title: Impact of feeding tubes on prospective functional outcomes in patients with locally advanced head and neck cancer undergoing radiation therapy.
abstract: OBJECTIVE
  The optimal timing of enteral feeding tube (FT) insertion during radiation therapy for head and neck cancer remains controversial. This study compares prospectively collected functional outcomes for prophylactic versus reactive insertion.
  
  
  METHODS
  Patients undergoing primary radiation therapy for stage III-IV head and neck cancer between 2004 and 2009 underwent functional outcome assessment at baseline and 3, 6, 12, 24, and 36 months posttreatment. Instruments included the Royal Brisbane Hospital Outcome Measure for Swallowing, Performance Status Scale for Head and Neck Cancer Patients, and modified Edmonton Symptom Assessment Scale. Multivariable regression analysis was conducted to determine the impact of FT use on functional outcomes.
  
  
  RESULTS
  A total of 178 patients were assessed with a median follow-up of 36.4 months. Use of an FT was prophylactic in 92 and reactive in 24; no tube was used in 62 patients. Compared with prophylactic placement, reactive FT use was not associated with worse function for Performance Status Scale for Head and Neck Cancer Patients Normalcy of Diet for soft foods (adjusted odds ratio [AOR] 1.16, P = .85) or Eating in Public (AOR 1.87, P = .31). Similarly, there were no differences in the Royal Brisbane Hospital Outcome Measure for Swallowing for modified diet (AOR 1.27, P = .7) or FT dependence (AOR 3.01, P = .2).
  
  
  CONCLUSIONS
  There were no significant differences in long-term swallowing function between patients who received a prophylactic versus reactive FT.
authors.affiliation: Section of Radiation Oncology, Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada; CancerCare Manitoba, Winnipeg, Manitoba, Canada. Electronic address: hquon@cancercare.mb.ca.
authors.forename: Harvey
authors.initials: H
authors.lastname: Quon
authors.affiliation: CancerCare Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Candace
authors.initials: C
authors.lastname: Myers
authors.affiliation: CancerCare Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Pascal
authors.initials: P
authors.lastname: Lambert
authors.affiliation: Section of Radiation Oncology, Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada; CancerCare Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: James
authors.initials: J
authors.lastname: Butler
authors.affiliation: Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Abdoh
authors.affiliation: Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Ross
authors.initials: R
authors.lastname: Stimpson
authors.affiliation: Section of Gastroenterology, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Donald R
authors.initials: DR
authors.lastname: Duerksen
authors.affiliation: CancerCare Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Heather
authors.initials: H
authors.lastname: Campbell-Enns
authors.affiliation: CancerCare Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Angela
authors.initials: A
authors.lastname: Martens
mesh_terms: D003679:Deglutition; D004750:Enteral Nutrition / Q000295:instrumentation*; D005260:Female; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D007441:Intubation, Gastrointestinal; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D050397:Radiotherapy, Intensity-Modulated; D020127:Recovery of Function; D012189:Retrospective Studies