Does Gastrostomy Tube Improve the Long-term Nutritional Outcome in Patients With Head and Neck Cancer?

Abstract

Introduction: Maintaining nutrition in patients with head and neck cancer receiving radiation therapy (RT) and/or chemotherapy (CT) remains a challenge. Previous studies have shown that gastrostomy for tube feedings has an important role in reducing nutritional compromise during and after treatment and hence often placed prophylactically. Research question: The aim of this study is to compare the nutritional benefits in patients with head and neck cancer who received tube feedings via gastrostomy with the patients who did not receive gastrostomy tube (GT). Methods: A retrospective chart review was conducted on patients with head and neck cancer from January 1, 2005 to March 31, 2014. Nutritional parameters (weight, BMI, albumin and total protein) were collected at baseline, 3 months, 6 months and 12 months after gastrostomy and in the no-gastrostomy group the data were collected at the same intervals after the cancer diagnosis. Results: There were 304 total patients, of whom 123 (40.5%) had gastrostomy tubes. Those who received tubes were older (78.4 vs. 66.7 years of age), had greater then T1N0M0 disease (99.1% vs. 67.3%), were more likely to undergo CT (79.7% vs. 26.8%) and were more likely to have RT (99.1% vs. 66.7%) than those without GT. Looking only those with greater than T1N0M0 disease, 113/222 (50.9%) received GT. The values of the nutritional variables over time declined in both those with and without GT. Those with GT at baseline had lower values in all four variables, but the time course did not differ between groups (change in weight depicted in fig 1). In linear regression, the net change over 12 months in weight and BMI depended only on whether CT was received. Use of GT was not predictive of any of these net changes. No variables predicted change in albumin or total protein. In those who had GT placed, neither duration or frequency of tube usage predicted any of these nutritional 12 month changes. Conclusion: Our study found no significant difference in the nutritional outcome between those with and without GT at the end of 1 year. However, patients in the GT group had lower baseline weight, BMI, albumin and total protein. Age, CT and stage of the tumor positively predicted the placement of the GT, which suggests that patients who have advanced disease or nutritionally compromised tend to get gastrostomy. Based on the above findings, we propose the GT should be placed on-demand rather than prophylactically to minimize the morbidity and mortality associated with GT placement.Figure: Change in weight with time between the two groups.