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Nutrition and Health (including climate and ecological aspects)

Effect of prophylactic gastrostomy on nutritional and clinical outcomes in patients with head and neck cancer

Abstract

Background

We aimed to identify which enteral feeding method was most beneficial for patients and compare clinical outcomes, quality of life, and complication rates by assessing patients who underwent prophylactic percutaneous endoscopic gastrostomy (pPEG) tube, reactive percutaneous endoscopic gastrostomy (rPEG) tube or reactive nasogastric tube (rNGT) insertion.

Methods

Patients with head and neck cancers (HNCs) were enrolled between April 1, 2013 and April 17, 2019 (n = 335; 296 males, 39 females). Data concerning patient characteristics and treatment modalities were extracted from the medical records. Comparisons between enteral feeding methods were made by univariate and multivariate analysis. Overall survival (OS) outcomes were analyzed by the log rank test using the Kaplan–Meier method.

Results

A total of 335 patients were included. The median follow-up time was 29.5 months. There were forty-six patients in the pPEG tube group, 23 patients in the rPEG tube group, and 266 patients in the rNGT group. pPEG, increased body-mass index (BMI), and N0-1 category were significantly associated with less weight loss in the multivariate analysis (all P < 0.05). pPEG decreased the rate of radiotherapy delay compared with that of reactive interventions (23.1% vs. 47.1%, P = 0.007). In terms of quality of life, global health status, role functioning, emotional functioning, cognitive functioning, pain, and dyspnea were significantly improved in the pPEG tube group (all P < 0.05). BMI and weight loss were independent prognostic factors for clinical survival outcomes (all P < 0.05).

Conclusions

pPEG could improve nutrition outcomes, reduce treatment delay, and maintain quality of life.

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Fig. 1: Overall survival curves separated by weight loss ≥ 2% and weight loss < 2% group.
Fig. 2: Overall survival curves of patients with or without BMI gain.

Data availability

Data sharing requests for data will be dealt with by the corresponding author after the study has been published. Subject to approval by the corresponding author and Sun Yat-sen University Cancer Center, de-identified participant data will be available. To evaluate whether a data request is reasonable, a detailed research protocol will be required. Depending on the materials provided by researchers, the corresponding author and Sun Yat-sen University Cancer Centre reserve the right to decide whether to share the data or not.

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Funding

This study was funded by the Planned Science and Technology Project of Guangdong Province (No 2016A020215085, 201707010087) and the 308 Clinical Research Funding of Sun Yat-Sen University Cancer Center (No 308-2015-011).

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Contributions

Conceptualization, LC and L-XL; methodology, Q-QX; software, Q-QX and L-LG; validation, J-HL, LC and YW; formal analysis, L-LG, J-HL, LC; investigation, YW; resources, L-XL; data curation, LC; writing—original draft preparation, Q-QX; writing—review and editing, Q-QX and L-LG; visualization, Q-QX and LC; supervision, L-XL; project administration, LC and L-XL; funding acquisition, L-XL. All authors have read and agreed to the published version of the manuscript.

Corresponding authors

Correspondence to Lei Chen or Li-Xia Lu.

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The authors declare no competing interests.

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Xu, QQ., Guo, LL., Lou, JH. et al. Effect of prophylactic gastrostomy on nutritional and clinical outcomes in patients with head and neck cancer. Eur J Clin Nutr (2022). https://doi.org/10.1038/s41430-022-01154-x

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