Prophylactic versus reactive gastrostomy tube placement in advanced head and neck cancer treated with definitive chemoradiotherapy: A systematic review

McClelland, Shearwood; Andrews, J.Z.; Chaudhry, Huma E; Teckie, Sewit; Goenka, Anuj

doi:10.1016/j.oraloncology.2018.10.028

Cited by 48 publications

(42 citation statements)

References 28 publications

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“…In patients undergoing surgery, the nutritional intervention aims to meet the nutritional requirements right after the surgery trying to return to oral intake when possible. The use of gastrostomy feeding tube is still a matter of debate (59)(60)(61)(62)(63). Some studies have shown minimize weight loss and quick return to oral intake once the treatment is finished with the use of a nasogastric tube when clinically indicated (62,64).…”

Section: The Role Of the Specialized Dietitianmentioning

confidence: 99%

“…Some studies have shown minimize weight loss and quick return to oral intake once the treatment is finished with the use of a nasogastric tube when clinically indicated (62,64). However, other authors (61,63,65) report the use of prophylactic gastrostomy feeding tubes without increasing the risk of long-term swallowing dysfunction. Recently, a systematic review reported the advantages and disadvantages ( Figure 2) of both percutaneous endoscopic gastrostomy and nasogastric feeding tubes (66).…”

Section: The Role Of the Specialized Dietitianmentioning

confidence: 99%

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The Multidisciplinary Team (MDT) Approach and Quality of Care

et al. 2020

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The core function of a multidisciplinary team (MDT) is to bring together a group of healthcare professionals from different fields in order to determine patients' treatment plan. Most of head and neck cancer (HNC) units are currently led by MDTs that at least include ENT and maxillofacial surgeons, radiation and medical oncologists. HNC often compromise relevant structures of the upper aerodigestive tract involving functions such as speech, swallowing and breathing, among others. The impairment of these functions can significantly impact patients' quality of life and psychosocial status, and highlights the crucial role of specialized nurses, dietitians, psycho-oncologists, social workers, and onco-geriatricians, among others. Hence, these professionals should be integrated in HNC MDTs. In addition, involving translational research teams should also be considered, as it will help reducing the existing gap between basic research and the daily clinical practice. The aim of this comprehensive review is to assess the role of the different supportive disciplines integrated in an MDT and how they help providing a better care to HNC patients during diagnosis, treatment and follow up.

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Section: The Role Of the Specialized Dietitianmentioning

confidence: 99%

Section: The Role Of the Specialized Dietitianmentioning

confidence: 99%

The Multidisciplinary Team (MDT) Approach and Quality of Care

et al. 2020

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“…Feeding tubes can be placed prophylactically prior to initiation of therapy or reactively when patients develops need for nutritional support. A systematic review suggests that prophylactic feeding tube reduces the number of malnourished (> 10% loss of body weight) patients and improves QOL after treatment, but does increase chance for long term feeding tube dependence [76]. A retrospective review of treatment outcome of concurrent platinum-based chemoradiation for advanced laryngeal cancer showed that 7% of the patients required percutaneous gastrostomy, 6% had persistent dysphagia, and 2% had chronic lung aspiration [77].…”

Section: Multidisciplinary Care and Importance Of Functional Outcomementioning

confidence: 99%

Squamous cell carcinoma of head and neck: what internists should know

Jung

Narwal

Min

et al. 2020

Korean J Intern Med

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Squamous cell carcinoma of head and neck (SCCHN) is a group of cancer arising from mucosal surfaces of the head and neck. Optimal management of SCCHN requires a multidisciplinary team of surgical oncologists, radiation oncologists, medical oncologists, nutritionist, and speech-language pathologists, due to the complexity of anatomical structure and importance of functional outcome. Human papilloma virus (HPV)-related SCCHN represents a distinct subset from HPV negative SCCHN which is associated with carcinogen exposure such as cigarette smoking, betel nut use and alcohol. HPV related SCCHN responds better to concurrent chemoradiation and has better overall prognosis, compared to HPV negative SCCHN. Radiation therapy has been introduced to the treatment of SCCHN, administered concurrently with systemic chemotherapy for locoregional SCCHN, as well as a palliative measure for recurrent and/or metastatic (R/M) SCCHN. Recently, immune checkpoint inhibitors have been shown to improve overall survival in R/M-SCCHN and have been incorporated into the standard of care. Combination approaches with immune therapy and targeted therapy for biomarker enriched population based on genomics are being actively investigated and will shape the future of SCCHN treatment.

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“…Close nutritional and clinical monitoring is essential to identify patients who will benefit from an early PEG to avoid nutritional deterioration. This must be balanced with some evidence suggesting that gastrostomy leads to more prolonged tube dependency and long-term dysphagia [38][39][40].…”

Section: Nasal Tubesmentioning

confidence: 99%

Nutritional Support of Cancer Patients without Oral Feeding: How to Select the Most Effective Technique?

Nunes

Fonseca

Barata

et al. 2019

GE Port J Gastroenterol

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Background: Digestive tumours are among the leading causes of morbidity and mortality. Many cancer patients cannot maintain oral feeding and develop malnutrition. The authors aim to: review the endoscopic, radiologic and surgical techniques for nutritional support in cancer patients; address the strategies for nutritional intervention according to the selected technique; and establish a decision-making algorithm to define the best approach in a specific tumour setting. Summary: This is a narrative non-systematic review based on an electronic search through the medical literature using PubMed and UpToDate. The impossibility of maintaining oral feeding is a major cause of malnutrition in head and neck (H&N) cancer, oesophageal tumours and malignant gastric outlet obstruction. Tube feeding, endoscopic stents and gastrojejunostomy are the three main nutritional options. Nasal tubes are indicated for short-term enteral feeding. Percutaneous endoscopic gastrostomy (PEG) is the gold standard when enteral nutrition is expected for more than 3-4 weeks, especially in H&N tumour and oesophageal cancer patients undergoing definite chemoradiotherapy. A gastropexy push system may be considered to avoid cancer seeding. Radiologic and surgical gastrostomy are alternatives when an endoscopic approach is not feasible. Postpyloric nutrition is indicated for patients intolerant to gastric feeding and may be achieved through nasoenteric tubes, PEG with jejunal extension, percutaneous endoscopic jejunostomy and surgical jejunostomy. Oesophageal and enteric stents are palliative techniques that allow oral feeding and improve quality of life. Surgical or EUS-guided gastrojejunostomy is recommended when enteric stents fail or prolonged survival is expected. Nutritional intervention is dependent on the technique chosen. Institutional protocols and decision algorithms should be developed on a multidisciplinary basis to optimize nutritional care. Conclusions: Gastroenterologists play a central role in the nutritional support of cancer patients performing endoscopic techniques that maintain oral or enteral feeding. The selection of the most effective technique must consider the cancer type, the oncologic therapeutic program, nutritional aims and expected patient survival.

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Prophylactic versus reactive gastrostomy tube placement in advanced head and neck cancer treated with definitive chemoradiotherapy: A systematic review

Cited by 48 publications

References 28 publications

The Multidisciplinary Team (MDT) Approach and Quality of Care

The Multidisciplinary Team (MDT) Approach and Quality of Care

Squamous cell carcinoma of head and neck: what internists should know

Nutritional Support of Cancer Patients without Oral Feeding: How to Select the Most Effective Technique?

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