Comparison of Prophylactic Versus Reactive Tube Feeding Approaches on Weight Loss and Unplanned Hospital Admissions in Patients with Head and Neck Cancer Receiving Chemoradiotherapy

TL;DR

This study compares two feeding methods for head and neck cancer patients during treatment, finding no significant difference in hospital admissions or weight loss.

Contribution

The study provides clinical insights into nutrition support strategies for head and neck cancer patients undergoing chemoradiotherapy.

Findings

No statistical differences were found in unplanned hospital admissions or weight loss between prophylactic and reactive tube feeding.

Older age was a predictor of unplanned nutrition-related hospital admissions.

Abstract

Patients with head and neck cancer undergoing chemoradiotherapy can have significant difficulties with eating and drinking, and often require tube feeding. There is controversy in the medical literature regarding the best of form of tube feeding—either a prophylactically placed feeding tube prior to treatment (usually a gastrostomy) or a feeding tube placed during treatment when necessary (usually a nasogastric tube). This study compares these two approaches to nutrition support at two different tertiary hospitals in Brisbane, Australia. The outcomes compared include weight loss during and post treatment, and the frequency of unplanned hospital admissions. There were no statistical differences seen between hospitals; however, clinically important differences in weight loss outcomes were seen, with the prophylactic approach having less critical weight loss during and post treatment. This can improve nutritional status and has been associated with other benefits such as improved quality of life, less treatment complications, and improved treatment tolerance and survival.

The study’s aim was to compare the unplanned admission rates and nutrition outcomes in patients with head and neck squamous cell cancer (HNSCC) receiving chemoradiotherapy at two different hospitals with different nutrition support approaches. Hospital Site A used prophylactic tube feeding and Site B used reactive tube feeding. Consecutive HNSCC patients receiving chemoradiotherapy with curative intent over six months in 2015 were eligible for this prospective comparative cohort study. Only patients who were classified as at high nutrition risk using validated guidelines were included. Patients’ weight was recorded at the start, end, and 4–6 weeks post treatment to determine percentage weight loss outcomes. Unplanned hospital admissions (for medical or nutrition related reasons) and associated length of stay (LOS) were collected throughout and up to 1-month post treatment. In total, 88 patients were included in the study (site A n = 58; site B n = 30). The mean age was 60 years, 86–90% were male, and predominantly had oropharyngeal cancer. There was no statistical difference between the groups for percentage weight loss at any timepoint, rates of unplanned nutrition related admissions, or LOS. Stepwise logistic analysis showed that being of an older age was predictive of having an unplanned nutrition-related admission. In summary, there was no difference in the rate of unplanned admissions or percentage weight loss for patients with HNSCC managed under the prophylactic versus reactive tube feeding approach. Decision making regarding the choice of feeding tube should be made in consultation with the patient and the multidisciplinary team.

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