Is PEG Tube Really the Way To Go: A Comparison of Symptoms Among Subjects With Head and Neck Cancer (760)

Abstract

1.To evaluate the effect of having a PEG tube in patients with head and neck cancer on their symptoms.2.To determine palliative care consult triggers of patients with head and neck cancer. Subjects with head and neck cancer (HNC) often undergo feeding tube placement (commonly Percutaneous Endoscopic Gastrostomies-PEG) prior to initiation of chemo-radiation to maintain weight and improve treatment tolerability. Long-term use of PEG was associated with complications like persistent dysphagia and increased need for pharyngoesophageal dilatation, adversely impacting subjects’ long term quality of life (QOL). To evaluate impact of PEG on symptoms and to identify triggers and extent of utilization of palliative care consult (PCC) in caring for HNC subjects. Retrospective electronic chart review, extracting data over 1 year from diagnosis, or until death, whichever comes first. Of 84 veterans discussed at ENT tumor board meetings (7/2009 till 6/2010), 47 with new HNC included. N = 47; 2 females. 33 had PEG. Most common presenting symptoms: mass (N = 32; 69.6%), dysphagia/odynophagia (N = 27; 57.4%), anorexia/weight loss (N = 23; 48.9%). PEG placed prior to initiation of treatment in all but one subject. 72.9% had PEG > 12 months. Frequency of interruptions of treatments, ECOG, cancer staging were the same regardless of PEG status. PEG group had more outpatient visits (P = 0.03.) Dysphagia/odynophagia more frequently reported by PEG group during/after completion of treatment (P = 0.004). No significant difference in weight change (P = 0.15) nor survival. 17 subjects (36.2%) had PCC; 15 for hospice referral/assistance in disposition; 2 for pain management. Subjects with more advanced cancer, worse ECOG, shorter survival had PCC (P = 0.01, <0.0001, 0.0028 respectively.) In this HNC cohort, PEG placement did not make a difference in weight or survival, but subjects with PEG reported more dysphagia/odynophagia during/after treatment. PCC was not requested on bases of symptom burden.