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Age most significant predictor of requiring enteral feeding in head-and-neck cancer patients.

Sachdev S, Refaat T, Bacchus ID, Sathiaseelan V, Mittal BB - Radiat Oncol (2015)

Bottom Line: Patients with significant weight loss (>10%) in the setting of severely reduced oral intake were referred for placement of a percutaneous endoscopic gastrostomy (PEG) tube.For patients 60 or older compared to younger adults, the odds ratio for needing enteral feeding was 4.188 (p=0.0019).Such interventions and others (e.g. swallowing therapy) could possibly delay or minimize the use of enteral feeding, thereby helping avoid tube dependence and tube-associated long-term physiologic consequences.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Northwestern University Robert H. Lurie Comprehensive Cancer Center, 251 E. Huron Street LC-178, Chicago, IL, 60611, USA. sean.sachdev@northwestern.edu.

ABSTRACT

Background: A significant number of patients treated for head and neck squamous cell cancer (HNSCC) undergo enteral tube feeding. Data suggest that avoiding enteral feeding can prevent long-term tube dependence and disuse of the swallowing mechanism which has been linked to complications such as prolonged dysphagia and esophageal constriction. We examined detailed dosimetric and clinical parameters to better identify those at risk of requiring enteral feeding.

Methods: One hundred patients with advanced stage HNSCC were retrospectively analyzed after intensity-modulated radiation therapy (IMRT) to a median dose of 70 Gy (range: 60-75 Gy) with concurrent chemotherapy in nearly all cases (97%). Patients with significant weight loss (>10%) in the setting of severely reduced oral intake were referred for placement of a percutaneous endoscopic gastrostomy (PEG) tube. Detailed DVH parameters were collected for several structures. Univariate and multivariate analyses using logistic regression were used to determine clinical and dosimetric factors associated with needing enteral feeding. Dichotomous outcomes were tested using Fisher's exact test and continuous variables between groups using the Wilcoxon rank-sum test.

Results: Thirty-three percent of patients required placement of an enteral feeding tube. The median time to tube placement was 25 days from start of treatment, after a median dose of 38 Gy. On univariate analysis, age (p=0.0008), the DFH (Docetaxel/5-FU/Hydroxyurea) chemotherapy regimen (p= .042) and b.i.d treatment (P=0.040) (used in limited cases on protocol) predicted need for enteral feeding. On multivariate analysis, age remained the single statistically significant factor (p=0.003) regardless of other clinical features (e.g. BMI) and all radiation planning parameters. For patients 60 or older compared to younger adults, the odds ratio for needing enteral feeding was 4.188 (p=0.0019).

Conclusions: Older age was found to be the most significant risk factor for needing enteral feeding in patients with locally advanced HNSCC treated with multimodal treatment. Pending further validation, this would support maximizing early nutritional guidance, targeted supplementation, and symptomatic support for older adults (>60) undergoing chemoradiation. Such interventions and others (e.g. swallowing therapy) could possibly delay or minimize the use of enteral feeding, thereby helping avoid tube dependence and tube-associated long-term physiologic consequences.

No MeSH data available.


Related in: MedlinePlus

Freedom from tube placement according to age.
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Fig3: Freedom from tube placement according to age.

Mentions: On multivariate analysis, after controlling for chemotherapy regimen and b.i.d treatment, age remained the single statistically significant factor in predicting need for enteral feeding (p = 0.003). This did not change when accounting for effects of significant dosimetric (treatment planning) parameters (p = 0.003) with or without including the larynx (p = 0.013) for the three patients who had undergone laryngectomy. Among all patients, age and BMI were not correlated (Pearson’s correlation coefficient; R = 0.0233, p = 0.82) and age remained a highly significant predictor after controlling for BMI (p = 0.003). A receiver operating characteristics (ROC) analysis revealed an optimal age cut-off of 60 as seen in Figure 2. For adults aged 60 or greater compared to younger adults, the odds ratio for needing enteral feeding was 4.188 (95% CI: 1.587-11.16; p = 0.0019). Figure 3 depicts FFTP according to this age cutoff.Figure 2


Age most significant predictor of requiring enteral feeding in head-and-neck cancer patients.

Sachdev S, Refaat T, Bacchus ID, Sathiaseelan V, Mittal BB - Radiat Oncol (2015)

Freedom from tube placement according to age.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4404131&req=5

Fig3: Freedom from tube placement according to age.
Mentions: On multivariate analysis, after controlling for chemotherapy regimen and b.i.d treatment, age remained the single statistically significant factor in predicting need for enteral feeding (p = 0.003). This did not change when accounting for effects of significant dosimetric (treatment planning) parameters (p = 0.003) with or without including the larynx (p = 0.013) for the three patients who had undergone laryngectomy. Among all patients, age and BMI were not correlated (Pearson’s correlation coefficient; R = 0.0233, p = 0.82) and age remained a highly significant predictor after controlling for BMI (p = 0.003). A receiver operating characteristics (ROC) analysis revealed an optimal age cut-off of 60 as seen in Figure 2. For adults aged 60 or greater compared to younger adults, the odds ratio for needing enteral feeding was 4.188 (95% CI: 1.587-11.16; p = 0.0019). Figure 3 depicts FFTP according to this age cutoff.Figure 2

Bottom Line: Patients with significant weight loss (>10%) in the setting of severely reduced oral intake were referred for placement of a percutaneous endoscopic gastrostomy (PEG) tube.For patients 60 or older compared to younger adults, the odds ratio for needing enteral feeding was 4.188 (p=0.0019).Such interventions and others (e.g. swallowing therapy) could possibly delay or minimize the use of enteral feeding, thereby helping avoid tube dependence and tube-associated long-term physiologic consequences.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Northwestern University Robert H. Lurie Comprehensive Cancer Center, 251 E. Huron Street LC-178, Chicago, IL, 60611, USA. sean.sachdev@northwestern.edu.

ABSTRACT

Background: A significant number of patients treated for head and neck squamous cell cancer (HNSCC) undergo enteral tube feeding. Data suggest that avoiding enteral feeding can prevent long-term tube dependence and disuse of the swallowing mechanism which has been linked to complications such as prolonged dysphagia and esophageal constriction. We examined detailed dosimetric and clinical parameters to better identify those at risk of requiring enteral feeding.

Methods: One hundred patients with advanced stage HNSCC were retrospectively analyzed after intensity-modulated radiation therapy (IMRT) to a median dose of 70 Gy (range: 60-75 Gy) with concurrent chemotherapy in nearly all cases (97%). Patients with significant weight loss (>10%) in the setting of severely reduced oral intake were referred for placement of a percutaneous endoscopic gastrostomy (PEG) tube. Detailed DVH parameters were collected for several structures. Univariate and multivariate analyses using logistic regression were used to determine clinical and dosimetric factors associated with needing enteral feeding. Dichotomous outcomes were tested using Fisher's exact test and continuous variables between groups using the Wilcoxon rank-sum test.

Results: Thirty-three percent of patients required placement of an enteral feeding tube. The median time to tube placement was 25 days from start of treatment, after a median dose of 38 Gy. On univariate analysis, age (p=0.0008), the DFH (Docetaxel/5-FU/Hydroxyurea) chemotherapy regimen (p= .042) and b.i.d treatment (P=0.040) (used in limited cases on protocol) predicted need for enteral feeding. On multivariate analysis, age remained the single statistically significant factor (p=0.003) regardless of other clinical features (e.g. BMI) and all radiation planning parameters. For patients 60 or older compared to younger adults, the odds ratio for needing enteral feeding was 4.188 (p=0.0019).

Conclusions: Older age was found to be the most significant risk factor for needing enteral feeding in patients with locally advanced HNSCC treated with multimodal treatment. Pending further validation, this would support maximizing early nutritional guidance, targeted supplementation, and symptomatic support for older adults (>60) undergoing chemoradiation. Such interventions and others (e.g. swallowing therapy) could possibly delay or minimize the use of enteral feeding, thereby helping avoid tube dependence and tube-associated long-term physiologic consequences.

No MeSH data available.


Related in: MedlinePlus