Impact of prophylactic percutaneous endoscopic gastrostomy on malnutrition and quality of life in patients with head and neck cancer — a randomized study

Silander, Ewa; Nyman, Jan; Bove, Mogens; Johansson, Leif; Larsson, S; Hammerlid, Eva

doi:10.1002/hed.21700

Cited by 193 publications

(249 citation statements)

References 38 publications

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“…Recently, a randomized controlled trial showed evidence for prophylactic PEG placement in the prevention of malnutrition and improved quality of life in patients with advanced head and neck cancer (12). Moreover, Raykher reported that PEG feeding allowed CRT to continue without interruption in 93% of patients with head and neck cancer (13).…”

Section: Discussionmentioning

confidence: 99%

Efficacy of percutaneous endoscopic gastrostomy on unplanned treatment interruption and nutritional status in patients undergoing chemoradiotherapy for advanced head and neck cancer

et al. 2015

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:Objective : Efficacy of percutaneous endoscopic gastrostomy (PEG) on unplanned treatment interruption and nutritional status was examined in patients undergoing chemoradiotherapy (CRT) for advanced head and neck cancer. Methods : We retrospectively reviewed hospital charts of 44 patients with advanced head and neck cancer who were treated with CRT. Results : CRT-induced mucositis of grade 3 or worse and inadequate oral intake of less than one third of their usual intake developed in 33 patients who were recommended PEG placement, but not in 11 patients. Thirteen patients accepted PEG placement and then completed CRT (compliant group). However, among 20 patients who refused both PEG and nasogastoric tube (NGT) placements (non-compliant group), 10 required unplanned interruptions of CRT at a radiation dose around 30-40 Gy (UI-CRT group) while 10 others could complete CRT without interruption (C-CRT group) CRT. Total serum protein levels were significantly decreased after CRT in all patients. Discussion : It is suggested that therapeutic PEG placement is useful for preventing unplanned interruption of CRT in patients with advanced head and neck cancer. After severe mucositis and inadequate oral intake have developed during CRT, PEG placement should be considered before the radiation therapy dose of 30 Gy.

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Section: Discussionmentioning

confidence: 99%

Efficacy of percutaneous endoscopic gastrostomy on unplanned treatment interruption and nutritional status in patients undergoing chemoradiotherapy for advanced head and neck cancer

et al. 2015

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“…Nasopharyngeal carcinoma is a subset of cancer in this area, with differences in natural history and treatment regimens were blended in with the studies. The number of nasopharyngeal carcinoma patients in these studies were 23%, 15% and 1.5% in Chen et al (2009) Mercuri et al (2010 and Silander et al (2011)'s studies, respectively. These results may not fit nasopharyngeal carcinoma because the chemotherapy regimen and target volume of radiation are different.…”

Section: Comparison Of Treatment Compliance and Nutritional Outcomes mentioning

confidence: 79%

“…They found 4.9 and 11.0% of weight loss from baseline in PPEG group and non-PPEG group (Mercuri et al, 2009). But Silander et al (2011) conducted a randomised control trial to evaluate the effect of PPEG on malnutrition and quality of life. They included 134 head and neck cancers, mainly oropharynx and oral cavity cancer.…”

Section: Discussionmentioning

confidence: 99%

“…Nourishment can be undertaken via percutaneous endoscopic gastrostomy and inserting the feeding tube to the stomach through the abdominal wall before radiation, called "prophylactic percutaneous endoscopic gastrostomy" (PPEG). PPEG has been effective in the maintenance of weight, reduced set-up error, reduced hospitalisation, reduced treatment interruption and improved quality of life (Lee et al, 1998;Chang et al, 2009;Mercuri et al, 2009;Salas et al, 2009;Chen et al, 2010;Assenat et al, 2011;Silander et al, 2011).…”

Section: Comparison Of Treatment Compliance and Nutritional Outcomes mentioning

confidence: 99%

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Comparison of Treatment Compliance and Nutritional Outcomes among Patients with Nasopharyngeal Carcinoma with and without Percutaneous Endoscopic Gastrostomy during Chemoradiation

Peerawong

Phungrassami²,

Pruegsanusak³

et al. 2012

Asian Pacific Journal of Cancer Prevention

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Aims: The study aimed to compare treatment compliance and nutritional outcomes in nasopharyngeal carcinoma (NPC) patients during chemoradiation. Methods: Clinical information of patients with NPC that underwent chemoradiation during 2004-2009 were retrieved from the hospital database and retrospectively reviewed. Patients were categorised into a prophylactic percutaneous endoscopic gastrostomy (PPEG) group and a non-PPEG group. Clinical information including treatment compliance, weight, haematological and renal toxicity was compared. Results: A total of 219 patients were reviewed and categorised into PPEG (n=77) and non-PPEG (n=142). Significant differences in absolute percentage weight loss between groups were found from the 3 rd cycle of chemotherapy. There were 24.2, 20.3 and 24.8% in the third, the fourth and the fifth cycles of chemotherapy, respectively. Migration of grade 2 to grade 3 weight loss was obviously seen in the 3 rd cycle as well. A significant difference of grade 3 or more hypokalemia was found with values of 14.3% and 50% in the PPEG and non-PPEG groups, respectively. Other toxicity parameters and treatment compliance were not different between the groups. Conclusions: Use of PPEG resulted in decreased severe weight loss, reduced migration from grade 2 to grade 3 weight loss and reduced hypokalaemia. However, benefits in treatment compliance could not be detected. So consideration of PPEG in NPC patients requires care.

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“…There were no differences in BMI at six months, but the proPEG group had a higher QOL for some domains at some time points. The second study (neutral quality) had no difference in weight loss outcomes, treatment delays, unplanned admissions or survival between groups, but the proPEG group had better QOL at six months for a number of domains, and less swallow problems at one year (Silander et al, 2012). These two studies both provide level II evidence that the prophylactic approach does not improve clinical or nutrition outcomes (although weight change was only monitored from six months post-treatment) but can improve some aspects of QOL compared to the reactive approach, with no impact on long-term swallow.…”

Section: Tube Feeding: Optimal Type and Timingmentioning

confidence: 90%

Optimising nutrition support in patients with head and neck cancer

Brown¹

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Impact of prophylactic percutaneous endoscopic gastrostomy on malnutrition and quality of life in patients with head and neck cancer — a randomized study

Abstract: Prophylactic PEG was associated with significantly earlier start and longer use of enteral nutrition, fewer malnourished patients over time, and improved HRQOL at 6 months posttreatment start.

Cited by 193 publications

References 38 publications

Efficacy of percutaneous endoscopic gastrostomy on unplanned treatment interruption and nutritional status in patients undergoing chemoradiotherapy for advanced head and neck cancer

Efficacy of percutaneous endoscopic gastrostomy on unplanned treatment interruption and nutritional status in patients undergoing chemoradiotherapy for advanced head and neck cancer

Comparison of Treatment Compliance and Nutritional Outcomes among Patients with Nasopharyngeal Carcinoma with and without Percutaneous Endoscopic Gastrostomy during Chemoradiation

Optimising nutrition support in patients with head and neck cancer

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