Reduced feeding tube duration with intensity‐modulated radiation therapy for head and neck cancer: A Surveillance, Epidemiology, and End Results‐Medicare Analysis

Abstract

Background Intensity-modulated radiation therapy (IMRT) is a technologically advanced and resource-intensive method of delivering radiation therapy (RT) used to minimize toxicity for patients with head and neck cancers (HNC). Dependence on feeding tubes is a significant marker of toxicity of RT. The goal of this analysis was to compare the placement and duration of feeding tube use for patients with HNC from 1999-2011. Methods The cohort, demographics, and cancer-related variables were determined using the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database and analyzed regarding treatment details using claims data. Results A total of 2993 patients were identified. With a median follow-up of 47 months, 54.4% of patients had a feeding tube placed. The median duration from feeding tube placement to removal was 277 days. On zero-inflated negative binomial regression, patients treated with IMRT and 3DRT (non-IMRT) had similar rates of feeding tube placement (odds ratio (OR) 1.10; p=.35); however, patients treated with 3DRT had the feeding tube in place 1.18 times longer than those treated with IMRT (p=.03). The difference was only seen amongst patients treated with definitive radiation; patients treated with surgery and adjuvant radiation had no statistically significant difference in placement or duration. Conclusions Patients with HNC treated with definitive IMRT had significantly shorter duration of feeding tubes in place than those treated with 3DRT. These data suggest that there may be significant quality of life benefits to IMRT with respect to long-term swallowing function for patients.

Two‐year prevalence of dysphagia and related outcomes in head and neck cancer survivors: An updated SEER‐Medicare analysis

“…Population‐level data are critical to examine broad outcomes outside academic institutions. Prior population‐level analyses from the United States often use Surveillance, Epidemiology, and End Results (SEER)‐Medicare; these include analyses of feeding tube duration as a function of radiotherapy modality, case‐control comparisons of aspiration pneumonia risk after chemoradiation (CRT), examination of dysphagia as a predictor of morbidity, as well as quality studies suggesting positive impact of early speech pathology utilization …”

“…analyses from the United States often use Surveillance, Epidemiology, and End Results (SEER)-Medicare; these include analyses of feeding tube duration as a function of radiotherapy modality, 5 case-control comparisons of aspiration pneumonia risk after chemoradiation (CRT), 2 examination of dysphagia as a predictor of morbidity, 6 as well as quality studies suggesting positive impact of early speech pathology utilization. 7 Perhaps, the most comprehensive assessment of national HNC trends in dysphagia using the SEER-Medicare database was published by Francis et al (2010) 8 reporting 3-year prevalence of dysphagia, stricture, and pneumonia of 40%, 7%, and 10%, respectively, among 8002 patients treated between the years 1992 and 1999.…”

Quality of care and short and long‐term outcomes of oropharyngeal cancer care in the elderly

“…Gastrostomy dependence was less likely for patients receiving higher quality care, but higher quality care was not associated with differences in survival in patients with gastrostomy dependence. [16][17][18][19][20][21][22][23][24] In addition to chemotherapy, there is a known relationship between radiation dose and the extent of short-term and longterm soft tissue toxicity, with doses >60 Gy associated with an increased risk of late dysphagia and gastrostomy use. In elderly patients with OPSCC, we found no significant association between high-quality care and the likelihood of dysphagia and gastrostomy dependence, but higher quality care was associated with improved survival in patients with dysphagia or gastrostomy dependence.…”

“…[13][14][15] The majority of patients with OPSCC treated with radiation have a gastrostomy placed before or during treatment, despite a growing body of evidence that suggests that prophylactic gastrostomy placement is associated with worse long-term swallowing outcomes. [16][17][18][19][20][21][22][23][24] In addition to chemotherapy, there is a known relationship between radiation dose and the extent of short-term and longterm soft tissue toxicity, with doses >60 Gy associated with an increased risk of late dysphagia and gastrostomy use. [25][26][27] In OPSCC, a dose-response relationship has been demonstrated between the radiation dose to the superior constrictors, the middle constrictors, the base of tongue, and severe dysphagia.…”

Optimising nutrition support in patients with head and neck cancer

“…To reduce the risk of secondary cancers developing or other chronic health diseases, it is strongly recommended that cancer survivors strive to maintain an optimal weight and maintain a healthy lifestyle (Arends et al, 2017). Given patients are recovering more quickly from treatment side effects due to advances in technology (Beadle et al, 2017) and the increasing incidence of HPV-related tumours is resulting in younger patients with improved survival outcomes (Mallen-St Clair et al, 2016), the transition into survivorship is becoming increasingly important to address. However, when designing education programs, long-term toxicities, which either persist posttreatment (e.g.…”