Prophylactic Feeding Tubes for Patients with Locally Advanced Head-and-Neck Cancer Undergoing Combined Chemotherapy and Radiotherapy—Systematic Review and Recommendations for Clinical Practice

Abstract

The available evidence was insufficient to draw definitive conclusions about the effectiveness of prophylactic feeding tubes in the target patient population or to support an evidence-based practice guideline. After review of the evidence, of guidelines from other groups, and of current clinical practice in Canada, the multidisciplinary panel made consensus-based recommendations regarding comprehensive interdisciplinary clinical care before, during, and after cancer treatment. The recommendations are based on the expert opinion of the panel members and on their understanding of best clinical practice.

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

“…Previous Systematic Reviews on the Impact of Prophylactic PEG Use Given the clinical controversy that exists, recent systematic reviews have assessed the benefits and risks associated with prophylactic PEG tube placement in patients with HNC [73][74][75][76]. Many of these reviews have only considered outcomes relating to nutrition, weight loss, and/or quality of life and have neglected swallowing-related outcomes [74,76,77].…”

“…Many of these reviews have only considered outcomes relating to nutrition, weight loss, and/or quality of life and have neglected swallowing-related outcomes [74,76,77]. Others have neglected to assess the quality of the studies included in their reviews [74,75].…”

The role of dietary counseling and nutrition support in head and neck cancer patients

“…Recent reviews have failed to provide evidence either for or against a role for nutrition support. In 2011, two reviews were published and due to a lack of high-quality studies, only recommendations for future studies could be made [23,24]. Multicenter RCTs and well designed observation studies at multiple sites that examine nutrition support were recommended [23]; however, the fundamental nature of the intervention makes randomization to a placebo difficult.…”

Quelle prise en charge nutritionnelle des patients atteints du cancer de la sphère oto-rhino-laryngée traités par la radiothérapie ? Une mise au point

“…Cependant, elle est nettement meilleure dans le bras d'étude six mois après le début du traitement. Une méta-analyse récente d'Orphanidou et al publiée en 2011 [48] a recherché le bénéfice et le risque d'une alimentation entérale prophylactique pour les patients avec un carcinome épidérmoïde de la sphère ORL chez qui une radiochimiothérapie concomitante à visée curative est prévue. Les auteurs recommandent que l'alimentation entérale doit être envisagée chez les patients avec un intestin fonctionnel qui sont incapables d'assurer les besoins nutritionnels journaliers par voie orale et de l'installer d'une façon individuelle à visée prophylactique chez les patients avec un ou plusieurs des signes suivants : perte de poids importante (plus de 5 % à 1 mois et plus de 10 % en 6 mois), l'indice de masse corporelle inférieur à 18,5, la dysphagie, l'anorexie, la déshydratation, la douleur ou d'autres symptômes qui peuvent altérer l'alimentation par voie orale.…”