Attitudes of radiation oncologists to percutaneous endoscopic gastrostomy in patients with head and neck cancer and eating difficulties: A survey in China

Multidisciplinary survey on use of feeding tubes in head and neck cancer patients undergoing chemoradiotherapy in Germany-the SUFEETUBE project

BACKGROUND AND OBJECTIVE

Data on enteral tube feeding in head and neck cancer (HNC) patients undergoing chemoradiotherapy vary considerably between German institutions. This survey aims to investigate the management of feeding tubes in an interdisciplinary context across Germany.

MATERIALS AND METHODS

Between December 2022 and May 2023, 70 participants (42 radiation oncologists, 12 medical oncologists, 14 head and neck surgeons, and 2 physicians covering several specialties) responded to our web-based survey. In addition to the type of institution (university hospital, private practice, etc.), their age, and professional experience (in years), participants were asked several questions on the indication and institutional policy for tube placement and management (prophylactic/reactive nasogastric or gastrostomy tube). All questions were mandatory single- or multiple-choice questions, while additional comments were possible by email.

RESULTS

Most participants were employed at a university hospital (n = 52; 74.3%) and came from a radiation oncology background (n = 42; 60%). Fifty-four contributors (77.1%) reported that no nutritional risk screening prior to chemoradiotherapy was routinely performed, and 71.4% (n = 50) stated that no standardized protocol was used at the institution to set the indication for tube placement. Generally, policies and methods of tube feeding vary considerably between the individual institutions and specialties. However, the majority (n = 56, 80%) recommended a prophylactic percutaneous enteral gastrostomy (PEG) tube to their patients before chemoradiotherapy. Still, there was no consistent trend regarding the approach for reactive tube feeding.

CONCLUSION

The policies and methods of tube feeding vary considerably between the individual institutions and specialties in Germany. In the era of individualized medicine, uniform protocols are difficult to establish. However, a baseline nutritional risk screening could simplify decision-making in clinical practice.

Comparison Between Percutaneous Endoscopic Gastrostomy and Nasogastric Feeding in 160 Patients with Swallowing Disturbances: A Two-Year Follow-Up Study

Purpose

We retrospectively compared the complications, blood biochemical indexes and outcomes in patients with swallowing disturbances receiving nasogastric tube (NGT) feeding and percutaneous endoscopy gastrostomy (PEG).

Methods

Among 160 patients, 72 cases received PEG and 88 cases received NGT. All patients were followed up for two years. We collected their clinical data from the medical records. Indicators, such as body mass index (BMI), white blood cell (WBC), hemoglobin (HGB), complications, including recurrent aspiration pneumonia, gastrointestinal bleeding, reflux esophagitis, and outcomes (survival or death) were compared between the two groups semi-annually.

Results

SAt both six months and one year after receiving treatment, there was no statistical difference between the two groups in indicators, complications and outcomes, with all P >0.05. It can be seen that, when the patients were followed up for one and a half years18 months, ALB was lower in the NGT group (33.81±0.46) compared with the PEG group (36.14±0.50) (P <0.05). After two years of follow-up, differences between the NGT and PEG group could be seen in a variety of indicators, including BMI (20.08±0.27 vs 21.03±0.25), WBC (9.12±0.56 vs 7.08±0.29), ALB (33.11±0.43 vs 35.75±0.49), creatinine (55.07±1.83 vs 63.21±2.94), and the complications, such as aspiration pneumonia, gastrointestinal bleeding, reflux esophagitis, and electrolyte disorder, in the PEG group were significantly reduced compared to the NGT groupthan that in its counterpart, P <0.05. In the two-year follow-up period, there were 13 and 22 patients died in the PEG group and NGT group, respectively.

Conclusion

Both techniques are safe and effective in the short term. However, on a longer-term basis, PEG is shown to be superior to NGT feeding in improving nutrition and preventing common complications for patients with swallowing disturbances.

Clinician's attitude to enteral nutrition with percutaneous endoscopic gastrostomy: a survey in China

BACKGROUND

Percutaneous endoscopic gastrostomy (PEG) is recommended for long-term enteral nutrition. However, long-term nasogastric (NGT) feeding is still commonplace in China. We surveyed Chinese clinicians' opinions toward PEG feeding in order to identify the potential barriers to acceptancy of PEG feeding.

METHODS

A self-reported questionnaire was developed and distributed to 600 doctors. Five-point Likert scales were used for most responses.

RESULTS

Of 525 respondents, the mainly nutritional support method was NGT while PEG was less used. Doctors working in the tertiary class A hospitals and radiotherapy department were more likely to choose PEG feeding (p = 0.000). Overall, 241 (46%) participants did not know PEG and 284 (54%) have different understanding degree of PEG. Age (p = 0.002), working life (p = 0.044) and professionalism (p = 0.005) were significantly related to the understanding of PEG. Levels of agreement was high (score of 3.47) for using PEG in patients with prolonged stroke-associated dysphagia. There was high agreement level in the statement that PEG was unnecessary when NGT could sustain the basic needs of patients, though better outcome can be predicted with PEG feeding. The highest scoring factor (score of 3.91) that influenced clinicians' choice of PEG was resistance from patients and families and the second one was the poor cooperation among departments (score of 3.80).

CONCLUSIONS

Doctors' insufficient knowledge of PEG feeding, resistance from patients and families, poor cooperation among departments, all these factors leading physicians to prefer more conservative treatment to avoid disputes rather than better ones.

Knowledge of medical professionals, their practices, and their attitudes toward traditional Chinese medicine for the prevention and treatment of coronavirus disease 2019: A survey in Sichuan, China

This study aimed to investigate the knowledge, practices, and attitudes of medical professionals toward Traditional Chinese Medicine (TCM) for the prevention and treatment of coronavirus disease 2019 (COVID-19). All 401 medical professionals were surveyed using an anonymous with an investigator using the Questionnaire star APP. The participants answered 14 questions; of the 401 participants, 55.2% agreed with the statement “TCM can be used for the prevention and treatment of COVID-19,” 40.4% remained neutral, and 4.4% disagreed. Moreover, 75.3% agreed with the statement “There is no specific drug for COVID-19,” 67% agreed with the statement “TCM can develop immunity to COVID-19” and 62.1% agreed with “TCM can alleviate the symptoms of patients with COVID-19.” Meanwhile, 69.1% were aware that TCM has been recommended for COVID-19 by the National Health Commission of the People’s Republic of China. Regarding the selection of sources of knowledge on whether “TCM can be used for the prevention and treatment of COVID-19,” There were 277, 123, 82, 369, and 17 participants selected sources from “Hospital training,” “Academic journals,” “Academic Conferences,” “Social media platforms (such as WeChat)” and “Others,” respectively. Further, 358 participants will take TCM for the prevention of COVID-19. Multiple logistic regression analysis showed that age, major and received TCM treatment within the last five years were independent factors affecting the participants’ attitudes. In the absence of specific drugs for COVID-19, more than half of the participants agreed that TCM could be used for the prevention and treatment of COVID-19 and most participants are willing to take TCM to prevent COVID-19, although unsure about its effectiveness. The main information sources on TCM for the treatment and prevention of COVID-19 were social platforms and hospital training.

A retrospective analysis on epidemiological characteristics of home enteral nutrition: results from a Chinese tertiary hospital in 2018

BACKGROUND

The use of home enteral nutrition (HEN) has increased enormously. HEN has been shown to decrease length of stays, improve clinical outcomes, and increase quality of life. Literature on HEN epidemiology has also sprouted recently. Nevertheless, studies on Chinese HEN users are hardly seen. The objective of this study was thus to describe the epidemiological characteristics of HEN users from a Chinese tertiary hospital in 2018.

METHODS

Data were retrospectively analyzed using the personal patient profiles we created upon each HEN initiation. In the year of 2018, 2007 patients and a cumulative total of 3375 episodes were recorded.

RESULTS

The median age was 61 (IQR 46-75) years, and 63 (IQR 49-75) for males and 55 (IQR 43-72) for females. The most frequent indication for HEN implementation was oncological diseases (35.8%), followed by digestive diseases (13.4%), and neurological diseases (9.0%). Overall, 90.0% of the episodes were prescribed for oral nutrition supplement (ONS) and 9.5% for tube feeding (TF). Majority (70.8%) of the episodes comprised standard commercial formula.

CONCLUSIONS

Our study revealed some fundamental epidemiological characteristics of Chinese HEN patients. This preliminary single-center study has multiple limitations but still possesses revelatory and referential significance for other Chinese practitioners in the field of HEN. In future, multicenter studies and qualified HEN registries are widely needed in China.