Prophylactic gastrostomy before chemoradiation in advanced head and neck cancer: a multiprofessional web-based survey to identify current practice and to analyse decision making.
OBJECTIVE
Patients with advanced squamous carcinoma of the head and neck who are treated with concurrent chemoradiotherapy schedules are often referred for gastrostomy tube (G-tube) insertion. Decision making to select appropriate patients is inconsistent and the factors that lead healthcare workers to make this recommendation are not well understood. Therefore, by means of a web-based questionnaire we sought the views of a variety of healthcare professionals as to their current practice with regard to various issues surrounding the recommendation of G-tube insertion use in these patients and analysed the responses with regard to decision making.


METHODS
Questions were generated after discussion among and agreement from all members of a single National Health Service Trust head and neck multidisciplinary team and were hosted on a website. Appropriate individuals were identified through their governing body organisations and invited by e-mail to complete the questionnaire. The results were pooled and analysed.


RESULTS
Recommendations for gastrostomy were not based on tumour subsite. Four of 14 patient-related factors were significantly associated with the recommendation for gastrostomy. Medical and allied healthcare professionals (including nursing staff) significantly differed in their opinions as to the effect of G-tubes on the resumption of oral intake (P=0.009).


CONCLUSIONS
There is no national consensus on which patients to recommend for gastrostomy and consideration should be given to the development of clinical decision-making models in an attempt to systematise the decision-making process.
Department of Otolaryngology-Head & Neck Surgery, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle Upon Tyne NE7 7DN, UK.
J W
JW
Moor
J
J
Patterson
C
C
Kelly
V
V
Paleri
D000970:Antineoplastic Agents / Q000009:adverse effects; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000628:therapy*; D003131:Combined Modality Therapy; D003625:Data Collection; D003657:Decision Making; D005743:Gastrectomy / Q000706:statistics & numerical data*; D006258:Head and Neck Neoplasms / Q000150:complications / Q000628:therapy*; D006282:Health Personnel / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D020407:Internet; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data*; D011878:Radiotherapy / Q000009:adverse effects
D000970:Antineoplastic Agents