Swallowing outcomes for patients with oropharyngeal squamous cell carcinoma treated with primary (chemo)radiation therapy receiving either prophylactic gastrostomy or reactive nasogastric tube: A prospective cohort study

Goff, Diane; Coward, Stephanie; Fitzgerald, Alastair; Paleri, Vinidh; Moor, James; Patterson, Joanne

doi:10.1111/coa.12836

Cited by 13 publications

(13 citation statements)

References 22 publications

(53 reference statements)

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“…A prior randomised study was converted to a prospective study after poor accrual [17]; in this study, an analysis of 32 PEG and 73 NG patients grade 3 dysphagia was found to significantly higher 6 months post treatment for PEG patients. A recent prospective cohort study [22] of 53 oropharyngeal cancer patients with normal pretreatment diet found higher MDADI scores at 12 months post treatment for patients managed with a reactive NG tube vs. a prophylactic gastrostomy (mean total MDADI 72.3 vs. 61.2) although differences were not statistically significant. In a retrospective analysis of 120 patients treated with chemoradiotherapy for head and neck cancer [21], gastrostomy dependence was higher at 12 months following a prophylactic gastrostomy (21% vs. 0%].…”

Section: Discussionmentioning

confidence: 90%

“…Previous studies are limited by potential confounding factors affecting why patients had received a prophylactic gastrostomy rather than a reactive approach to feeding [17,[21][22][23][24]38]. Clinicians may be more likely to recommend a prophylactic gastrostomy tube to patients they consider at higher risk of requiring enteral feeding support i.e., in patients with more advanced/bulky disease.…”

Section: Discussionmentioning

confidence: 99%

“…A potential concern with insertion of a prophylactic gastrostomy is that the convenience of enteral feeding may lead to slower reintroduction of oral intake post-treatment [15]. This is a highly controversial area, with some prospective [17,22] and retrospective [15,21,23,24] studies suggesting that approach of an NG tube as required may be associated with superior long-term swallow function. One randomised study did not find any difference in long-term swallow function (although lacked a validated dysphagia outcome) [13] whilst two more recent randomised controlled trials have failed to complete recruitment [17,25].…”

Section: Introductionmentioning

confidence: 99%

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Impact of choice of feeding tubes on long-term swallow function following chemoradiotherapy for oropharyngeal carcinoma

Prestwich¹,

Murray²,

Williams

et al. 2019

Acta Oncologica

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Background: Prior reports have raised concerns that a prophylactic gastrostomy may be detrimental to long-term swallow function. This study evaluates patient-reported swallow function following chemoradiotherapy for oropharyngeal carcinoma in relation to the use of a prophylactic gastrostomy or nasogastric (NG) tube as required. Material and methods: The MD Anderson Dysphagia Inventory (MDADI) was posted to 204 diseasefree patients at least 2 years following chemoradiotherapy for oropharyngeal carcinoma between 2010 and 2014. Results: Overall, 181/204 (89%) patients returned questionnaire at a median of 34 months post-treatment. 97/181 (54%) and 84/181 (46%) were managed with an approach of a prophylactic gastrostomy or NG tube as required, respectively. A prophylactic gastrostomy was associated with higher rates of enteral feeding (92% vs. 58%, p < .001), lower median percentage weight loss (7.0% vs. 9.4%, p < .001), increased duration of enteral feed (median 3.3 vs. 1.1 months, p < .001). There was no significant difference in patient-reported swallow function measured by MDADI summary scores and subscales for patients managed with an approach of prophylactic gastrostomy or NG as required. Duration of enteral feed correlated negatively with composite MDADI scores. A subgroup of 116/181 (64%) patients were documented as having been offered a choice of enteral feeding approach and therefore can be considered to represent clinical equipoise; there were no significant differences in MDADI scores according to route. Conclusions: Despite concern regarding the use of a prophylactic gastrostomy in prior studies, the approaches of using a prophylactic gastrostomy or an NG tube as required to support patients during/after chemoradiotherapy for oropharyngeal carcinoma were associated with similar long-term swallow outcomes.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of choice of feeding tubes on long-term swallow function following chemoradiotherapy for oropharyngeal carcinoma

Prestwich¹,

Murray²,

Williams

et al. 2019

Acta Oncologica

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“…There is an ongoing question in our field as to whether prophylactic feeding tube placement may contribute to long‐term dysphagia. Past studies have had mixed results, with some showing better long‐term quality of life and shorter tube dependence without prophylactic gastrostomy tube placement and others refuting this . Unfortunately, we are unable to determine definitively from our data which gastrostomy tubes were placed prophylactically and which were placed reactively, therefore, we were unable to analyze the possible contribution of this risk factor.…”

Section: Discussionmentioning

confidence: 75%

Individualized prediction of late‐onset dysphagia in head and neck cancer survivors

et al. 2020

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Background Limited data exist regarding which head and head and neck cancer (HNC) survivors will suffer from long‐term dysphagia. Methods From a population‐based cohort of 1901 Utah residents with HNC and ≥3 years follow‐up, we determined hazard ratio for dysphagia, aspiration pneumonia, or gastrostomy associated with various risk factors. We tested prediction models with combinations of factors and then assessed discrimination of our final model. Results Cancer site in the hypopharynx, advanced tumor classification, chemoradiation, preexisting dysphagia, stroke, dementia, esophagitis, esophageal spasm, esophageal stricture, gastroesophageal reflux, thrush, or chronic obstructive pulmonary disease were associated with increased risk of long‐term dysphagia. Our final prediction tool gives personalized risk calculation for diagnosis of dysphagia, aspiration pneumonia, or gastrostomy tube placement at 5, 10, and 15 years after HNC based on 18 factors. Conclusion We developed a clinically useful risk prediction tool to identify HNC survivors most at risk for dysphagia.

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“…However, the present literature is ambiguous on the relationship between prophylactic TF and long-term OD. 18,[62][63][64][65][66] Therefore, supplemental TF to maximize the chance to reach the nutritional target remains to be a regime that deserves validation.…”

Section: Discussionmentioning

confidence: 99%

Disease‐induced and treatment‐induced alterations in body composition in locally advanced head and neck squamous cell carcinoma

Willemsen

Hoeben

Lalisang

et al. 2019

J cachexia sarcopenia muscle

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Background Chemoradiation or bioradiation treatment (CRT/BRT) of locally advanced head and neck squamous cell carcinoma (LAHNSCC) comes with high toxicity rates, often leading to temporary tube feeding (TF) dependency. Cachexia is a common problem in LAHNSCC. Yet changes in body composition and muscle weakness during CRT/BRT are underexplored. Strong evidence on the effect of TF on body composition during treatment is lacking. The aim of this cohort study was to assess (i) the relationship of fat‐free mass index (FFMI) and handgrip strength (HGS) with CRT/BRT toxicity and outcome, (ii) body composition in patients treated with chemoradiation (cisplatin) vs. bioradiation (cetuximab), and (iii) the effect of the current TF regime on body composition and muscle strength. Methods Locally advanced head and neck squamous cell carcinoma patients treated with CRT/BRT between January 2013 and December 2016 were included (n = 137). Baseline measurements of body composition (bioelectrical impedance analysis) and HGS were performed. Toxicity grades (Common Terminology Criteria for Adverse Events) were scored. In a subset of 69 patients, weight loss, body composition, and HGS were additionally assessed during and after CRT/BRT. TF was initiated according to the Dutch guidelines for malnutrition. Results In this cohort (68% male, mean age 59 ± 8 years), the incidence of baseline muscle wasting, defined as FFMI < P10, was 29%. Muscle wasting was present in 23 of 100 (23%) chemoradiation patients and 17 of 37 (46%) bioradiation patients (P = 0.009). Muscle‐wasted patients required more unplanned hospitalizations during CRT (P = 0.035). In the chemoradiation subset, dose‐limiting toxicity was significantly higher in wasted vs. non‐wasted patients (57% vs. 25%, P = 0.004). Median follow‐up was 32 months. Multivariate Cox regression analysis identified muscle wasting as independent unfavourable prognostic factor for overall survival [hazard ratio 2.1 (95% CI 1.1–4.1), P = 0.022] and cisplatin as favourable prognostic factor [hazard ratio 0.3 (95% CI 0.2–0.6), P = 0.001]. Weight and HGS significantly decreased during CRT/BRT, −3.7 ± 3.5 kg (P < 0.001) and −3.1 ± 6.0 kg (P < 0.001), respectively. Sixty‐four per cent of the patients required TF 21 days (range 0–59) after CRT/BRT initiation. Total weight loss during CRT/BRT was significantly (P = 0.007) higher in the total oral diet group (5.5 ± 3.7 kg) compared with the TF group (3.0 ± 3.2 kg). Loss of FFM and HGS was similar in both groups. Conclusions In LAHNSCC patients undergoing CRT/BRT, FFMI < P10 is an unfavourable prognostic factor for overall survival, treatment toxicity, and tolerance. Patients experience significant weight and FFM loss during treatment. Current TF regime attenuates weight loss but does not overcome loss of muscle mass and function during therapy. Future interventions should consider nutritional intake and additional strategies specifically targeting metabolism, loss of muscle mass, and function.

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Swallowing outcomes for patients with oropharyngeal squamous cell carcinoma treated with primary (chemo)radiation therapy receiving either prophylactic gastrostomy or reactive nasogastric tube: A prospective cohort study

Cited by 13 publications

References 22 publications

Impact of choice of feeding tubes on long-term swallow function following chemoradiotherapy for oropharyngeal carcinoma

Impact of choice of feeding tubes on long-term swallow function following chemoradiotherapy for oropharyngeal carcinoma

Individualized prediction of late‐onset dysphagia in head and neck cancer survivors

Disease‐induced and treatment‐induced alterations in body composition in locally advanced head and neck squamous cell carcinoma

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