Comparison of Nutritional and Clinical Outcomes in Patients with Head and Neck Cancer Undergoing Chemoradiotherapy Utilizing Prophylactic versus Reactive Nutrition Support Approaches

Abstract Background The optimal method of tube feeding for patients with head and neck cancer remains unclear. A validated protocol is available that identifies high-nutritional-risk patients who would benefit from prophylactic gastrostomy tube placement. Adherence to this protocol is ultimately det...

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Published inJournal of the Academy of Nutrition and Dietetics Vol. 118; no. 4; pp. 627 - 636
Main Authors Brown, Teresa E, Banks, Merrilyn D., PhD, Hughes, Brett G.M., FRACP, Lin, Charles Y., FRANZCR, Kenny, Lizbeth M., FRANZCR, Bauer, Judith D., PhD
Format Journal Article
LanguageEnglish
Published United States Elsevier Inc 01.04.2018
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Abstract Abstract Background The optimal method of tube feeding for patients with head and neck cancer remains unclear. A validated protocol is available that identifies high-nutritional-risk patients who would benefit from prophylactic gastrostomy tube placement. Adherence to this protocol is ultimately determined by clinical team discretion or patient decision. Objective The study aim was to compare outcomes after adherence and nonadherence to this validated protocol, thus comparing a prophylactic and reactive approach to nutrition support in this patient population. Design We conducted a prospective comparative cohort study. Patients were observed during routine clinical practice over 2 years. Participants/setting Patients with head and neck cancer having curative-intent treatment between August 2012 and July 2014 at a tertiary hospital in Queensland, Australia, were included if assessed as high nutrition risk according to the validated protocol (n=130). Patients were grouped according to protocol adherence as to whether they received prophylactic gastrostomy (PEG) per protocol recommendation (prophylactic PEG group, n=69) or not (no PEG group, n=61). Main outcome measures Primary outcome was percentage weight change during treatment. Secondary outcomes were feeding tube use and hospital admissions. Statistical analysis performed Fisher’s exact, χ2 , and two sample t tests were performed to determine differences between the groups. Linear and logistic regression were used to examine weight loss and unplanned admissions, respectively. Results Patients were 88% male, median age was 59 years, with predominantly stage IV oropharyngeal cancer receiving definitive chemoradiotherapy. Statistically significantly less weight loss in the prophylactic PEG group (7.0% vs 9.0%; P =0.048) and more unplanned admissions in the no PEG group (82% vs 75%; P =0.029). In the no PEG group, 26 patients (43%) required a feeding tube or had ≥10% weight loss. Conclusions Prophylactic gastrostomy improved nutrition outcomes and reduced unplanned hospital admissions. Additional investigation of characteristics of patients with minimal weight loss or feeding tube use could help refine and improve the protocol.
AbstractList The optimal method of tube feeding for patients with head and neck cancer remains unclear. A validated protocol is available that identifies high-nutritional-risk patients who would benefit from prophylactic gastrostomy tube placement. Adherence to this protocol is ultimately determined by clinical team discretion or patient decision. The study aim was to compare outcomes after adherence and nonadherence to this validated protocol, thus comparing a prophylactic and reactive approach to nutrition support in this patient population. We conducted a prospective comparative cohort study. Patients were observed during routine clinical practice over 2 years. Patients with head and neck cancer having curative-intent treatment between August 2012 and July 2014 at a tertiary hospital in Queensland, Australia, were included if assessed as high nutrition risk according to the validated protocol (n=130). Patients were grouped according to protocol adherence as to whether they received prophylactic gastrostomy (PEG) per protocol recommendation (prophylactic PEG group, n=69) or not (no PEG group, n=61). Primary outcome was percentage weight change during treatment. Secondary outcomes were feeding tube use and hospital admissions. Fisher's exact, χ , and two sample t tests were performed to determine differences between the groups. Linear and logistic regression were used to examine weight loss and unplanned admissions, respectively. Patients were 88% male, median age was 59 years, with predominantly stage IV oropharyngeal cancer receiving definitive chemoradiotherapy. Statistically significantly less weight loss in the prophylactic PEG group (7.0% vs 9.0%; P=0.048) and more unplanned admissions in the no PEG group (82% vs 75%; P=0.029). In the no PEG group, 26 patients (43%) required a feeding tube or had ≥10% weight loss. Prophylactic gastrostomy improved nutrition outcomes and reduced unplanned hospital admissions. Additional investigation of characteristics of patients with minimal weight loss or feeding tube use could help refine and improve the protocol.
BACKGROUNDThe optimal method of tube feeding for patients with head and neck cancer remains unclear. A validated protocol is available that identifies high-nutritional-risk patients who would benefit from prophylactic gastrostomy tube placement. Adherence to this protocol is ultimately determined by clinical team discretion or patient decision.OBJECTIVEThe study aim was to compare outcomes after adherence and nonadherence to this validated protocol, thus comparing a prophylactic and reactive approach to nutrition support in this patient population.DESIGNWe conducted a prospective comparative cohort study. Patients were observed during routine clinical practice over 2 years.PARTICIPANTS/SETTINGPatients with head and neck cancer having curative-intent treatment between August 2012 and July 2014 at a tertiary hospital in Queensland, Australia, were included if assessed as high nutrition risk according to the validated protocol (n=130). Patients were grouped according to protocol adherence as to whether they received prophylactic gastrostomy (PEG) per protocol recommendation (prophylactic PEG group, n=69) or not (no PEG group, n=61).MAIN OUTCOME MEASURESPrimary outcome was percentage weight change during treatment. Secondary outcomes were feeding tube use and hospital admissions.STATISTICAL ANALYSIS PERFORMEDFisher's exact, χ2, and two sample t tests were performed to determine differences between the groups. Linear and logistic regression were used to examine weight loss and unplanned admissions, respectively.RESULTSPatients were 88% male, median age was 59 years, with predominantly stage IV oropharyngeal cancer receiving definitive chemoradiotherapy. Statistically significantly less weight loss in the prophylactic PEG group (7.0% vs 9.0%; P=0.048) and more unplanned admissions in the no PEG group (82% vs 75%; P=0.029). In the no PEG group, 26 patients (43%) required a feeding tube or had ≥10% weight loss.CONCLUSIONSProphylactic gastrostomy improved nutrition outcomes and reduced unplanned hospital admissions. Additional investigation of characteristics of patients with minimal weight loss or feeding tube use could help refine and improve the protocol.
Abstract Background The optimal method of tube feeding for patients with head and neck cancer remains unclear. A validated protocol is available that identifies high-nutritional-risk patients who would benefit from prophylactic gastrostomy tube placement. Adherence to this protocol is ultimately determined by clinical team discretion or patient decision. Objective The study aim was to compare outcomes after adherence and nonadherence to this validated protocol, thus comparing a prophylactic and reactive approach to nutrition support in this patient population. Design We conducted a prospective comparative cohort study. Patients were observed during routine clinical practice over 2 years. Participants/setting Patients with head and neck cancer having curative-intent treatment between August 2012 and July 2014 at a tertiary hospital in Queensland, Australia, were included if assessed as high nutrition risk according to the validated protocol (n=130). Patients were grouped according to protocol adherence as to whether they received prophylactic gastrostomy (PEG) per protocol recommendation (prophylactic PEG group, n=69) or not (no PEG group, n=61). Main outcome measures Primary outcome was percentage weight change during treatment. Secondary outcomes were feeding tube use and hospital admissions. Statistical analysis performed Fisher’s exact, χ2 , and two sample t tests were performed to determine differences between the groups. Linear and logistic regression were used to examine weight loss and unplanned admissions, respectively. Results Patients were 88% male, median age was 59 years, with predominantly stage IV oropharyngeal cancer receiving definitive chemoradiotherapy. Statistically significantly less weight loss in the prophylactic PEG group (7.0% vs 9.0%; P =0.048) and more unplanned admissions in the no PEG group (82% vs 75%; P =0.029). In the no PEG group, 26 patients (43%) required a feeding tube or had ≥10% weight loss. Conclusions Prophylactic gastrostomy improved nutrition outcomes and reduced unplanned hospital admissions. Additional investigation of characteristics of patients with minimal weight loss or feeding tube use could help refine and improve the protocol.
The optimal method of tube feeding for patients with head and neck cancer remains unclear. A validated protocol is available that identifies high-nutritional-risk patients who would benefit from prophylactic gastrostomy tube placement. Adherence to this protocol is ultimately determined by clinical team discretion or patient decision. The study aim was to compare outcomes after adherence and nonadherence to this validated protocol, thus comparing a prophylactic and reactive approach to nutrition support in this patient population. We conducted a prospective comparative cohort study. Patients were observed during routine clinical practice over 2 years. Patients with head and neck cancer having curative-intent treatment between August 2012 and July 2014 at a tertiary hospital in Queensland, Australia, were included if assessed as high nutrition risk according to the validated protocol (n=130). Patients were grouped according to protocol adherence as to whether they received prophylactic gastrostomy (PEG) per protocol recommendation (prophylactic PEG group, n=69) or not (no PEG group, n=61). Primary outcome was percentage weight change during treatment. Secondary outcomes were feeding tube use and hospital admissions. Fisher’s exact, χ2, and two sample t tests were performed to determine differences between the groups. Linear and logistic regression were used to examine weight loss and unplanned admissions, respectively. Patients were 88% male, median age was 59 years, with predominantly stage IV oropharyngeal cancer receiving definitive chemoradiotherapy. Statistically significantly less weight loss in the prophylactic PEG group (7.0% vs 9.0%; P=0.048) and more unplanned admissions in the no PEG group (82% vs 75%; P=0.029). In the no PEG group, 26 patients (43%) required a feeding tube or had ≥10% weight loss. Prophylactic gastrostomy improved nutrition outcomes and reduced unplanned hospital admissions. Additional investigation of characteristics of patients with minimal weight loss or feeding tube use could help refine and improve the protocol.
Author Brown, Teresa E
Hughes, Brett G.M., FRACP
Lin, Charles Y., FRANZCR
Bauer, Judith D., PhD
Banks, Merrilyn D., PhD
Kenny, Lizbeth M., FRANZCR
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Issue 4
Keywords Gastrostomy
Head and neck cancer
Enteral tube feeding
Nasogastric tube
Weight loss
Language English
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Snippet Abstract Background The optimal method of tube feeding for patients with head and neck cancer remains unclear. A validated protocol is available that...
The optimal method of tube feeding for patients with head and neck cancer remains unclear. A validated protocol is available that identifies...
BACKGROUNDThe optimal method of tube feeding for patients with head and neck cancer remains unclear. A validated protocol is available that identifies...
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SubjectTerms Enteral tube feeding
Gastroenterology and Hepatology
Gastrostomy
Head and neck cancer
Internal Medicine
Nasogastric tube
Weight loss
Title Comparison of Nutritional and Clinical Outcomes in Patients with Head and Neck Cancer Undergoing Chemoradiotherapy Utilizing Prophylactic versus Reactive Nutrition Support Approaches
URI https://www.clinicalkey.es/playcontent/1-s2.0-S2212267216312953
https://dx.doi.org/10.1016/j.jand.2016.10.013
https://www.ncbi.nlm.nih.gov/pubmed/27986517
https://search.proquest.com/docview/1852692089
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