2020; 44:3070-3076. [PMID: 32358639 DOI: 10.1007/s00268-020-05532-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Conventional percutaneous endoscopic gastrostomy (PEG) in patients with upper aerodigestive malignancies inevitably carries a risk of stomal metastasis that could be avoided by the direct insertion of the gastrostomy tube through the abdomen. This study compared the efficacy and safety between surgical gastrostomy (SG) and Introducer PEG in patients with upper aerodigestive malignancies. METHODS We retrospectively reviewed patients with upper aerodigestive malignancies undergoing SG or Introducer PEG. Procedure data, postprocedural clinical outcomes and 30-day mortality were assessed. RESULTS In total, 99 patients were feasible to analysis: 53 were in the SG group, and 46 were in the Introducer PEG group. The SG group had a higher incidence of (in-hospital) major complications [28.3% VS 4.3%, p = 0.002], a longer procedure duration [52.02 ± 21.30 VS 21.46 ± 8.22 min, p < 0.001], higher pain scores at 24 h [median (interquartile range, IQR); 5(3-8) VS 1(0-5), p < 0.001] and longer length of hospitalization (LOH) [median (IQR); 5(4-6) days VS 3(2-4) days, p < 0.001)]. In-hospital (3.8% VS 0%, p = 0.493) and 30-day mortality (17.0% VS 13.0%, p = 0.586) were not different between the two groups. In univariate analysis, high BMI, anemia (hemoglobin <11 g/dL), normal nutritional status (serum albumin >3 g/dL) and procedural type were found to be predicting factors for complications. Procedural type (Introducer PEG) was an independent factor for major complications in multivariate analysis [OR = 0.12, 95% CI 0.02-0.61, p= 0.011]. CONCLUSIONS In patients with upper aerodigestive malignancies, Introducer PEG was associated with lower rate of (in-hospital) major complications, faster operative time, lower pain scores and shorter LOH. CLINICAL TRIALS REGISTRY NUMBER TCTR20181220004.
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Affiliation(s)
- Arunchai Chang
- Division of Gastroenterology, Department of Internal Medicine, Hatyai Hospital, Songkhla, Thailand
| | | | - Attapon Rattanasupa
- Division of Gastroenterology, Department of Internal Medicine, Hatyai Hospital, Songkhla, Thailand
| | | | - Bunlue Chowdok
- Department of Surgery, Hatyai Hospital, Songkhla, Thailand
| | - Araya Khaimook
- Division of Minimally Invasive Surgery, Department of Surgery, Hatyai Hospital, Songkhla, Thailand
| | - Bancha Ovartlarnporn
- Faculty of Medicine, NKC Institute of Gastroenterology and Hepatology, Songklanagarind Hospital, Prince of Songkla University, Songkhla, Thailand
| | - Varayu Prachayakul
- Siriraj Gastrointestinal Endoscopy Center, Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand.
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Hausmann J, Kubesch A, Müller von der Grün J, Goettlich CM, Filmann N, Oliver Tal A, Vermehren J, Friedrich-Rust M, Wächtershäuser A, Bojunga J, Blumenstein I. Prophylactic percutaneous endoscopic gastrostomy in patients with head and neck cancer: Influence on nutritional status, utilisation rate and complications. Int J Clin Pract 2019; 73:e13405. [PMID: 31408231 DOI: 10.1111/ijcp.13405] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/30/2019] [Accepted: 08/08/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Patients with head and neck cancer (HNC) are at high risk for malnutrition because of tumour localisation and therapy. Prophylactic percutaneous endoscopic gastrostomy (PEG) tube placement is common practice to prevent malnutrition. OBJECTIVE To investigate the benefits of prophylactic PEG tube placement for HNC patients in terms of the influence on patients' nutritional status, utilisation rate, complications and to identify the predictors of PEG tube utilisation. METHODS All consecutive HNC patients who underwent prophylactic PEG tube insertion between 1 January 2011 and 31 December 2012 prior to therapy were enrolled. The PEG tube utilisation rate, complications, the patients' nutritional status and tumour therapy were evaluated with the help of electronic patient charts and telephone interviews. RESULTS A total of 181 patients (48 female, median 67.5 years) were included. The PEG utilisation rate in the entire cohort was 91.7%. One hundred and forty-nine patients (82.3%) used the PEG tube for total enteral nutrition, 17 patients (9.4%) for supplemental nutrition and 15 patients (8.3%) made no use of the PEG tube. Peristomal wound infections were the most common complications (40.3%) in this study. A high Nutritional Risk Screening (NRS) score prior to tube insertion was found to be independently associated with PEG utilisation. No significant weight changes were observed across the three patient subgroups. CONCLUSIONS The overall PEG tube utilisation rate was high in this study. However, given the high rate of infections, diligent patient selection is crucial in order to determine which patients benefit most from prophylactic PEG tube insertion.
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Affiliation(s)
- Johannes Hausmann
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Alica Kubesch
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Jens Müller von der Grün
- Department of Radiotherapy and Oncology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Carmen M Goettlich
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Natalie Filmann
- Institute of Biostatistics and Mathematical Modeling, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Andrea Oliver Tal
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Johannes Vermehren
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Mireen Friedrich-Rust
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Astrid Wächtershäuser
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Jörg Bojunga
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Irina Blumenstein
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
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11
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Quality of life of patients with head and neck cancer after prophylactic percutaneous-gastrostomy. Eur J Clin Nutr 2019; 74:565-572. [PMID: 31570758 DOI: 10.1038/s41430-019-0499-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 09/10/2019] [Accepted: 09/11/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND HNC patients often experience weight loss during treatment. To date, there is only limited data on patient quality of life (QLQ) and subjective benefit of the PEG insertion. OBJECTIVE To investigate the nutritional status, QLQ, and overall benefit. METHODS 181 patients fitting our inclusion criteria (01/2012-12/2012) were enrolled. Utilization rate, nutritional status, QLQ, and subjective PEG assessment were determined with electronic charts and the Quality of life-questionnaire (EORTC-QLQ-C30). RESULTS The utilization rate of the entire cohort was 91.7%. The PEG was used full-time by 149 patients. No statistical differences in QLQ were observed between the groups. Of the patients that used the PEG entirely (99.7%), partially (85.3%) or not all (55.3%) would 99.7%, 85.3 and 55.8% undergo the procedure in the future if necessary. CONCLUSIONS QLQ was not significantly reduced by insertion. Especially patients using the PEG full-time had an objective and subjective benefit from the inserted PEG tube.
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12
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The patient experience of having a feeding tube during treatment for head and neck cancer: A systematic literature review. Clin Nutr ESPEN 2019; 33:66-85. [DOI: 10.1016/j.clnesp.2019.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/30/2019] [Accepted: 07/09/2019] [Indexed: 01/08/2023]
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13
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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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14
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Gill A, Givi B, Moore MG. AHNS Series - Do you know your guidelines?: Assessment and management of malnutrition in patients with head and neck cancer: Review of the NCCN Clinical Practice Guidelines In Oncology (NCCN Guidelines). Head Neck 2018; 41:577-583. [PMID: 30597657 DOI: 10.1002/hed.24866] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 05/22/2017] [Indexed: 01/08/2023] Open
Abstract
This article is a part of the "Do you know your guidelines" series by the Education Committee of the American Head and Neck Society. The aim is to summarize the core principles outlined by the NCCN Clinical Practice Guidelines In Oncology (NCCN Guidelines® ) on management of malnutrition in patients with head and neck cancer. We outline the current recommendations from the National Comprehensive Cancer Network® (NCCN® ) for the screening and management of malnutrition, including indications for nutritional supplementation and placement of a nasogastric or gastrostomy tube. We also include a brief review of the available literature on additional screening tools, alternative guidelines, as well as an update on the emerging data surrounding the use of immune-enhancing nutrition.
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Affiliation(s)
- Amarbir Gill
- University of California at Davis, Department of Otolaryngology - Head and Neck Surgery, Sacramento, California
| | - Babak Givi
- Department of Otolaryngology - Head and Neck Surgery, New York University Langone Medical Center, New York, New York
| | - Michael G Moore
- University of California at Davis, Department of Otolaryngology - Head and Neck Surgery, Sacramento, California
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15
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Orlemann T, Reljic D, Zenker B, Meyer J, Eskofier B, Thiemt J, Herrmann HJ, Neurath MF, Zopf Y. A Novel Mobile Phone App (OncoFood) to Record and Optimize the Dietary Behavior of Oncologic Patients: Pilot Study. JMIR Cancer 2018; 4:e10703. [PMID: 30459139 PMCID: PMC6280033 DOI: 10.2196/10703] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/26/2018] [Accepted: 08/14/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Catabolism and tumor-specific therapy lead to reduced nutrient intake and weight loss in cancer patients. Maintaining a specific individualized diet can be challenging for the patient as the nutritional counseling options are limited. Monitoring of nutrient intake and frequent feedback are, however, vital for successful nutritional therapy because they support the patient's compliance and realization of dietary therapeutic goals. OBJECTIVE This study aimed at investigating the feasibility and applicability of a novel mobile phone app to assess and evaluate dietary behaviors in oncologic patients. METHODS To determine dietary habits and food preferences in oncologic patients, initially 1400 nutritional records were evaluated and analyzed. The results provided the basis for creating a nutritional mobile phone app. Key requirements for the app included simple handling, recording the daily intake, and a comparison of nutrient targets and current status. In total, 39 cancer patients were recruited for the study; 15 patients dropped out prior to the study. All patients received a nutritional anamnesis, nutritional analysis, and nutritional counseling. Individual energy and nutrient aims were defined. The intervention group (n=12) additionally used the app. Weight and body composition of each group were evaluated after 4 weeks. RESULTS The app group gained significantly more weight (P=.045; mean weight 1.03 kg vs -1.46 kg). Also, skeletal muscle mass showed a significant increase in the app group (P=.009; mean skeletal muscle mass 0.58 kg vs -0.61 kg) compared with the control group. There was no significant difference between groups relating to the daily protein intake (P=.06). Additionally, there was a decrease in macronutrient intake during the study period in the control group. CONCLUSIONS Our study indicates that patients who track their daily dietary habits using a mobile phone app are more likely to reach their nutritional goals than the control patients. Further large-scale studies are needed to confirm these initial findings and test the applicability on a broader basis.
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Affiliation(s)
- Till Orlemann
- Hector Center for Nutrition, Exercise, and Sports, Department of Internal Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Dejan Reljic
- Hector Center for Nutrition, Exercise, and Sports, Department of Internal Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Björn Zenker
- Embedded Systems Institute, Department of Informatics, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Julia Meyer
- Hector Center for Nutrition, Exercise, and Sports, Department of Internal Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Bjoern Eskofier
- Machine Learning and Data Analytics Lab, Department of Computer Science, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Jana Thiemt
- Machine Learning and Data Analytics Lab, Department of Computer Science, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Hans Joachim Herrmann
- Hector Center for Nutrition, Exercise, and Sports, Department of Internal Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Markus Friedrich Neurath
- Department of Internal Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Yurdagül Zopf
- Hector Center for Nutrition, Exercise, and Sports, Department of Internal Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
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16
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Molina Villalba C, Vázquez Rodríguez JA, Gallardo Sánchez F. Percutaneous endoscopic gastrostomy. Indications, care and complications. Med Clin (Barc) 2018; 152:229-236. [PMID: 30424936 DOI: 10.1016/j.medcli.2018.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/05/2018] [Accepted: 09/05/2018] [Indexed: 02/08/2023]
Abstract
Percutaneous endoscopic gastrostomy (PEG) is an effective and safe method for nutritional support in patients with malnutrition and impossibility of oral intake with an estimated survival higher than the months that require enteral nutrition beyond four weeks. The main indications include neoplasms of the upper air-digestive tract and neurological diseases, with dementia currently considered a controversial indication. Anatomical alterations and infectious diseases are the most frequent contraindications. There are different endoscopic techniques; the most widely used being the "pull" method, with a low mortality. Complications are more frequent in patients with multiple pathologies and the elderly. Wound infection, extraction of the tube, tube blockage and bronchoaspiratory pneumonia are the most prevalent complications. Adequate prior preparation of the patient and exhaustive maintenance of the tube can reduce the appearance of these.
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17
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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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18
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Gill A, Farwell DG, Moore MG. Nutrition and Perioperative Care for the Patient with Head and Neck Cancer. Oral Maxillofac Surg Clin North Am 2018; 30:411-420. [DOI: 10.1016/j.coms.2018.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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19
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Greaves JR. Head and Neck Cancer Tumor Seeding at the Percutaneous Endoscopic Gastrostomy Site. Nutr Clin Pract 2018; 33:73-80. [PMID: 29323421 DOI: 10.1002/ncp.10021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 10/10/2017] [Indexed: 01/14/2023] Open
Abstract
The National Institutes of Health National Cancer Institute estimates that over 13,000 new cases of head and neck cancer (HNC) will be diagnosed in 2017. Patients with HNC often require enteral nutrition (EN) via gastrostomy tube to provide nutrition support and hydration because of tumor obstruction of the oropharynx and/or cumulative effects of chemoradiation therapy. The percutaneous endoscopic gastrostomy (PEG) tube has become the preferred technique for EN access because placement is considered a minimally invasive procedure. There are 3 methods of PEG placement: Gauderer-Ponsky "pull," Sachs-Vine "push," and Russell "push" method. The Gauderer-Ponsky "pull" method has become the preferred method of PEG placement. It has been previously reported that the rate of stomal metastasis can be 0.5%-1% of those undergone the Gauderer-Ponsky "pull" method that is consistent with HNC morphology. Other researchers believe the rate may be as high as 0.5%-3%. This article reviews the 3 methods of PEG placement, as well as all potential complications, including metastatic seeding at the PEG site. In addition, 1 additional case of tumor seeding at the PEG site will be reviewed. Consideration for avoidance of the Gauderer-Ponsky pull method of PEG placement or other methods of feeding tube placement where the gastrostomy tube has to pass through the oral cavity before exiting the abdominal wall in patients with squamous cell carcinoma of the head and neck should be considered.
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Affiliation(s)
- June R Greaves
- Coram CVS Specialty Infusion Services, Denver, Colorado, USA
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20
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Abstract
Head and neck cancer (HNC) patients often face multiple nutritional challenges before, during, and after treatment due to the close proximity of the cancer to organs that are vital for normal eating function. Common treatment-related side effects, such as dysphagia, odynophagia, dysgeusia, xerostomia, thick saliva, mucositis, nausea, and vomiting, all further impair the patient's ability to maintain adequate oral intake. Malnutrition and unintentional weight loss in HNC patients during and after treatment are associated with poorer treatment outcomes, increased morbidity and mortality, and poor quality of life, even in overweight and obese patients whose Body Mass Index (BMI) is not suggestive of malnutrition. The main nutrition goal for HNC patients is thus to maximize nutrition intake either orally or through nutrition support therapy in order to prevent or limit weight loss, preserve lean body mass, minimize treatment delays and unplanned hospitalizations, and improve treatment outcomes. This chapter will discuss nutrition interventions to manage common symptoms before, during, and after treatment for HNC. Guidelines will be provided for patients that require enteral nutrition or less commonly, parenteral nutrition.
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Affiliation(s)
- Denise Ackerman
- Department of Surgery, Division of Head and Neck Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Meghan Laszlo
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Arlene Provisor
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Adern Yu
- Department of Surgery, Division of Head and Neck Surgery, City of Hope National Medical Center, Duarte, CA, USA
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21
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Alberda C, Alvadj-Korenic T, Mayan M, Gramlich L. Nutrition Care in Patients With Head and Neck or Esophageal Cancer: The Patient Perspective. Nutr Clin Pract 2017; 32:664-674. [DOI: 10.1177/0884533617725050] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
| | - Tatjana Alvadj-Korenic
- Women’s and Children’s Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Maria Mayan
- Women’s and Children’s Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Leah Gramlich
- Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
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22
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Jamal N, Ebersole B, Erman A, Chhetri D. Maximizing Functional Outcomes in Head and Neck Cancer Survivors. Otolaryngol Clin North Am 2017; 50:837-852. [DOI: 10.1016/j.otc.2017.04.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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23
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Rueda A, Giralt J, Mañós M, Lozano A, Sistiaga A, García-Miragall E, Cacicedo J, Esteban F, Scola B, Contreras J, Ruiz A, Carral A, Sanchez-Aniceto G, Pastor M, Herranz J, Bernal M, Mesía R. Multidisciplinary management of head and neck cancer: First expert consensus using Delphi methodology from the Spanish Society for Head and Neck Cancer (part 2). Oral Oncol 2017; 70:65-72. [DOI: 10.1016/j.oraloncology.2017.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 03/31/2017] [Accepted: 04/08/2017] [Indexed: 10/19/2022]
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24
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The Effects of Compliance with Nutritional Counselling on Body Composition Parameters in Head and Neck Cancer Patients under Radiotherapy. J Nutr Metab 2017; 2017:8631945. [PMID: 28116152 PMCID: PMC5237737 DOI: 10.1155/2017/8631945] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 11/09/2016] [Accepted: 12/12/2016] [Indexed: 11/17/2022] Open
Abstract
Background. Radiotherapy (RT) has been associated with increased risk of malnutrition in cancer patients, particularly in those with head and neck cancer (HNC). The aim of this prospective study was to evaluate the effects of compliance of patients with individual dietary counselling on body composition parameters in HNC patients under RT. Material and Methods. Sixty-nine consecutive patients (mean age: 61.0 ± 13.8) were prospectively followed. Bioelectrical impedance analysis (BIA) was performed to determine body composition parameters before, in the middle of, and at the end of RT. All patients received nutritional counselling and majority of them (94.6%) received oral nutritional supplement (ONS) during RT or chemoradiotherapy. If a patient consumed ≥75% of the recommended energy and protein intake via ONS and regular food, he/she was considered to be “compliant” (n = 18), while those who failed to meet this criteria were considered to be “noncompliant” (n = 30). Results. Body mass index, weight, fat percentage, fat mass, fat free mass, and muscle mass did not decrease significantly over time in compliant patients, but in noncompliant patients, all of these indices decreased significantly from baseline compared to the end of treatment (p < 0.001). Hand grip strength did not differ significantly between the two groups at baseline and over time in each group. When retrospectively evaluated, heavy mucositis was less commonly observed in compliant than noncompliant patients (11.1% versus 88.9%, resp.) (p < 0.009). Conclusion. We conclude that body composition parameters were better in head and neck cancer patients considered as compliant with nutritional counselling than noncompliant ones during RT period.
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25
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Szturz P, Vermorken JB. Treatment of Elderly Patients with Squamous Cell Carcinoma of the Head and Neck. Front Oncol 2016; 6:199. [PMID: 27630826 PMCID: PMC5006317 DOI: 10.3389/fonc.2016.00199] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 08/23/2016] [Indexed: 12/27/2022] Open
Abstract
The demographics of squamous cell carcinoma of the head and neck (SCCHN) is marked by a growing number of patients aged 65 and over, which is in line with global projections for other cancer types. In developed countries, more than half of new SCCHN cases are diagnosed in older people, and in 15 years from now, the proportion is expected to rise by more than 10%. Still, a high-level evidence-based consensus to guide the clinical decision process is strikingly lacking. The available data from retrospective studies and subset analyses of prospective trials suffer from a considerable underrepresentation of senior participants. The situation is even more challenging in the recurrent and/or metastatic setting, where usually only palliative measures are employed. Nevertheless, it is becoming clear that, if treated irrespective of chronological age, fit elderly patients in a good general condition and with a low burden of comorbidities may derive a similar survival advantage as their younger counterparts. Despite that, undertreatment represents a widespread phenomenon and, together with competing non-cancer mortality, is suggested to be an important cause of the worse treatment outcomes observed in this population. Due to physiological changes in drug metabolism occurring with advancing age, the major concerns relate to chemotherapy administration. In locally advanced SCCHN, concurrent chemoradiotherapy in patients over 70 years remains a point of controversy owing to its possibly higher toxicity and questionable benefit. However, accumulating evidence suggests that it should, indeed, be considered in selected cases when biological age is taken into account. Results from a randomized trial conducted in lung cancer showed that treatment selection based on a comprehensive geriatric assessment (CGA) significantly reduced toxicity. However, a CGA is time-consuming and not necessary for all patients. To overcome this hurdle, geriatric screening tools have been introduced to decide who needs such a full evaluation. Among the various screening instruments, G8 and Flemish version of the Triage Risk Screening Tool were prospectively verified and found to have prognostic value. We, therefore, conclude that also in SCCHN, the application of elderly specific prospective trials and integration of clinical practice-oriented assessment tools and predictive models should be promoted.
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Affiliation(s)
- Petr Szturz
- Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno, Czech Republic
- School of Medicine, Masaryk University, Brno, Czech Republic
| | - Jan B. Vermorken
- Department of Medical Oncology, Antwerp University Hospital, Edegem, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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26
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Li W, Shen LJ, Chen T, Sun XQ, Zhang Y, Wu M, Shu WH, Chen C, Pan CC, Xia YF, Wu PH. Overweight/obese status associates with favorable outcome in patients with metastatic nasopharyngeal carcinoma: a 10-year retrospective study. CHINESE JOURNAL OF CANCER 2016; 35:75. [PMID: 27507261 PMCID: PMC4977870 DOI: 10.1186/s40880-016-0139-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 07/22/2016] [Indexed: 01/08/2023]
Abstract
Background Although the prognostic impact of body mass index (BMI) in patients with non-metastatic nasopharyngeal carcinoma (NPC) had been extensively studied, its effect among metastatic NPC patients remains unknown. The purpose of this study was to evaluate the prognostic effect of BMI in patients with metastatic NPC. Methods We retrospectively studied 819 patients who were diagnosed with distant metastasis from NPC and received treatment between 1998 and 2007. The patients were divided into three subgroups according to the World Health Organization classifications for Asian populations: underweight (BMI <18.5 kg/m2), normal weight (BMI 18.5–22.9 kg/m2), and overweight/obese (BMI ≥23.0 kg/m2). The associations of BMI with overall survival (OS) and progression-free survival (PFS) were determined by Cox regression analysis. Results Of the 819 patients, 168 (20.5%) were underweight, 431 (52.6%) were normal weight, and 220 (26.9%) were overweight/obese. Multivariate analysis adjusted for covariates showed that overweight/obese patients had a longer OS than underweight patients [hazard ratio (HR), 0.64; 95% confidence interval (CI), 0.49–0.84] and normal weight patients (HR, 0.72; 95% CI, 0.57–0.90); no significant difference in PFS was observed among these three groups (P = 0.407). Moreover, in stratified analysis, no statistically significant differences in the effect of overweight/obese status among different subgroups were observed. Conclusion For patients with metastatic NPC, overweight/obese status was associated with longer OS but not longer PFS compared with underweight or normal weight status.
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Affiliation(s)
- Wang Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Medical Imaging and Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Lu-Jun Shen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Medical Imaging and Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Tao Chen
- Zhongshan School of Medical, Sun Yat-sen University, Guangzhou, 510080, Guangdong, P. R. China
| | - Xu-Qi Sun
- Department of Medical Imaging and Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Zhongshan School of Medical, Sun Yat-sen University, Guangzhou, 510080, Guangdong, P. R. China
| | - Ying Zhang
- Department of Medical Imaging and Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Zhongshan School of Medical, Sun Yat-sen University, Guangzhou, 510080, Guangdong, P. R. China
| | - Ming Wu
- Department of Medical Imaging and Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Zhongshan School of Medical, Sun Yat-sen University, Guangzhou, 510080, Guangdong, P. R. China
| | - Wan-Hong Shu
- Department of Medical Imaging and Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Zhongshan School of Medical, Sun Yat-sen University, Guangzhou, 510080, Guangdong, P. R. China
| | - Chen Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Chang-Chuan Pan
- Department of Medical Oncology, Sichuan Cancer Hospital and Institute, Second People's Hospital of Sichuan Province, Chengdu, 610041, Sichuan, P. R. China
| | - Yun-Fei Xia
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Pei-Hong Wu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China. .,Department of Medical Imaging and Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.
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Yamazaki T, Enokida T, Wakasugi T, Zenda S, Motegi A, Arahira S, Akimoto T, Tahara M. Impact of prophylactic percutaneous endoscopic gastrostomy tube placement on treatment tolerance in head and neck cancer patients treated with cetuximab plus radiation. Jpn J Clin Oncol 2016; 46:825-31. [PMID: 27317736 DOI: 10.1093/jjco/hyw079] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 05/17/2016] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE We conducted a retrospective analysis to evaluate the efficacy and safety of cetuximab plus radiation with or without prophylactic percutaneous endoscopic gastrectomy in locally advanced squamous cell carcinoma of the head and neck patients who were not suitable to receive platinum. PATIENTS AND METHODS We reviewed the case records of 27 locally advanced squamous cell carcinoma of the head and neck patients treated with cetuximab plus radiation (RT) between January 2013 and July 2014. No patient was able to receive platinum because of renal dysfunction or other contraindications. Patients received an initial dose of cetuximab of 400 mg/m(2), followed by weekly doses of 250 mg/m(2). The total dose of radiotherapy was 66-70 Gy in five daily fractions of 2-2.12 Gy per week. RESULTS The incidence of leukopenia was significantly higher in patients without percutaneous endoscopic gastrectomy placement than in those with (67.5% vs. 7%, P = 0.002). The incidence of Grade 3 or 4 mucositis tended to be higher in patients without percutaneous endoscopic gastrectomy placement than in those with (83% vs. 47%, P = 0.058). Five of twelve patients without percutaneous endoscopic gastrectomy placement required interruption of treatment. More patients without percutaneous endoscopic gastrectomy placement had significantly >10% weight loss than patients with (75% vs. 27%, P = 0.013). The overall response rate was 56% in all patients. The 1-year progression-free survival rate was 30.6% in all patients. CONCLUSIONS Prophylactic percutaneous endoscopic gastrectomy-feeding tube placement could reduce the incidence of severe toxicities, including mucositis and weight loss, and avoid RT interruption. These results require confirmation in a larger study.
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Affiliation(s)
- Tomoko Yamazaki
- Department of Head and Neck Cancer Oncology, National Research Cancer Center Hospital East, Kashiwa Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, 6-5-1 Kashiwanoha, Kashiwa, Chiba
| | - Tomohiro Enokida
- Department of Head and Neck Cancer Oncology, National Research Cancer Center Hospital East, Kashiwa
| | - Tetsuro Wakasugi
- Department of Head and Neck Cancer Oncology, National Research Cancer Center Hospital East, Kashiwa
| | - Sadamoto Zenda
- Department of Radiation Oncology, National Cancer Research Center Hospital East, Kashiwa, Japan
| | - Atsushi Motegi
- Department of Radiation Oncology, National Cancer Research Center Hospital East, Kashiwa, Japan
| | - Satoko Arahira
- Department of Radiation Oncology, National Cancer Research Center Hospital East, Kashiwa, Japan
| | - Tetsuo Akimoto
- Department of Radiation Oncology, National Cancer Research Center Hospital East, Kashiwa, Japan
| | - Makoto Tahara
- Department of Head and Neck Cancer Oncology, National Research Cancer Center Hospital East, Kashiwa
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Chang WK, Lin KT, Tsai CL, Chung CH, Chien WC, Lin CS. Trends regarding percutaneous endoscopic gastrostomy: A nationwide population-based study from 1997 to 2010. Medicine (Baltimore) 2016; 95:e3910. [PMID: 27310995 PMCID: PMC4998481 DOI: 10.1097/md.0000000000003910] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Percutaneous endoscopic gastrostomy (PEG) is widely used in patients requiring long-term tube feeding. Traditional PEG studies usually focused on practical, technical, and ethical issues. There have been little epidemiological studies on PEG utilization and services in Asia. We evaluated the changes in PEG utilization, patient selection, patient characteristics, and medical service in Taiwan from 1997 to 2010.This retrospective study analyzed the data of patients admitted for PEG tube placement according to the International Classification of Diseases, Ninth Revision (procedure code 43.11) extracted from the National Health Insurance database between 1997 and 2010.From 1997 to 2010, the incidence of PEG increased from 0.1 to 3.8/10 population and incidence of PEG among aged patients increased from 0.9 to 19.0/10 population. Compared 1997-2004 to 2005-2010 periods, the percentage of cerebrovascular diseases decreased and esophageal cancer increased in the later period. PEG was mainly performed in male patients and at medical centers. Medical costs, Charlson Comorbidity Index (CCI) scores, and post-PEG mortality rates were higher in the 2005-2010 period than in the 1997-2004 period.PEG procedures are being increasingly performed in Taiwan, and changes in patient selection were noted. The seriousness of accompanying diseases, medical costs, and post-PEG mortality rates in patients undergoing PEG has increased. The present findings may help in the implementation of PEG, relocation of medical resources, and improvement of PEG-related care.
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Affiliation(s)
- Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine
| | | | - Chen-Liang Tsai
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center
| | | | - Wu-Chien Chien
- School of Public Health, National Defense Medical Center
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
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Roman BR, Goldenberg D, Givi B. AHNS Series-Do you know your guidelines? Guideline recommended follow-up and surveillance of head and neck cancer survivors. Head Neck 2016; 38:168-74. [DOI: 10.1002/hed.24100] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 04/16/2015] [Indexed: 12/17/2022] Open
Affiliation(s)
- Benjamin R. Roman
- The Education Committee of American Head and Neck Society (AHNS) and Head and Neck Service; Memorial Sloan Kettering Cancer Center; New York New York
| | - David Goldenberg
- The Education Committee of American Head and Neck Society (AHNS) and Division of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University; College of Medicine; Hershey Pennsylvania
| | - Babak Givi
- The Education Committee of American Head and Neck Society (AHNS) and Department of Otolaryngology; New York University Langone Medical Center; New York New York
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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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31
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Gastrostomy in head and neck cancer: current literature, controversies and research. Curr Opin Otolaryngol Head Neck Surg 2015; 23:162-70. [PMID: 25692626 DOI: 10.1097/moo.0000000000000135] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW This article explores the literature on the role of gastrostomy tube feeding use in the management of head and neck cancer, with special attention to its indications, timing of insertion, advantages, complications and quality of life issues. RECENT FINDINGS The current guidelines in place across different countries and two ongoing randomized controlled trials are discussed in detail, and placed in the context of current evidence. SUMMARY There remains a lack of consensus about when and which enteral feeding routes (gastrostomy or nasogastric tube) should be used and controversy about the long-term effects on swallowing function as well as quality of life for patients. Local guidelines should be used or generated to guide practice or patients enrolled into existing trials until higher level evidence is generated.
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32
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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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Trignani M, Di Pilla A, Taraborrelli M, Perrotti F, Caponigro G, Santarelli G, Campitelli G, Croce A, De Nicola M, Genovesi D. Early percutaneous endoscopic gastrostomy and nutritional supplementation for patients with head and neck cancer: an Italian survey of head and neck radiation oncologists. Support Care Cancer 2015; 23:3539-43. [DOI: 10.1007/s00520-015-2729-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 03/29/2015] [Indexed: 11/28/2022]
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34
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Burney RE, Bryner BS. Safety and long-term outcomes of percutaneous endoscopic gastrostomy in patients with head and neck cancer. Surg Endosc 2015; 29:3685-9. [DOI: 10.1007/s00464-015-4126-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 02/13/2015] [Indexed: 11/30/2022]
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35
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Shaw SM, Flowers H, O'Sullivan B, Hope A, Liu LWC, Martino R. The effect of prophylactic percutaneous endoscopic gastrostomy (PEG) tube placement on swallowing and swallow-related outcomes in patients undergoing radiotherapy for head and neck cancer: a systematic review. Dysphagia 2015; 30:152-75. [PMID: 25737196 DOI: 10.1007/s00455-014-9592-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 08/11/2014] [Indexed: 11/29/2022]
Abstract
Patients undergoing radiotherapy for head and neck cancer (HNC) often experience malnutrition and dehydration during treatment. As a result, some centres place PEG tubes prophylactically (pPEG) to prevent these negative consequences. However, recent research has suggested that pPEG use may negatively affect swallowing physiology, function and/or quality of life, especially in the long term. The purpose of this study was to systematically review the literature on pPEG use in HNC patients undergoing radiotherapy and to determine its impact on swallowing-related outcomes. The following electronic databases were searched for all relevant primary research published through February 24, 2014: AMED, CINAHL, the Cochrane Library, Embase, Healthstar, Medline, and PsycINFO. Main search terms included HNC, radiotherapy, deglutition disorders, feeding tube(s), and prophylactic or elective. References for all accepted papers were hand searched to identify additional relevant research. Methodological quality was assessed using Cochrane's Risk of Bias. At all levels, two blinded raters provided judgments. Discrepancies were resolved by consensus. The search retrieved 181 unique citations. Twenty studies met our inclusion criteria. Quality assessment revealed that all studies were at risk for bias due to non-randomized sampling and unreported or inadequate blinding. Ten studies demonstrated selection bias with significant baseline differences between pPEG patients and controls. Results regarding the frequency and severity of dysphagia and swallowing-related outcomes were varied and inconclusive. The impact of pPEG use on swallowing and swallowing-related outcomes remains unclear. Well-controlled, randomized trials are needed to determine if pPEG places patients at greater risk for developing long-term dysphagia.
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Affiliation(s)
- Stephanie M Shaw
- Department of Speech-Language Pathology, Faculty of Medicine, University of Toronto, 160-500 University Ave., Toronto, ON, M5G 1V7, Canada,
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36
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Boll J, Daly S, Smolevitz J, Francescatti A, Myers J, Bines S, Luu M. Safety and Efficacy of Outpatient Percutaneous Endoscopic Gastrostomy for Patients with Head and Neck Cancer. Am Surg 2015. [DOI: 10.1177/000313481508100238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Julia Boll
- Department of General Surgery Rush University Medical Center Chicago, Illinois
| | - Shaun Daly
- Department of General Surgery Rush University Medical Center Chicago, Illinois
| | - Jill Smolevitz
- Department of General Surgery Rush University Medical Center Chicago, Illinois
| | - Amanda Francescatti
- Department of General Surgery Rush University Medical Center Chicago, Illinois
| | - Jonathan Myers
- Department of General Surgery Rush University Medical Center Chicago, Illinois
| | - Steven Bines
- Department of General Surgery Rush University Medical Center Chicago, Illinois
| | - Minh Luu
- Department of General Surgery Rush University Medical Center Chicago, Illinois
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38
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Goda M, Jinnouchi O, Takaoka T, Abe K, Tamura K, Nakaya Y, Furukita Y, Takechi H, Tangoku A, Takeda N. Efficacy of percutaneous endoscopic gastrostomy on unplanned treatment interruption and nutritional status in patients undergoing chemoradiotherapy for advanced head and neck cancer. THE JOURNAL OF MEDICAL INVESTIGATION 2015; 62:173-6. [DOI: 10.2152/jmi.62.173] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Masakazu Goda
- Department of Otolaryngology, University of Tokushima School of Medicine
| | - Osamu Jinnouchi
- Department of Otolaryngology, University of Tokushima School of Medicine
| | - Tsukasa Takaoka
- Department of Otolaryngology, University of Tokushima School of Medicine
| | - Koji Abe
- Department of Otolaryngology, University of Tokushima School of Medicine
| | - Koich Tamura
- Department of Otolaryngology, University of Tokushima School of Medicine
| | - Yutaka Nakaya
- Nutrition and Metabolism, University of Tokushima School of Medicine
| | | | | | | | - Noriaki Takeda
- Department of Otolaryngology, University of Tokushima School of Medicine
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39
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Szuecs M, Kuhnt T, Punke C, Witt G, Klautke G, Kramp B, Hildebrandt G. Subjective voice quality, communicative ability and swallowing after definitive radio(chemo)therapy, laryngectomy plus radio(chemo)therapy, or organ conservation surgery plus radio(chemo)therapy for laryngeal and hypopharyngeal cancer. JOURNAL OF RADIATION RESEARCH 2015; 56:159-168. [PMID: 25348250 PMCID: PMC4572584 DOI: 10.1093/jrr/rru093] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 09/06/2014] [Accepted: 09/10/2014] [Indexed: 06/04/2023]
Abstract
This retrospective analysis focusses on the impact of therapy on perceived long-term post-cancer treatment function. A validated questionnaire including items and components for the assessment of communicative ability, quality of voice and swallowing was sent to 129 patients. All patients were treated between 1998 and 2007. A total of 76 patients (58.9%) with carcinoma of the larynx or hypopharynx replied to the questionnaire. Data was evaluated retrospectively. Therapy delivered was definitive radio(chemo)therapy (defchRT/RT) (21/76, 28%), laryngectomy + radio(chemo)therapy (LE + chRT/RT) (28/76, 37%), or larynx conservation surgery + radio(chemo)therapy (LCS + chRT/RT) (27/76, 36%). Radiotherapy was administered using 2D- or 3D-conformal planning. The most common concomitant chemotherapy delivered was cisplatin + 5FU. For statistical analyses of the components, averages were calculated and tested using the Kruskal-Wallis test and the U-test of Mann and Whitney. Differences were assessed by the Monte Carlo method or Fisher's exact test. The single item rates were compared with Fisher's exact test. Mean follow-up was 56.7 months (range, 8-130 months). After defchRT/RT, patients trended towards more substantial-strong hoarseness compared with LCS + chRT/RT (P = 0.2). After LE, patients were dissatisfied with their artificial larynx/electrolarynx and the tone of their voice (P = 0.3, P = 0.07) and communicative ability (P = 0.005, P = 0.008) compared with those treated with defchRT/RT and LCS + chRT/RT, respectively. Dysphagia and additional percutaneous endoscopic gastrostomy (PEG) feeding were more frequent after defchRT/RT in comparison with the other two groups (P < 0.05). Voice quality and communicative ability were slightly worse after defchRT/RT and LE + chRT/RT, but satisfying with all treatment modalities. Further development of the therapy approach is necessary to reduce long-term side effects, with measures of post-treatment function as important endpoints.
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Affiliation(s)
- Marcella Szuecs
- Department of Radiotherapy, University of Rostock, Südring 75, 18059 Rostock, Germany
| | - Thomas Kuhnt
- Department of Radiotherapy, University of Leipzig, Stephanstraße 9a, 04103 Leipzig, Germany
| | - Christoph Punke
- Department of Otolaryngology, Head and Neck Surgery 'Otto Körner', University of Rostock, Doberaner Straße 137-139, 18057 Rostock, Germany
| | - Gabriele Witt
- Department of Otolaryngology, Head and Neck Surgery 'Otto Körner', University of Rostock, Doberaner Straße 137-139, 18057 Rostock, Germany
| | - Gunther Klautke
- Department of Radiation Oncology, Hospital Chemnitz, Bürgerstraße 2, 09113 Chemnitz, Germany
| | - Burkhard Kramp
- Department of Otolaryngology, Head and Neck Surgery 'Otto Körner', University of Rostock, Doberaner Straße 137-139, 18057 Rostock, Germany
| | - Guido Hildebrandt
- Department of Radiotherapy, University of Rostock, Südring 75, 18059 Rostock, Germany
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Osera S, Yano T, Odagaki T, Oono Y, Ikematsu H, Ohtsu A, Kaneko K. Peritonitis related to percutaneous endoscopic gastrostomy using the direct method for cancer patients. Surg Endosc 2014; 29:2941-6. [PMID: 25515981 DOI: 10.1007/s00464-014-4026-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 12/02/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) using the direct method is generally indicated for cancer patients. However, there are little available data about peritonitis related to this method. The aim of this retrospective analysis was to assess peritonitis related to PEG using the direct method in patients with cancer. METHODS We assessed the prevalence of peritonitis and the relationship between peritonitis and patients' backgrounds, as well as the clinical course after peritonitis. RESULTS Between December 2008 and December 2011, peritonitis was found in 9 (2.1 %) of 421 patients. Of the 9 patients with peritonitis, 4 had received PEG prior to chemoradiotherapy. Emergency surgical drainage was required in 1 patient, and the remaining 8 recovered with conservative treatment. Peritonitis occurred within 8 days of PEG for 8 of the 9 patients and occurred within 2 days of suture removal for 4 of the 9 patients. CONCLUSION Peritonitis related to PEG using the direct method was less frequent for cancer patients. Peritonitis tended to occur within a few days after removal of securing suture and in patients with palliative stage.
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Affiliation(s)
- Shozo Osera
- Endoscopy Division, Department of Gastroenterology and GI Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan.
- Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - Tomonori Yano
- Endoscopy Division, Department of Gastroenterology and GI Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan.
| | - Tomoyuki Odagaki
- Endoscopy Division, Department of Gastroenterology and GI Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Yasuhiro Oono
- Endoscopy Division, Department of Gastroenterology and GI Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Hiroaki Ikematsu
- Endoscopy Division, Department of Gastroenterology and GI Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Atsushi Ohtsu
- Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kazuhiro Kaneko
- Endoscopy Division, Department of Gastroenterology and GI Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan
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Clavier JB, Antoni D, Atlani D, Ben Abdelghani M, Schumacher C, Dufour P, Kurtz JE, Noel G. Baseline nutritional status is prognostic factor after definitive radiochemotherapy for esophageal cancer. Dis Esophagus 2014; 27:560-7. [PMID: 23106980 DOI: 10.1111/j.1442-2050.2012.01441.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Identify prognostic factors for survival and patterns of treatment failure after definitive radiochemotherapy for esophageal cancer. Between 2003 and 2006, 143 patients with squamous cell carcinoma and adenocarcinoma of the esophagus were retrospectively reviewed. Median age was 65 years (42-81). Median radiation dose was 62.5 Gy (38-72) with 1.8-2 Gy fraction. Median follow-up was 20.8 months (2.8-92.4). Three and 5-year local recurrence-free survival rates were 58.3% and 50.9%. In univariate analysis, traversable esophageal stricture was a prognostic factor. Three, 5-year locoregional recurrence-free survival rates were 42.4% and 34.9%. In multivariate analysis, traversable esophageal stricture and stage < IIB were independent prognostic factors. Three and 5-year disease-free survival rates were 30.5% and 25.9%. In multivariate analysis, Nutritional Risk Index (NRI) ≥ 97.5 and performance status (PS) = 0 were independent prognostic factors. Median, 3, and 5-year overall survival rates were 22.1 months, 34.4%, and 19.8%. In multivariate analysis, independent prognostic factors were NRI ≥ 97.5 and PS = 0. Median survival times for the NRI classes (no denutrition, moderate and severe denutrition) were 29.5, 19.7, and 12 months (P = 0.0004), respectively. A major impact of baseline NRI was found in terms of survival; it should be included in future prospective trials.
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Affiliation(s)
- J-B Clavier
- Department of Radiation Oncology, Paul Strauss Cancer Center, Strasbourg, France
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42
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Shariff AH, Waqas M, Akhtar S. Transcervical approach to percutaneous endoscopic gastrostomy tube insertion in a patient with head and neck cancer. Asian J Endosc Surg 2014; 7:256-9. [PMID: 25131323 DOI: 10.1111/ases.12104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 02/24/2014] [Accepted: 03/16/2014] [Indexed: 01/01/2023]
Abstract
This is the case of a 48-year-old woman with recurrent head and neck cancer. Six years before presenting at our institution, she was diagnosed with a moderately differentiated squamous cell carcinoma involving the right maxilla and underwent surgical resection followed by chemoradiation. More recently, she presented at our institution with oral bleeding and pain. Examination revealed severe trismus, and biopsy demonstrated recurrent squamous cell carcinoma. She underwent surgical resection with a plan for simultaneous placement of a feeding gastrostomy tube. Owing to the near non-existent mouth opening, traditional per-oral placement of a percutaneous endoscopic gastrostomy (PEG) tube was impossible. Intraoperatively, following tumor resection, endoscopy was performed via direct pharyngeal access through a right cervical incision. The PEG tube was then placed uneventfully. Numerous studies have shown the superiority of PEG tubes over either radiologically or surgically placed gastrostomy tubes. This report describes an approach to PEG placement in a patient in whom per-oral placement was not feasible.
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Affiliation(s)
- Amir Hafeez Shariff
- Section of General Surgery, Department of Surgery, The Aga Khan University, Karachi, Pakistan
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43
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Bäck LJJ, Benders A, Pietarinen P, Keski-Säntti H, Markkanen-Leppänen M, Udd M, Halttunen J, Mäkitie AA, Kylänpää L. Percutaneous endoscopic gastrostomy tube placement by otorhinolaryngologist-head and neck surgeons. Acta Otolaryngol 2014; 134:760-7. [PMID: 24791808 DOI: 10.3109/00016489.2014.895040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
CONCLUSION Percutaneous endoscopic gastrostomy (PEG) tube placement by an otorhinolaryngologist-head and neck surgeon is a feasible procedure with logistical advantages for the patient. Patient selection, co-morbidities, and the prognosis of the underlying disease are factors determining the outcome. Patient evaluation by a multidisciplinary team, with a gastroenterologist surgeon as a technical adviser, is proposed. OBJECTIVE PEG tube placement offers an alternative to enteral nutrition. We aimed to analyze complication rates after PEG tube placement in order to evaluate the changed management policy. METHODS This was a retrospective review of complication rates in two patient cohorts with consecutive PEG tube placement at the Departments of Otorhinolaryngology - Head and Neck Surgery (group I, n = 120) and Surgery (group II, n = 172) at Helsinki University Central Hospital, Helsinki, Finland. Data were collected on the patients' age, sex, preoperative condition, tumor site and stage, preoperative laboratory parameters, coexisting medical diagnoses, indication and date for PEG tube placement, complications, time of PEG use, follow-up time, and clinical status at the last follow-up. RESULTS The only baseline differences between the cohorts were a higher ASA classification and fewer prophylactic PEG tubes in group II. The rate of major complications was 7.5% in group I and 13.9% in group II; in group I the rate of minor complications was 25%, compared with 15% in group II; and the procedure-related mortality rate was 0.8% in group I and 0.5% in group II. The differences were not significant (p = 0.105-0.795).
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Affiliation(s)
- Leif J J Bäck
- Departments of Otorhinolaryngology - Head and Neck Surgery
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Anghel AG, Grumezescu AM, Chirea M, Grumezescu V, Socol G, Iordache F, Oprea AE, Anghel I, Holban AM. MAPLE fabricated Fe3O4@Cinnamomum verum antimicrobial surfaces for improved gastrostomy tubes. Molecules 2014; 19:8981-94. [PMID: 24979402 PMCID: PMC6271288 DOI: 10.3390/molecules19078981] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 06/14/2014] [Accepted: 06/23/2014] [Indexed: 11/17/2022] Open
Abstract
Cinnamomum verum-functionalized Fe3O4 nanoparticles of 9.4 nm in size were laser transferred by matrix assisted pulsed laser evaporation (MAPLE) technique onto gastrostomy tubes (G-tubes) for antibacterial activity evaluation toward Gram positive and Gram negative microbial colonization. X-ray diffraction analysis of the nanoparticle powder showed a polycrystalline magnetite structure, whereas infrared mapping confirmed the integrity of C. verum (CV) functional groups after the laser transfer. The specific topography of the deposited films involved a uniform thin coating together with several aggregates of bio-functionalized magnetite particles covering the G-tubes. Cytotoxicity assays showed an increase of the G-tube surface biocompatibility after Fe3O4@CV treatment, allowing a normal development of endothelial cells up to five days of incubation. Microbiological assays on nanoparticle-modified G-tube surfaces have proved an improvement of anti-adherent properties, significantly reducing both Gram negative and Gram positive bacteria colonization.
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Affiliation(s)
- Alina Georgiana Anghel
- ENT, "Carol Davila" University of Medicine and Pharmacy, Traian Vuia no.6, Bucharest 020956, Romania.
| | - Alexandru Mihai Grumezescu
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Faculty of Applied Chemistry and Materials Science, Politehnica University of Bucharest, Polizu Street no 1-7, Bucharest 011061, Romania.
| | - Mariana Chirea
- Departamento de Química Fisica, Universidade de Vigo, 36310 Vigo, Pontevedra, Spain.
| | - Valentina Grumezescu
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Faculty of Applied Chemistry and Materials Science, Politehnica University of Bucharest, Polizu Street no 1-7, Bucharest 011061, Romania.
| | - Gabriel Socol
- National Institute for Lasers, Plasma & Radiation Physics, Lasers Department, P.O. Box MG-36, Bucharest-Magurele, Bucharest 769231, Romania.
| | - Florin Iordache
- Flow Cytometry and Cell Therapy Laboratory, Institute of Cellular Biology and Pathology "Nicolae Simionescu" (ICBP), Bucharest 050568, Romania.
| | - Alexandra Elena Oprea
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Faculty of Applied Chemistry and Materials Science, Politehnica University of Bucharest, Polizu Street no 1-7, Bucharest 011061, Romania.
| | - Ion Anghel
- ENT, "Carol Davila" University of Medicine and Pharmacy, Traian Vuia no.6, Bucharest 020956, Romania.
| | - Alina Maria Holban
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Faculty of Applied Chemistry and Materials Science, Politehnica University of Bucharest, Polizu Street no 1-7, Bucharest 011061, Romania.
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Habib SF, Ahmed S, Skelly R, Bhatt K, Patel B, Lowe D, Tuson J, Rogers SN. Developing a protocol for gastrostomy tube insertion in patients diagnosed with head and neck cancer. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 117:551-559. [DOI: 10.1016/j.oooo.2013.12.412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 12/01/2013] [Accepted: 12/30/2013] [Indexed: 01/05/2023]
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Wang J, Liu M, Liu C, Ye Y, Huang G. Percutaneous endoscopic gastrostomy versus nasogastric tube feeding for patients with head and neck cancer: a systematic review. JOURNAL OF RADIATION RESEARCH 2014; 55:559-67. [PMID: 24453356 PMCID: PMC4014167 DOI: 10.1093/jrr/rrt144] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 11/14/2013] [Accepted: 11/17/2013] [Indexed: 05/29/2023]
Abstract
There are two main enteral feeding strategies-namely nasogastric (NG) tube feeding and percutaneous gastrostomy-used to improve the nutritional status of patients with head and neck cancer (HNC). But up till now there has been no consistent evidence about which method of enteral feeding is the optimal method for this patient group. To compare the effectiveness of percutaneous gastrostomy and NGT feeding in patients with HNC, relevant literature was identified through Medline, Embase, Pubmed, Cochrane, Wiley and manual searches. We included randomized controlled trials (RCTs) and non-experimental studies comparing percutaneous gastrostomy-including percutaneous endoscopic gastrostomy (PEG) and percutaneous fluoroscopic gastrostomy (PFG) -with NG for HNC patients. Data extraction recorded characteristics of intervention, type of study and factors that contributed to the methodological quality of the individual studies. Data were then compared with respect to nutritional status, duration of feeding, complications, radiotherapy delays, disease-free survival and overall survival. Methodological quality of RCTs and non-experimental studies were assessed with separate standard grading scales. It became apparent from our studies that both feeding strategies have advantages and disadvantages.
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Affiliation(s)
- Jinfeng Wang
- Department of Radiation Oncology, The Affiliated Lianyungang Hospital of Bengbu Medical College, Jiangsu, China
| | - Minjie Liu
- Faculty of Nursing, University of NanTong, Jiangsu, China
| | - Chao Liu
- Department of Emergency Surgery, Bengbu Medical University, Anhui, China
| | - Yun Ye
- Faculty of Nursing, University of NanTong, Jiangsu, China
| | - Guanhong Huang
- Department of Radiation Oncology, Second People Hospital of Lianyungang, 222000, Lianyungang, Jiangsu, China
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Virani A, Kunduk M, Fink DS, McWhorter AJ. Effects of 2 different swallowing exercise regimens during organ-preservation therapies for head and neck cancers on swallowing function. Head Neck 2014; 37:162-70. [PMID: 24347440 DOI: 10.1002/hed.23570] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2013] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND This study investigated the effects of 2 different swallowing exercise regimens performed during radiation therapy with/without chemotherapy on swallowing function. METHODS Fifty patients were recruited prospectively to 2 groups (the exercise group, n = 26 and the repetitive swallow group, n = 24). Functional Oral Intake Scale (FOIS) scores and percutaneous endoscopic gastrostomy (PEG) placements were compared at posttreatment and at 3 months. RESULTS The exercise group eliminated significantly more PEG tubes at 3 months posttreatment compared to the swallow group (16% vs 50%). Among patients who received both radiation and chemotherapy, the exercise group had significantly less PEG tubes immediately posttreatment as well as 3 months posttreatment (35% and 10%), compared to the swallow group (69% and 50%). CONCLUSION Findings indicate significant benefits of the exercise group's exercise regimen in reducing PEG dependence and oral intake difficulties.
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Affiliation(s)
- Aneesha Virani
- Department of Communication Sciences and Disorders, Louisiana State University, Baton Rouge, Louisiana
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Kramer S, Newcomb M, Hessler J, Siddiqui F. Prophylactic versus reactive PEG tube placement in head and neck cancer. Otolaryngol Head Neck Surg 2013; 150:407-12. [PMID: 24381015 DOI: 10.1177/0194599813517081] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To understand the impact of percutaneous endoscopic gastrostomy (PEG) tube placement timing on tube duration, weight loss, and disease control in patients with head and neck cancer (HNC). SETTING A tertiary academic center. STUDY DESIGN Historical cohort study. SUBJECTS AND METHODS Seventy-four patients with HNC were reviewed. Patients underwent cisplatinum-based chemoradiation therapy with or without surgical resection. They received a PEG tube either before radiation therapy began (prophylactic) or after (reactive). Patients were matched on the basis of age, gender, TNM stage, tumor subsite, human papillomavirus (HPV) status, and chemoradiation dose. RESULTS Patients receiving reactive PEG tubes had them in place for fewer days than those placed prophylactically (227 vs 139 days, P < .01). There was no difference in percentage weight loss at 2, 6, or 12 months. There was no difference in survival or disease control between the groups. CONCLUSIONS Reactive PEG tube placement may afford patients a shorter duration of usage without incurring greater weight loss or poorer oncologic outcomes.
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Affiliation(s)
- Scott Kramer
- College of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Via MA, Mechanick JI. Malnutrition, Dehydration, and Ancillary Feeding Options in Dysphagia Patients. Otolaryngol Clin North Am 2013; 46:1059-71. [DOI: 10.1016/j.otc.2013.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Ogino H, Akiho H. Usefulness of percutaneous endoscopic gastrostomy for supportive therapy of advanced aerodigestive cancer. World J Gastrointest Pathophysiol 2013; 4:119-125. [PMID: 24244880 PMCID: PMC3829456 DOI: 10.4291/wjgp.v4.i4.119] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Revised: 08/06/2013] [Accepted: 10/16/2013] [Indexed: 02/06/2023] Open
Abstract
Aerodigestive cancer, like esophageal cancer or head and neck cancer, is well known to have a poor prognosis. It is often diagnosed in the late stages, with dysphagia being the major symptom. Insufficient nutrition and lack of stimulation of the intestinal mucosa may worsen immune compromise due to toxic side effects. A poor nutritional status is a significant prognostic factor for increased mortality. Therefore, it is most important to optimize enteral nutrition in patients with aerodigestive cancer before and during treatment, as well as during palliative treatment. Percutaneous endoscopic gastrostomy (PEG) may be useful for nutritional support. However, PEG tube placement is limited by digestive tract stenosis and is an invasive endoscopic procedure with a risk of complications. There are three PEG techniques. The pull/push and introducer methods have been established as standard techniques for PEG tube placement. The modified introducer method, namely the direct method, allows for direct placement of a larger button-bumper-type catheter device. PEG tube placement using the introducer method or the direct method may be a much safer alternative than the pull/push method. PEG may be recommended in patients with aerodigestive cancer because of the improved complication rate.
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