Validation of an updated evidence-based protocol for proactive gastrostomy tube insertion in patients with head and neck cancer

Abstract

The results of this study confirm that the updated high-risk category in the protocol for the swallowing and nutrition management of patients with head and neck cancer remains valid to predict proactive gastrostomy in a mixed population receiving helical intensity-modulated radiotherapy and 3-D conformal radiotherapy. The protocol has an improved sensitivity and specificity and hence remains just as relevant for advanced techniques of radiation treatment delivery.

Optimising nutrition support in patients with head and neck cancer

“…Of the 181 that were deemed low risk, 18% (n=32) were deemed to have been candidates for a proactive gastrostomy and 82% (n=149) were correctly identified to not require a proactive gastrostomy (true negatives). Thus the protocol has a high sensitivity and specificity and a high positive predictive value (92%) in classifying those who would benefit from a proactive gastrostomy (Brown et al, 2016b). Age was not found to be associated with the outcome "met criteria for proactive gastrostomy" (p=0.463), however smoking status was associated (p=0.041).…”

“…Whilst we have previously shown the guidelines in their current format have a high validity (Brown et al, 2016b), this study has confirmed that the two key variables of tumour site and treatment are strongly associated to a number of other clinical variables, thus eliminating the need to include any additional variables which would unnecessarily add to the complexity of the high risk criteria definition. The significance of tumour site is expected given the role of the pharynx in the swallowing process.…”

“…The validated revised Australian protocol describing the risk factors which inform the high risk criteria for consideration of proPEG insertion (Brown et al, 2016b) was selected to be used for the studies included in this thesis. o Unintentional weight loss >10% in 6 months o BMI <20 with unintentional weight loss 5-10% in 6 months o Dietitian assessment SGA C Abbreviations: BMI=Body Mass Index; ENT=Ear Nose Throat; TNM=Tumour, Nodal, Metastases Staging; PGSGA=Patient-Generated Subjective Global Assessment; SGA=Subjective Global Assessment; SSG=Split Skin Graft.…”

“…Whilst our previous research has indicated that the protocol has a high sensitivity and specificity in predicting patients that would benefit from a proactive gastrostomy (Brown et al, 2016b), the aim of this study was to explore whether any of these other newly identified relevant clinical factors should also be considered and incorporated into the protocol to improve the validity even further.…”

“…A validated protocol has been developed in Australia (Brown et al, 2016b) The true extent of protocol implementation is unknown, however the literature continues to report the approach to prophylactic gastrostomy selection remains varied between hospitals in Australia (Brown & Findlay, 2011) and worldwide (Koyfman & Adelstein, 2012;Moor et al, 2010;Orphanidou et al, 2011). The protocol uses clinical information at diagnosis based on tumour site and treatment plan and nutritional status to determine the patients' future nutrition risk rating and pathway of care.…”