Head and Neck Cancer

PV QA 2 - Poster Viewing Q&A 2

MO_25_2585 - Effect of Feeding Tube Strategy on Hospitalization Rates and Outcomes in Head and Neck Cancer Patients Treated With Chemoradiotherapy

Monday, October 22
10:45 AM - 12:15 PM
Location: Innovation Hub, Exhibit Hall 3

Effect of Feeding Tube Strategy on Hospitalization Rates and Outcomes in Head and Neck Cancer Patients Treated With Chemoradiotherapy
G. Bhattacharya1, J. Ivars2, S. El-Sayed3,4, L. Eapen3,4, A. Haddad3,4, and M. Gaudet3,4; 1University of Ottawa, Ottawa, ON, Canada, 2Bishop's University, Sherbrooke, QC, Canada, 3University of Ottawa, Faculty of Medicine, Ottawa, ON, Canada, 4Division of Radiation Oncology, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada

Purpose/Objective(s): Patients receiving definitive chemoradiation for head and neck cancers remain at risk for hospital admission often owing to poor oral intake and frequent underlying dehydration. The objective of this study was to determine potential differences between those receiving prophylactic versus emergent enteral nutrition in regards to hospitalization rates and survival outcomes.

Materials/Methods: A retrospective chart review of adult head and neck cancer patients receiving radical radiation therapy +/- chemotherapy (CRT) at our tertiary care cancer centre was completed. Patients were grouped into 2 categories; group 1 receiving either no tube feeding or emergent nasogastric (e-NG) or percutaneous gastrostomy (e-PEG) tube and group 2 which received prophylactic PEG (p-PEG) tube. Hospitalisation rates while on treatment and the 3 months after treatment were compared via Chi-Square test. Baseline characteristics were compared between groups by either t-tests or chi-square tests. Survival was determined by Kaplan-Meier Method and Log-Rank tests.

Results: Overall, 203 patients treated between 2006 and 2016 were included with median follow-up of 22 months. Incidence was predominantly male at 82%. Median age at diagnosis was 62 years with most common sites treated being oropharynx (72%; 31% of these being base of tongue) followed by larynx (15%) and nasopharynx (8%). Seventy-two percent of all patients received primary chemoradiation therapy with most common fractionation regimen being 70 Gy in 35 daily fractions. Details regarding the two groups are presented in the table below:
Group 1 (n=182) Group 2 (n=21)
Age (years) 62 62
Male (%) 82 86
Disease Site (%) (p=0.08)
Oropharynx Larynx Hypopharynx Nasopharynx 75 14 3 7 43 29 14 14
Histology (%) (p=0.73)
Squamous Cell Carcinoma Adenocarcinoma 99.5 (n=181) 0.5 (n=1) 100 0
P16 positivity (%) 49 29
Social History (%)
Tobacco use (p=0.43)
Current smokers Former smokers Pack history (years) 30 44 25 24 57 31
Alcohol Use (p=0.16)
>10 Drinks/ week 30 24
AJCC 7 Stage (%) (p=0.76)
I 2 0
II 6 5
III 25 14
IVA 63 76
IVB 5 1
Enteral Nutrition Rates (%)
None 51 0
e-NG 28 0
e-PEG 21 0
p-PEG 0 100
Hospitalization during/3 months post treatment (%) (p=0.62) 37 (n=68) 43 (n=9)
Of the 60 patients in either group who had a PEG tube placed, 53% went on to have a tube dependent lifestyle. Median survival was 63 months for group 1 and 35 months for Group 2 (p<0.001).

Conclusion: In definitive CRT treated head and neck cancer, patients with prophylactic PEG enteral nutrition possessed several negative prognostic factors such as higher smoking rates, lower HPV association and more advanced stage disease at time of presentation. These patients also required hospitalization at a higher rate and had poorer median survival. This likely demonstrates current practice patterns for prophylactic enteral feeding but does not provide convincing evidence in favor of prophylactic PEG tube placement.

Author Disclosure: G. Bhattacharya: None. J. Ivars: None. S. El-Sayed: None. L. Eapen: Research Grant; Astra Zeneca, Abott, Paladin labs, Sanofi Aventis. Honoraria; Astra Zeneca, Abott, Paladin labs, Sanofi Aventis. A. Haddad: None.

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