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Clinical Nutrition

Validation of an updated evidence-based protocol for proactive gastrostomy tube insertion in patients with head and neck cancer

European Journal of Clinical Nutrition volume 70, pages 574–581 (2016)Cite this article

Subjects

Abstract

Background/Objectives:

Evidence-based practice guidelines are available to assist in the decision making for nutrition interventions in patients with head and neck cancer. Re-assessment of guideline recommendations is important with changing demographics, new treatment regimens, advancing radiotherapy techniques, such as helical intensity-modulated radiotherapy, and the emergence of new literature. The aim of this study was to validate the updated high-risk category definition in our local hospital protocol for the swallowing and nutrition management of patients with head and neck cancer to determine the ongoing predictive ability for identifying proactive gastrostomy requirement in a new cohort.

Subjects/Methods:

Patients attending a major tertiary hospital for head and neck cancer treatment from 2010 to 2011 were included (n=270). Data were collected on patient demographics (age and gender), clinical factors (tumour site, staging and treatment), nutrition outcome measures (weight, enteral feeding) and protocol adherence. Sensitivity and specificity were calculated and compared with the original validation study.

Results:

Proactive gastrostomy tubes were inserted in 86 patients. Overall protocol adherence was 93%. Sensitivity improved to 72% (increase of 18%) and specificity improved to 96% (increase of 3%) compared with the original validation study where patients received three-dimensional (3-D) conformal radiotherapy.

Conclusions:

The results of this study confirm that the updated high-risk category in the protocol for the swallowing and nutrition management of patients with head and neck cancer remains valid to predict proactive gastrostomy in a mixed population receiving helical intensity-modulated radiotherapy and 3-D conformal radiotherapy. The protocol has an improved sensitivity and specificity and hence remains just as relevant for advanced techniques of radiation treatment delivery.

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Acknowledgements

We thank Dr Tuan Ha, Radiation Oncology, for his assistance in data collection, Dr Lynda Ross for advice on writing the manuscript, Ann-Louise Spurgin and Jane Crombie, Speech Pathology, for their involvement in the initial development of the protocol, and the support of staff in medical records and the Combined Head and Neck Clinic at the Royal Brisbane and Women’s Hospital. Funding source: Royal Brisbane and Women’s Hospital PhD Scholarship.

Author contributions

TB initiated the study concept. TB, JB, MB and BH contributed to study design. VG, TB and CL participated in the acquisition of data. VG and TB analysed the data, and VG prepared the first draft of the manuscript. All the authors participated in the interpretation of the data, critical revision of the manuscript and the final approval of the submitted version. As corresponding author TB has full access to all the data in the study and has final responsibility for the decision to submit for publication.

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Authors and Affiliations

  1. Department of Nutrition and Dietetics, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia,

    T E Brown & M D Banks

  2. Centre for Dietetics Research (C-DIET-R), School of Human Movement Studies, University of Queensland, Brisbane, QLD, Australia

    T E Brown, V Getliffe & J D Bauer

  3. Cancer Care Services, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia

    B G M Hughes, C Y Lin & L M Kenny

  4. School of Medicine, University of Queensland, Brisbane, QLD, Australia

    B G M Hughes

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  1. T E Brown
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Correspondence to T E Brown.

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Competing interests

TB received a Royal Brisbane and Women’s Hospital PhD Scholarship. The funding body was not involved in the study design, data collection, analysis and interpretation of results, writing of the report or the decision to submit the article for publication. The remaining authors declare no conflict of interest.

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Brown, T., Getliffe, V., Banks, M. et al. Validation of an updated evidence-based protocol for proactive gastrostomy tube insertion in patients with head and neck cancer. Eur J Clin Nutr 70, 574–581 (2016). https://doi.org/10.1038/ejcn.2015.230

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