Impact of feeding tubes on prospective functional outcomes in patients with locally advanced head and neck cancer undergoing radiation therapy

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

“…All 20 studies relied, instead, on subjective evaluations to determine the presence/absence and/or severity of dysphagia-related function and/or quality of life during or after radiotherapy (see Tables 3 and 4). Thirteen studies used standardized measurement tools to assess swallowing-related outcomes: four used quality of life scales with swallowing-related questions [71,72,94,96], seven used scales that specifically measure swallow function and/or quality of life in patients with head and neck cancer [50,83,84,86,[92][93][94], two used generic dysphagia assessment scales that measure swallow-related function based on clinician and/or patient report [84,94], and one used radiation-related toxicity scales that measure swallow-related function based on physician report [87]. Four additional studies used diet level to assess swallow function [67,72,88,94], three failed to report how dysphagia was assessed [44,90,95], and four only reported on PEG prevalence/duration as a surrogate marker of dysphagia [46,85,89,91].…”

“…Eight studies measured dysphagia frequency and/or severity at multiple time points [22,67,71,72,84,87,88,95]. Fifteen studies evaluated swallowing during the chronic phase (C3 months posttreatment) [22, 50, 67, 71, 72, 83, 84, 86-88, 90, 92-95], with 11 evaluating swallowing at C12 months post treatment [22,67,71,72,83,84,88,[92][93][94][95] and eight evaluating dysphagia at C2 years post treatment [71,72,83,84,87,[92][93][94]. One additional study did not report on the timing of dysphagia assessment [44].…”

“…Two of the 20 studies were randomized controlled trials (RCTs) [71,72] (see Table 1), one followed a case-control design [83], and the remaining 17 involved observational cohorts (three prospective [84][85][86], nine retrospective [22,44,67,[87][88][89][90][91][92], three mixed (with some outcomes being retrieved retrospectively and others being collected prospectively) [46,93,94], and two unclear [50,95]). …”

“…Four studies used IMRT [50,[85][86][87], two used 3DCRT [88,92], one used conventional radiotherapy [46], four used various forms of radiotherapy [22,67,90,91], and nine were unclear regarding the type of radiotherapy used [44,71,72,83,84,89,[93][94][95] (see Table 1). …”

“…Seven studies included patients who either received no PEG or a therapeutic PEG as needed [67,72,84,85,87,91,93], three included only patients who received a therapeutic PEG (placed during or after radiotherapy) [44,89,94], one included patients who either had a therapeutic PEG or an NG tube as needed [88], and two included patients who either maintained oral nutrition or received an NG tube as needed [83,92]. The remaining five studies were unclear regarding their requirements for inclusion within the control group (although the majority included at least some patients managed with a therapeutic PEG [22,50,71,86,95]; see Table 1).…”