Prophylactic gastrostomy tubes in head and neck cancer patients – a time out project

Abstract

The Time Out Project at Barts and the London NHS Trust is designed to allow allied health professionals (AHP) to develop their research skills. This is done by funding a locum to cover an AHP's post for 10 working days to allow them to undertake a mini research project.Background: Head and neck cancer (HNC) patients are at high risk of nutrition‐related problems due to the nature of their disease and the side effects of cancer treatment. Emergency admissions to hospital for nutrition‐related and dehydration problems are common in this group of patients due to difficulties associated with administering nutrition and fluids. The aim of this project was to examine the efficacy of prophylactic gastrostomy tubes in HNC patients undergoing cancer therapy. The objectives were to review current literature relating to the use of feeding tubes in such patients and to develop guidelines on which group of patients benefit from prophylactic placement of a gastrostomy.Method: The Medline database, 1996 to February 2003, was searched for relevant papers. Other papers cited in these were also used, if they were pertinent to the project. Medline was also searched between 1966 and March 2003 for any randomized controlled trials in this clinical area. The Cochrane Database was reviewed to see whether any systematic reviews relating to the subject matter were available. Inclusion criteria Exclusion criteria Studies looking at enteral feeding in HNC patients Studies looking at total parenteral nutrition, immunonutrition or jejunal feeding Studies looking at quality of life in HNC patients Studies looking primarily at anti‐cancer therapy rather than nutrition Studies looking at the different tube insertion techniques in HNC patients Studies focussing on gut motility English language papers only Studies written in foreign languages HNC, head and neck cancer. Results: Studies showed that prophylactic gastrostomy tubes in HNC patients undergoing cancer treatment can offer the following advantages: (i) a significantly reduced incidence of weight loss, (ii) significantly fewer nutrition‐related hospital admissions when compared to controls and (iii) potentially fewer treatment interruptions. No randomized trial has conclusively demonstrated improved local control or survival as a result of nutritional intervention before or during radiotherapy. Most studies reviewed concluded that gastrostomy placement in HNC patients was a safe and effective way to maintain nutritional status but acknowledged that there were some complications associated with placement (Lee et al., 1998; Scolapio et al., 2001).Conclusion: The evidence suggests that prophylactic gastrostomy prior to cancer therapy offers some benefits; however, this evidence is based on retrospective studies with small sample sizes and flaws in study design. The studies reviewed do, however, tend to suggest that gastrostomy placement is a safe and effective method of delivering enteral nutrition, so, could be useful in patients at high risk of malnutrition. In order to minimize risks associated with gastrostomy placement, patients should be assessed adequately and skilled staff should perform the insertion procedure.