Which feeding tubes do head and neck cancer clinicians prefer to use in patients undergoing radiotherapy?
Author: Susan Moench, PhD, PA-C
A study of the perceptions of health care professionals involved in the care of patients with head and neck cancer undergoing radiation therapy regarding optimal feeding tube practices showed no consensus; however, feeding tube placement was considered important for some patients. This study was published in JPEN Journal of Parenteral Enteral Nutrition.
Patients with head and neck cancer frequently undergo intensive treatment that may include a long course of radiation therapy in addition to surgery and chemotherapy. Treatment-related toxicity can involve severe dysphagia and mucositis, as well as reduced food intake and unintentional weight loss; these clinical sequelae can also lead to treatment delays and an increased risk of hospitalization.
Clinical practice guidelines include recommendations for early enteral feeding in patients with stage IV disease or hypopharyngeal tumors who are receiving chemoradiotherapy, as well as other patients with head and neck cancer, “depending on factors including their treatment, nutrition status, dysphagia, social support, and food intake.” However, there is no conclusive evidence as to which of the most commonly used feeding tubes — a nasogastric tube (NGT) placed when additional nutritional support is needed or a prophylactic gastrostomy tube (PGT) placed before radiation therapy — is preferable.
In this qualitative study, in-depth interviews were conducted with interdisciplinary health care professionals from 4 radiation therapy departments (2 in the United States and 2 in Australia) to evaluate their perspectives and experiences regarding feeding tube practices in patients with head and neck cancer.
Of the 46 health care professionals participating in the study, 26% were nurses, 37% were radiation oncologists, 24% dieticians, and 13% were speech pathologists.
One of the interesting findings from this study was the lack of a feeding tube protocol in place at all 4 radiation oncology departments, with decisions regarding feeding tube placement typically made by staff specialists on a case-by-case basis.
When use of a feeding tube was deemed appropriate, healthcare professionals at 3 of the radiation oncology departments favored the use of PGT, whereas NGT was preferred at the remaining department.
Patient-related factors considered to be important in decision making regarding feeding tube placement included planned treatment, tumor characteristics, nutrition and swallow status, risk of tube dependence, psychosocial status, and patient preferences. Other factors cited as potentially bearing on decisions related to feeding tubes were access to a dietician and a speech pathologist, as well as interdisciplinary collaboration, and the infrastructure to support timely feeding tube placements and intravenous fluids.
“Further research is needed to explore patient preferences, tube dependence, interdisciplinary collaboration, and department infrastructure to promote consistent evidence-based and patient-centered feeding tube practices,” the investigators concluded.
Hazzard E, Walton K, McMahon AT, et al. Healthcare professionals’ perceptions of feeding tube practices for patients with head and neck cancer across 4 international radiation oncology departments [published online September 2, 2019]. JPEN J Parenter Enteral Nutr. doi: 10.1002/jpen.1699