title: Toxicities and costs of placing prophylactic and reactive percutaneous gastrostomy tubes in patients with locally advanced head and neck cancers treated with chemoradiotherapy.
abstract: BACKGROUND
  We compared dependence rates, complications, toxicities, and costs associated with prophylactic versus reactive percutaneous endoscopic gastrostomy (PEG) tube placement.
  
  
  METHODS
  One hundred ninety-three patients with locally advanced head and neck squamous cell carcinoma treated with concurrent chemoradiotherapy were retrospectively reviewed.
  
  
  RESULTS
  The 1-year and 2-year actuarial PEG tube dependence rate of the entire cohort was 24% and 13%, respectively. There was no difference in the PEG tube dependence rates between those placed prophylactically versus reactively. Patients who received a PEG tube reactively had a significantly higher stricture rate (p = .03) and aspiration rate (p < .001) compared to the prophylactic group. There were significantly fewer hospitalizations in the prophylactic group compared to the reactive group (p = .003). When accounting for both PEG placement and hospitalizations, the prophylactic approach was found to be more cost effective.
  
  
  CONCLUSIONS
  PEG tubes placed prophylactically were associated with lower rates of strictures, aspirations, hospitalizations, and costs compared to those placed reactively.
authors.affiliation: Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Baschnagel
authors.forename: Siddhartha
authors.initials: S
authors.lastname: Yadav
authors.forename: Ovidiu
authors.initials: O
authors.lastname: Marina
authors.forename: Aaron
authors.initials: A
authors.lastname: Parzuchowski
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Lanni
authors.forename: Jillian N
authors.initials: JN
authors.lastname: Warner
authors.forename: Jeanne S
authors.initials: JS
authors.lastname: Parzuchowski
authors.forename: Renjitha T
authors.initials: RT
authors.lastname: Ignatius
authors.forename: Jan
authors.initials: J
authors.lastname: Akervall
authors.forename: Peter Y
authors.initials: PY
authors.lastname: Chen
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Krauss
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000191:economics / Q000628:therapy*; D059248:Chemoradiotherapy / Q000379:methods*; D003365:Costs and Cost Analysis; D003680:Deglutition Disorders / Q000191:economics / Q000517:prevention & control*; D016099:Endoscopy, Gastrointestinal; D004750:Enteral Nutrition / Q000295:instrumentation*; D005260:Female; D005774:Gastrostomy / Q000191:economics / Q000379:methods*; D006258:Head and Neck Neoplasms / Q000191:economics / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D000077195:Squamous Cell Carcinoma of Head and Neck; D016896:Treatment Outcome
keywords: percutaneous endoscopic gastrostomy (PEG) tube; prophylactic PEG tube; reactive PEG tube