title: Comparison of Nutritional and Clinical Outcomes in Patients with Head and Neck Cancer Undergoing Chemoradiotherapy Utilizing Prophylactic versus Reactive Nutrition Support Approaches.
abstract: 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.
authors.forename: Teresa E
authors.initials: TE
authors.lastname: Brown
authors.forename: Merrilyn D
authors.initials: MD
authors.lastname: Banks
authors.forename: Brett G M
authors.initials: BGM
authors.lastname: Hughes
authors.forename: Charles Y
authors.initials: CY
authors.lastname: Lin
authors.forename: Lizbeth M
authors.initials: LM
authors.lastname: Kenny
authors.forename: Judith D
authors.initials: JD
authors.lastname: Bauer
mesh_terms: D001835:Body Weight; D059248:Chemoradiotherapy / Q000009:adverse effects*; D002985:Clinical Protocols; D004750:Enteral Nutrition / Q000379:methods* / Q000592:standards; D005260:Female; D005774:Gastrostomy / Q000379:methods* / Q000592:standards; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006258:Head and Neck Neoplasms / Q000628:therapy*; D006801:Humans; D007441:Intubation, Gastrointestinal; D016014:Linear Models; D008297:Male; D044342:Malnutrition / Q000209:etiology / Q000517:prevention & control*; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D065286:Prophylactic Surgical Procedures / Q000379:methods / Q000592:standards; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: Enteral tube feeding; Gastrostomy; Head and neck cancer; Nasogastric tube; Weight loss