Long-term Swallow Function after Chemoradiotherapy for Oropharyngeal Cancer: The Influence of a Prophylactic Gastrostomy or Reactive Nasogastric Tube

Abstract

Background

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

“…Fifteen studies (75 %) enrolled patients with a range of head and neck cancers (see Table 1), four enrolled patients with only oropharyngeal cancer [87,88,92,93], and one included patients with specific HNC sites (oral, pharyngeal, and tumor colli) [71].…”

“…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]). …”

Optimising nutrition support in patients with head and neck cancer

“…Other studies have shown no difference in outcomes with feeding tube selection and suggest a reactive approach may be more favourable to reduce duration of feeding tube use (Kramer et al, 2014;Sheth, Sharp, & Walters, 2013). Whilst there are concerns that gastrostomy placement may result in gastrostomy dependency and increased dysphagia post-treatment (Corry et al, 2008;Ward et al, 2016), other studies have not supported this finding (Crombie et al, 2015;Prestwich et al, 2014).…”

“…There are concerns that gastrostomy placement may result in feeding tube dependency and increased dysphagia post-treatment (Corry et al, 2008), however several studies have shown that prophylactic gastrostomy placement does not impact on long-term swallow function (Crombie et al, 2015;Prestwich et al, 2014;Silander et al, 2012). Although not collected specifically as part of this study, additional research is being carried out locally to determine swallow function and incidence of dysphagia during and post-treatment, as this remains an important area of research and will be reported on separately.…”

“…Some studies have compared prophylactic gastrostomy to reactive gastrostomy (Kramer et al, 2014;Olson et al, 2013), or to a reactive nasogastric tube (Prestwich et al, 2014) or to either type of reactive feeding tube or no feeding tube (Lewis et al, 2014;Silander et al, 2012;Williams et al, 2012). Many of these historical cohort studies are deemed to have a high degree of selection bias, as patients with most advanced disease or nutritional deficits are often those selected for prophylactic gastrostomy.…”