 |
|
Prophylactic versus reactive percutaneous endoscopic gastrostomy tube placement in a cohort of oropharyngeal cancer patients undergoing chemoradiotherapy
V Thirayan*, RT Gregor**, M Jameson***, C Rule
* Waikato clinical school, Waikato hospital, Hamilton 3204, New Zealand; School of Medicine, University of Auckland, Auckland 1010, New Zealand
** Department of ENT, Waikato hospital, Hamilton 3204, New Zealand
*** Department of Medical Oncology, Waikato hospital, Hamilton 3204, New Zealand
Introduction
Chemoradiotherapy is associated with decreased oral intake and resultant malnutrition in oropharyngeal cancer (OPC) patients who are at an increased risk of treatment-related mucositis and dysphagia. Prophylactic PEG (pPEG) tubes are an efficient means of long term enteral supplementation. Their use has been shown to mitigate weight loss which is historically associated with better outcome; however, there is conflict regarding the benefits in long term side effects 1, 2. We hypothesise that pPEG may expose patients to adverse swallowing outcomes that reactive PEG (rPEG) may otherwise avoid.
Aims
To investigate the clinical outcomes in pPEG versus rPEG placement in a cohort of OPC patients receiving chemoradiotherapy.
Methods
This retrospective cohort study includes patients with OPC undergoing chemoradiotherapy that were selected from a pre-existing OPC patient database, a Multidisciplinary meeting database and a database compiled by the Waikato hospital medical coding department during the period including 2010 to 2015. Clinical notes and electronic records were reviewed manually by the principal investigator. Analysis was conducted using Microsoft Excel.
Results
A total of 142 patients undergoing chemoradiotherapy for OPC were identified of which 46 received a PEG: 23 pPEG, 13 rPEG and 10 as yet undetermined. The cohort is 82% New Zealand European, 67% male and 59 is the mean age. Alcohol and tobacco exposure is 77% and 76%, respectively. Tumour p16 presence and absence is 61% and 17%, respectively.
Conclusion
32% of OPC patients received a PEG tube. Prophylactic PEG placement is utilized approximately twice as often as reactive placement in this selected clinical site. Further collection, analysis and interpretation of data are expected to be completed by October 2016.
References
1. Romesser PB, Romanyshyn JC, Schupak KD, et al. Percutaneous endoscopic gastrostomy in oropharyngeal cancer patients treated with intensity-modulated radiotherapy with concurrent chemotherapy. Cancer. 2012 Dec 15;118(24):6072-8. doi: 10.1002/cncr.27633. Epub 2012 Jun 15.
2. Ward MC, Bhateja P, Nwizu T, et al. Impact of feeding tube choice on severe late dysphagia after definitive chemoradiotherapy for human papillomavirus-negative head and neck cancer. Head Neck. 2016 Apr;38 Suppl 1:E1054-60. doi: 10.1002/hed.24157. Epub 2015 Sep 2.
|