Paleri V, Patterson J. Use of gastrostomy in head and neck cancer: a systematic review to identify areas for future research

The Newcastle upon Tyne Foundation Hospitals NHS Trust, Newcastle Upon Tyne, UK.
Clinical otolaryngology: official journal of ENT-UK; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery (Impact Factor: 2.11). 06/2010; 35(3):177-89. DOI: 10.1111/j.1749-4486.2010.02128.x
Source: PubMed


To perform a systematic review of studies, which investigate the role of gastrostomy tube feeding in head and neck squamous cell cancer.
A systematic review of the English literature, identifying areas of clinical equipoise and recommendations for future studies.
Varying practices in G-tube use in HNSCC, the benefits and disadvantages of G-tubes, the effect of G-tube placement on multidimensional outcomes in patients with head and neck cancer, including quality of life and health economics and to draw themes that may lend themselves to future research.
The search identified 216 articles of which 59 were considered relevant. During treatment, a significant number of patients need enteral nutritional supplementation through nasogastric or G-tubes. Gastrostomy tubes have a good safety profile. Most clinicians agree that the use should be restricted to advanced tumours. Studies on prophylactic insertion of G-tubes do not show a consistent advantage to the nutritional status compared with NG tubes. At 1 year, G-tube retention rates vary between 10% and 30%. The presence of a feeding tube has a negative impact on quality of life. Placing G-tubes may have an adverse effect on swallowing after chemoradiation.
There is a lack of consensus among clinicians about indications for placing G-tubes. There is sufficient equipoise in this area for further investigation of the effect of varying feeding practices on functional outcomes, quality of life and health economics.

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    • "One hundred and fifty participants ( 56% ) were fitted with a feeding tube during their treatment for HNC , and our data show that having a tube was associated with a higher level of distress and a greater number of concerns . Previous studies have also suggested that feeding tubes can adversely affect quality of life ( Paleri & Patterson 2010 ) . Although nutritional support is extremely impor - tant for HNC patients , the benefits and risks of prophylac - tic gastrostomy feeding tubes are currently being questioned ( National Institute for Health Research 2015 ; Shaw et al . "
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    ABSTRACT: The aim of this study was to identify the distress, unmet needs and concerns of head and neck cancer (HNC) survivors in the first 5 years after treatment. Two hundred and eighty HNC survivors from three Scottish health boards responded to a cross-sectional postal survey in 2011. Questionnaires included the Distress Thermometer, Patient Concerns Inventory (PCI) and an adapted version of the PCI to measure unmet needs. One-third of the survivors had moderate or severe levels of distress, and 74% had at least one unmet need. The most common concerns and unmet needs included oral and eating problems, fear of recurrence and fatigue. Multivariate analysis revealed that being younger, out of work (not retired), ever having had a feeding tube fitted, having a greater number of comorbidities and living alone were associated with higher levels of distress, concerns and unmet needs. The diversity of concerns and unmet needs identified in this study highlights the importance of holistic needs assessment as part of follow-up care for HNC survivors with tailoring of support for particular concerns. Specific information resources and self-management strategies are required to help HNC survivors with the practical and functional consequences of HNC treatment. © 2015 John Wiley & Sons Ltd.
    European Journal of Cancer Care 07/2015; 24(5). DOI:10.111/ecc.12370 · 1.56 Impact Factor
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    • "short-term benefits, has led several centres to avoid prophylactic placement [6] [11]. Many factors influence the duration of enteral feeding and it has not been shown that the duration of enteral feeding after treatment is a surrogate for long-term swallow function. "
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    ABSTRACT: Two contrasting approaches of a prophylactic gastrostomy or a nasogastric tube as needed are widely used to support patients receiving chemoradiotherapy for head and neck cancer. The influence of the type and timing of enteral feeding tube support upon long-term swallowing is uncertain. This study analysed the patients' perspective on long-term swallowing, comparing two groups of patients who received chemoradiotherapy for oropharyngeal cancer managed with the two approaches. The MD Anderson Dysphagia Inventory (MDADI) was posted to 63 consecutive patients with oropharyngeal squamous cell cancer treated with concurrent chemoradiotherapy between January 2007 and June 2009, who had not required therapeutic enteral feeding before treatment and who were disease free on follow-up at least 2 years after treatment. In total, 56/63 patients completed questionnaires; 43 had been managed with a prophylactic gastrostomy and 13 with a policy of nasogastric tube as needed. There were no significant differences in all global, emotional, physical or functional domains of the MDADI according to enteral feeding strategy. Diet at 6 months after treatment was significantly correlated with better MDADI scores. In this study, the choice of a prophylactic gastrostomy or nasogastric tube as needed did not seem to influence long-term swallowing function.
    Clinical Oncology 11/2013; 26(2). DOI:10.1016/j.clon.2013.10.005 · 3.40 Impact Factor
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