title: Prophylactic feeding tubes for patients with locally advanced head-and-neck cancer undergoing combined chemotherapy and radiotherapy-systematic review and recommendations for clinical practice.
abstract: OBJECTIVE
  This work aimed to determine the benefits and risks of prophylactic feeding tubes for adult patients with squamous cell carcinoma of the head and neck who receive combined chemotherapy and radiotherapy with curative intent and to make recommendations on the use of prophylactic feeding tubes and the provision of adequate nutrition to this patient population.
  
  
  METHODS
  A national multidisciplinary panel conducted a systematic review of the evidence and formulated recommendations to guide clinical decision-making. The draft evidence summary and recommendations were distributed to clinicians across Canada for their input.
  
  
  RESULTS
  No randomized controlled trials have directly addressed this question. Evidence from studies in the target population was limited to seven descriptive studies: two with control groups (one prospective, one retrospective) and five without control groups. Results from ten controlled studies in patients treated with radiotherapy alone were also reviewed.
  
  
  CONCLUSIONS
  The available evidence was insufficient to draw definitive conclusions about the effectiveness of prophylactic feeding tubes in the target patient population or to support an evidence-based practice guideline. After review of the evidence, of guidelines from other groups, and of current clinical practice in Canada, the multidisciplinary panel made consensus-based recommendations regarding comprehensive interdisciplinary clinical care before, during, and after cancer treatment. The recommendations are based on the expert opinion of the panel members and on their understanding of best clinical practice.
authors.affiliation: Oncology Nutrition, BC Cancer Agency, Centre for the Southern Interior, Kelowna, BC.
authors.forename: C
authors.initials: C
authors.lastname: Orphanidou
authors.forename: K
authors.initials: K
authors.lastname: Biggs
authors.forename: M E
authors.initials: ME
authors.lastname: Johnston
authors.forename: J R
authors.initials: JR
authors.lastname: Wright
authors.forename: A
authors.initials: A
authors.lastname: Bowman
authors.forename: S J
authors.initials: SJ
authors.lastname: Hotte
authors.forename: A
authors.initials: A
authors.lastname: Esau
authors.forename: C
authors.initials: C
authors.lastname: Myers
authors.forename: V
authors.initials: V
authors.lastname: Blunt
authors.forename: M
authors.initials: M
authors.lastname: Lafleur
authors.forename: B
authors.initials: B
authors.lastname: Sheehan
authors.forename: M A
authors.initials: MA
authors.lastname: Griffin