Assessing the Dependence of Feeding Gastrostomy Tube in Patients of Head and Neck Carcinomas

Abstract

Objective: To investigate the dependency on feeding gastrostomy tubes in patients with head and neck cancers treated with radiotherapy alone or concurrent chemo-radiotherapy. Study Design: Retrospective longitudinal study. Place and Duration of Study: Combined Military Hospital, Rawalpindi and Shaukat Khanum Hospital, Peshawar Pakistan, from Jan and Jul 2022. Methodology: A total of 115 patients with head and neck cancers having no baseline dysphagia and having gastrostomy tubes were included. All had received an equivalent of 60 greys in 30 fractions or more of radiotherapy. Their swallowing was evaluated weekly during radiotherapy and then every 4–6 weeks on post-treatment follow-up. The total time duration of patient dependency on feeding gastrostomy tube after treatment completion was noted for each head and neck cancer subsite.Results: Of a total of 115 patients, 49(43%) of the patients had nasopharyngeal cancers, 22(19%) had laryngeal, 29(24%) oral cavity, 7(6%) hypopharyngeal and 9(8%) had cervical esophageal cancers. Proportion retaining gastrostomy tube for more than six months of treatment was 8.7% (median duration of retention was five months) with hypopharyngeal, nasopharyngeal, oral cavity, and laryngeal cancer were 14%, 9%, 9% and 5%, respectively. Conclusion: The proportion of patients with head and neck cancers requiring more than six months of a gastrostomy tube is 5-14%. Baseline assessment of swallowing and nutrition and prophylactic feeding gastrostomy can avoid treatment interruptions. Longer duration of retention of a gastrostomy tube is associated with poor quality of life in head and neck cancer patients receiving radiation or concurrent chemo-radiation.