# Association of Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement with Unplanned Hospitalization for Head and Neck Cancer

## TL;DR

This study finds that head and neck cancer patients with therapeutic PEG tubes are more likely to be hospitalized, which is linked to worse survival but not cancer outcomes.

## Contribution

The study identifies unplanned hospitalization as an independent prognostic factor for survival, not cancer control, and links therapeutic PEG tube use to higher hospitalization risk.

## Key findings

- Unplanned hospitalization is associated with worse overall and progression-free survival but not with cancer recurrence outcomes.
- Therapeutic PEG tube placement increases the risk of unplanned hospitalization compared to prophylactic or no PEG use.
- Patients who never needed PEG tubes had the lowest hospitalization rates.

## Abstract

This study aims to answer the following question: are there differences in the outcomes among head and neck cancer patients with prophylactic versus therapeutic percutaneous endoscopic gastrostomy (PEG) tubes? We found that unplanned hospitalizations were associated with poor survival, but not oncologic outcomes. Compared to patients with a prophylactic PEG tube, those without a PEG tube were less likely to be hospitalized, while others with a therapeutic PEG tube were more likely to be hospitalized. These results indicate that unplanned hospitalization is an independent, adverse prognostic factor for poor survival. The hospitalization incidence was the lowest among those who never needed PEG tubes, while those with therapeutic PEG tubes were most likely to be hospitalized.

Background/Objectives: There is a varying need for nutritional support among head and neck cancer (HNC) patients. Unplanned hospitalization is frequent with definitive chemoradiation. However, the association of unplanned hospitalizations with cancer control outcomes and percutaneous endoscopic gastrostomy (PEG) tube placement is not well-understood. This study aims to evaluate the clinical outcomes stratified by unplanned hospitalizations and to identify the prognostic factors associated with unplanned hospitalizations. Methods: This retrospective cohort study included 657 HNC patients treated with definitive chemoradiation at a single institution between 2007 and 2023. Relevant clinical data were evaluated for unplanned hospitalizations, prophylactic vs. therapeutic PEG tube placement, and clinical outcomes. Multivariable, subgroup, and matched-pair analyses were performed to account for potential confounding variables. The main outcomes and measures used are overall survival (OS), progression-free survival (PFS), locoregional failure (LRF), distant failure (DF), and incidence of unplanned hospitalization. Results: Unplanned hospitalizations occurred in 190 (29%) patients, which were associated with worse OS (adjusted hazards ratio [aHR] of 2.07, 95% confidence interval [CI] of 1.53–2.81, p < 0.001) and progression-free survival (aHR 1.83, 95% CI 1.38–2.41, p < 0.001). However, hospitalizations were not associated with LRF or DF outcomes. Similar findings were noted on 180 matched pairs as well as subgroups stratified by p16 status. In addition, when compared to patients with a prophylactic PEG tube, therapeutic PEG tube placement was associated with a higher risk of hospitalization (adjusted odds ratio [aOR] of 1.96, 95% CI 1.10–3.54, p = 0.02), while those without PEG tubes were less likely to be hospitalized (aOR 0.48, 95% CI 0.27–0.86, p = 0.01). Conclusions: Unplanned hospitalization was an independent, adverse prognostic factor for poor survival, but not oncologic outcomes. Unplanned hospitalization incidence was largely driven by those who required a therapeutic PEG tube, while it was the lowest for those who never needed a PEG tube.