Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Clinical nutrition

Quality of life of patients with head and neck cancer after prophylactic percutaneous-gastrostomy

Abstract

Background

HNC patients often experience weight loss during treatment. To date, there is only limited data on patient quality of life (QLQ) and subjective benefit of the PEG insertion.

Objective

To investigate the nutritional status, QLQ, and overall benefit.

Methods

181 patients fitting our inclusion criteria (01/2012–12/2012) were enrolled. Utilization rate, nutritional status, QLQ, and subjective PEG assessment were determined with electronic charts and the Quality of life-questionnaire (EORTC-QLQ-C30).

Results

The utilization rate of the entire cohort was 91.7%. The PEG was used full-time by 149 patients. No statistical differences in QLQ were observed between the groups. Of the patients that used the PEG entirely (99.7%), partially (85.3%) or not all (55.3%) would 99.7%, 85.3 and 55.8% undergo the procedure in the future if necessary.

Conclusions

QLQ was not significantly reduced by insertion. Especially patients using the PEG full-time had an objective and subjective benefit from the inserted PEG tube.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Lau SKM, Iyengar P. Implications of weight loss for cancer patients receiving radiotherapy. Curr Opin Support Palliat Care. 2017;11:261–5.

    PubMed  Google Scholar 

  2. Forastiere AA, Zhang Q, Weber RS, Maor MH, Goepfert H, Pajak TF, et al. Long-term results of RTOG 91-11: a comparison of three nonsurgical treatment strategies to preserve the larynx in patients with locally advanced larynx cancer. J Clin Oncol. 2013;31:845–52.

    CAS  PubMed  Google Scholar 

  3. Bradley PT, Brown T, Paleri V. Gastrostomy in head and neck cancer: current literature, controversies and research. Curr Opin Otolaryngol Head Neck Surg. 2015;23:162–70.

    PubMed  Google Scholar 

  4. Tisdale MJ. Cancer cachexia. Curr Opin Gastroenterol. 2010;26:146–51.

    PubMed  Google Scholar 

  5. Bonner JA, Harari PM, Giralt J, Azarnia N, Shin DM, Cohen RB, et al. Radiotherapy plus cetuximab for squamous-cell carcinoma of the head and neck. N Engl J Med. 2006;354:567–78.

    CAS  PubMed  Google Scholar 

  6. Christianen MEMC, Verdonck-de Leeuw IM, Doornaert P, Chouvalova O, Steenbakkers RJHM, Koken PW, et al. Patterns of long-term swallowing dysfunction after definitive radiotherapy or chemoradiation. Radiother Oncol. 2015;117:139–44.

    PubMed  Google Scholar 

  7. van der Laan HP, Bijl HP, Steenbakkers RJHM, van der Schaaf A, Chouvalova O, Vemer-van den Hoek JGM, et al. Acute symptoms during the course of head and neck radiotherapy or chemoradiation are strong predictors of late dysphagia. Radiother Oncol. 2015;115:56–62.

    PubMed  Google Scholar 

  8. Capuano G, Grosso A, Gentile PC, Battista M, Bianciardi F, Di Palma A, et al. Influence of weight loss on outcomes in patients with head and neck cancer undergoing concomitant chemoradiotherapy. Head Neck. 2008;30:503–8.

    PubMed  Google Scholar 

  9. Marin Caro MM, Laviano A, Pichard C. Nutritional intervention and quality of life in adult oncology patients. Clin Nutr. 2007;26:289–301.

    PubMed  Google Scholar 

  10. Sinicrope FA, Foster NR, Yothers G, Benson A, Seitz JF, Labianca R, et al. Body mass index at diagnosis and survival among colon cancer patients enrolled in clinical trials of adjuvant chemotherapy. Cancer. 2013;119:1528–36.

    CAS  PubMed  Google Scholar 

  11. Arends J, Bodoky G, Bozzetti F, Fearon K, Muscaritoli M, Selga G, et al. ESPEN guidelines on enteral nutrition: non-surgical oncology. Clin Nutr. 2006;25:245–59.

    CAS  PubMed  Google Scholar 

  12. Bankhead R, Boullata J, Brantley S, Corkins M, Guenter P, Krenitsky J, et al. Enteral nutrition practice recommendations. JPEN J Parenter Enter Nutr. 2009;33:122–67.

    Google Scholar 

  13. Lees J. Nasogastric and percutaneous endoscopic gastrostomy feeding in head and neck cancer patients receiving radiotherapy treatment at a regional oncology unit: A two year study. Eur J Cancer Care (Engl). 1997;6:45–9.

    CAS  Google Scholar 

  14. Magne N, Marcy PY, Foa C, Falewee MN, Schneider M, Demard F, et al. Comparison between nasogastric tube feeding and percutaneous fluoroscopic gastrostomy in advanced head and neck cancer patients. Eur Arch Otorhinolaryngol. 2001;258:89–92.

    CAS  PubMed  Google Scholar 

  15. Cady J. Nutritional support during radiotherapy for head and neck cancer: the role of prophylactic feeding tube placement. Clin J Oncol Nurs. 2007;11:875–80.

    PubMed  Google Scholar 

  16. Locher JL, Bonner JA, Carroll WR, Caudell JJ, Allison JJ, Kilgore ML, et al. Patterns of prophylactic gastrostomy tube placement in head and neck cancer patients: a consideration of the significance of social support and practice variation. Laryngoscope. 2013;123:1918–25.

    PubMed  PubMed Central  Google Scholar 

  17. Martin Villares C, San Roman Carbajo J, Fernandez Pello ME, Tapia Risueno M, Dominguez Calvo J. Nutritional status in head and neck cancer patients: the impact on the prognoses. Nutr Hosp. 2003;18:91–4.

    CAS  PubMed  Google Scholar 

  18. Kramer S, Newcomb M, Hessler J, Siddiqui F. Prophylactic versus reactive PEG tube placement in head and neck cancer. Otolaryngol Head Neck Surg. 2014;150:407–12.

    PubMed  Google Scholar 

  19. Loeser C, Herz U, von, Kuchler T, Rzehak P, Muller MJ. Quality of life and nutritional state in patients on home enteral tube feeding. Nutrition. 2003;19:605–11.

    PubMed  Google Scholar 

  20. Locher JL, Bonner JA, Carroll WR, Caudell JJ, Keith JN, Kilgore ML, et al. Prophylactic percutaneous endoscopic gastrostomy tube placement in treatment of head and neck cancer: A comprehensive review and call for evidence-based medicine. JPEN J Parenter Enter Nutr. 2011;35:365–74.

    Google Scholar 

  21. Kondrup J, Allison SP, Elia M, Vellas B, Plauth M. ESPEN guidelines for nutrition screening 2002. Clin Nutr. 2003;22:415–21.

    CAS  PubMed  Google Scholar 

  22. Valentini L, Volkert D, Schütz T, Ockenga J, Pirlich M, Druml W, et al. Leitlinie der Deutschen Gesellschaft für Ernährungsmedizin (DGEM). Aktuel- Ernahrungsmed. 2013;38:97–111.

    Google Scholar 

  23. Bjordal K, Graeff A, de, Fayers PM, Hammerlid E, van Pottelsberghe C, Curran D, et al. A 12 country field study of the EORTC QLQ-C30 (version 3.0) and the head and neck cancer specific module (EORTC QLQ-H&N35) in head and neck patients. EORTC Quality of Life Group. Eur J Cancer. 2000;36:1796–807.

    CAS  PubMed  Google Scholar 

  24. Terrell JE, Ronis DL, Fowler KE, Bradford CR, Chepeha DB, Prince ME, et al. Clinical predictors of quality of life in patients with head and neck cancer. Arch Otolaryngol Head Neck Surg. 2004;130:401–8.

    PubMed  Google Scholar 

  25. Trask PC, Hsu M-A, McQuellon R. Other paradigms: Health-related quality of life as a measure in cancer treatment: its importance and relevance. Cancer J. 2009;15:435–40.

    PubMed  Google Scholar 

  26. Gotay CC, Moore TD. Assessing quality of life in head and neck cancer. Qual Life Res. 1992;1:5–17.

    CAS  PubMed  Google Scholar 

  27. Ringash J, Lockwood G, O’Sullivan B, Warde P, Bayley A, Cummings B, et al. Hyperfractionated, accelerated radiotherapy for locally advanced head and neck cancer: Quality of life in a prospective phase I/II trial. Radiother Oncol. 2008;87:181–7.

    PubMed  Google Scholar 

  28. Ojo B, Genden EM, Teng MS, Milbury K, Misiukiewicz KJ, Badr H. A systematic review of head and neck cancer quality of life assessment instruments. Oral Oncol. 2012;48:923–37.

  29. Senft M, Fietkau R, Iro H, Sailer D, Sauer R. The influence of supportive nutritional therapy via percutaneous endoscopically guided gastrostomy on the quality of life of cancer patients. Support Care Cancer. 1993;1:272–5.

    CAS  PubMed  Google Scholar 

  30. Salas S, Baumstarck-Barrau K, Alfonsi M, Digue L, Bagarry D, Feham N, et al. Impact of the prophylactic gastrostomy for unresectable squamous cell head and neck carcinomas treated with radio-chemotherapy on quality of life: prospective randomized trial. Radiother Oncol. 2009;93:503–9.

    PubMed  Google Scholar 

  31. Chandu A, Smith ACH, Rogers SN. Health-related quality of life in oral cancer: a review. J Oral Maxillofac Surg. 2006;64:495–502.

    PubMed  Google Scholar 

  32. Moleiro J, Faias S, Fidalgo C, Serrano M, Pereira AD. Usefulness of prophylactic percutaneous gastrostomy placement in patients with head and neck cancer treated with chemoradiotherapy. Dysphagia. 2016;31:84–9.

    PubMed  Google Scholar 

  33. Beer KT, Krause KB, Zuercher T, Stanga Z. Early percutaneous endoscopic gastrostomy insertion maintains nutritional state in patients with aerodigestive tract cancer. Nutr Cancer. 2005;52:29–34.

    PubMed  Google Scholar 

  34. Wiggenraad RGJ, Flierman L, Goossens A, Brand R, Verschuur HP, Croll GA, et al. Prophylactic gastrostomy placement and early tube feeding may limit loss of weight during chemoradiotherapy for advanced head and neck cancer, a preliminary study. Clin Otolaryngol. 2007;32:384–90.

    CAS  PubMed  Google Scholar 

  35. Paleri V, Patterson J. Use of gastrostomy in head and neck cancer: a systematic review to identify areas for future research. Clin Otolaryngol. 2010;35:177–89.

  36. Rogers SN, Thomson R, O’Toole P, Lowe D. Patients experience with long-term percutaneous endoscopic gastrostomy feeding following primary surgery for oral and oropharyngeal cancer. Oral Oncol. 2007;43:499–507.

    PubMed  Google Scholar 

  37. Jordan S, Philpin S, Warring J, Cheung WY, Williams J. Percutaneous endoscopic gastrostomies: The burden of treatment from a patient perspective. J Adv Nurs. 2006;56:270–81.

    PubMed  Google Scholar 

  38. Silander E, Nyman J, Bove M, Johansson L, Larsson S, Hammerlid E. Impact of prophylactic percutaneous endoscopic gastrostomy on malnutrition and quality of life in patients with head and neck cancer: A randomized study. Head Neck. 2012;34:1–9.

    PubMed  Google Scholar 

  39. Deutsche Gesellschaft für Radioonkologie (DEGRO). S2e-Leitlinie: Supportive Maßnahmen in der Radioonkolige: AWMF-Register-Nr. 052/014. 2015.

  40. Ravasco P, Monteiro-Grillo I, Marques Vidal P, Camilo ME. Impact of nutrition on outcome: A prospective randomized controlled trial in patients with head and neck cancer undergoing radiotherapy. Head Neck. 2005;27:659–68.

    PubMed  Google Scholar 

  41. Langius JAE, Zandbergen MC, Eerenstein SEJ, van Tulder MW, Leemans CR, Kramer MHH et al. Effect of nutritional interventions on nutritional status, quality of life and mortality in patients with head and neck cancer receiving (chemo)radiotherapy: a systematic review. Clin Nutr. 2013;32:671–8.

  42. Robinson G, Goldstein M, Levine GM. Impact of nutritional status on DRG length of stay. JPEN J Parenter Enter Nutr. 1987;11:49–51.

    CAS  Google Scholar 

  43. Verhoef MJ, van Rosendaal GM. Patient outcomes related to percutaneous endoscopic gastrostomy placement. J Clin Gastroenterol. 2001;32:49–53.

    CAS  PubMed  Google Scholar 

  44. Madhoun MF, Blankenship MM, Blankenship DM, Krempl GA, Tierney WM. Prophylactic PEG placement in head and neck cancer: How many feeding tubes are unused (and unnecessary)? World J Gastroenterol. 2011;17:1004–8.

    PubMed  PubMed Central  Google Scholar 

  45. Wolff K-D, Follmann M, Nast A. The diagnosis and treatment of oral cavity cancer. Dtsch Arztebl Int. 2012;109:829–35.

    PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Contributions

The authors have contributed to the manuscript by planning the study (Blumenstein, Bojunga, Wächtershäuser), collecting the data (Hausmann, Göttlich, Wächtershäuser), analysis and interpretation of data (Hausmann, Kubesch, Blumenstein, Goettlich, Rey), and preparation (Kubesch, Hausmann, Blumenstein) and revision of the manuscript (all authors).

Corresponding author

Correspondence to Alica Kubesch.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hausmann, J., Kubesch, A., Goettlich, C.M. et al. Quality of life of patients with head and neck cancer after prophylactic percutaneous-gastrostomy. Eur J Clin Nutr 74, 565–572 (2020). https://doi.org/10.1038/s41430-019-0499-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41430-019-0499-5

This article is cited by

Search

Quick links