Impact of prophylactic gastrostomy or reactive NG tube upon patient-reported long term swallow function following chemoradiotherapy for oropharyngeal carcinoma: A matched pair analysis. (August 2016)

• Record Type: Journal Article
• Authors: Sethugavalar, Brinda; Teo, Mark T.; Buchan, Catriona; Ermiş, Ekin; Williams, Gillian F.; Sen, Mehmet; Prestwich, Robin J.D.
• Is Part Of: Oral oncology. Volume 59(2016:Aug.)
• Page Start: 80
• Page End: 85
• Publication Date: 2016-08
• Subjects: Head and neck cancer -- Oropharynx cancer -- Radiotherapy -- Chemotherapy -- Swallow -- Late toxicity -- Quality of life -- Gastrostomy -- Nasogastric tube; Mouth -- Cancer -- Periodicals; Mouth -- Tumors -- Periodicals; Mouth Diseases -- Periodicals; Mouth Neoplasms -- Periodicals; Bouche -- Cancer -- Périodiques; Bouche -- Tumeurs -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9943105
• DOI: 10.1016/j.oraloncology.2016.06.007
• Languages: English
• ISSNs: 1368-8375

Abstract

Highlights: Influence of prophylactic gastrostomy on long term swallow outcomes is uncertain. Study of patient-reported long term swallow outcomes following chemoradiotherapy. Matched pair analysis used to assess influence of route of enteral feed. Reactive nasogastric feed associated with superior long term swallow outcomes. Summary: Objectives: The purpose of this matched pair analysis is to assess patient-reported long term swallow function following chemoradiotherapy for locally advanced oropharyngeal cancer in relation to the use of a prophylactic gastrostomy or reactive nasogastric (NG) tube. Materials and methods: The MD Anderson Dysphagia Inventory (MDADI) was posted to 68 consecutive patients with stage III/IV oropharyngeal squamous cell carcinoma who had completed parotid sparing intensity modulated radiotherapy with concurrent chemotherapy between 2010 and 2012, had not required therapeutic enteral feeding prior to treatment, minimum 2 years follow up post treatment, and who were disease free. 59/68 replies were received, and a matched pair analysis (matching for T and N stage) was performed for 52 patients, 26 managed with a prophylactic gastrostomy and 26 with an approach of an NG tube as needed. Results: There were no significant differences in patient demographics, pre-treatment diet and treatment factors between the two groups. Patient-reported swallowing function measured using the MDADI was superior for patients managed with an NG tube as required compared with a prophylactic gastrostomy: overall composite score 68.1 versus 59.4 ( p = 0.04), global score 67.7 versus 60 ( p = 0.04), emotional subscale 73.5 versus 60.4 ( p < 0.01), functional subscale 75.4 versus 61.7 ( p < 0.01), and physical subscale 59.6 versus 57.1 ( p = 0.38). Conclusions: Compared with an approach of an NG tube as required, the use of a prophylactic gastrostomy was associated with inferior long term patient-reported long term swallow outcomes.