Impact of early prophylactic feeding on long term tube dependency outcomes in patients with head and neck cancer

- Prophylactic gastrostomy tube use is high in the acute phase post-treatment.
- Long term tube dependency rates at 12 months are low (4%).
- Encouraging early tube use does not increase long term dependency rates.
- Measuring tube use is important to prevent over-estimation of dependency rates.

ObjectivesProphylactic gastrostomy tube (PGT) is frequently used in patients with head and neck cancer (HNSCC). There are concerns this leads to tube dependency but this phenomena is not well defined. This study aimed to determine whether early feeding via PGT impacted on longer term tube feeding outcomes.Materials and methodsPatients with HNSCC with PGT were observed monthly post-treatment regarding tube use and time to removal up to twelve months. Patients were from a randomised controlled trial comparing an early feeding intervention via the PGT (n = 57) versus usual care which commenced feeding when clinically indicated (n = 67).ResultsPatient characteristics; male (88%), mean age 60 ± 10.1 years, oropharyngeal tumours (76%), receiving chemoradiotherapy (82%). Tubes were used by 87% (108/124) on completion of treatment and 66% (83/124) one month post. No differences in tube use between groups at any time point or tube removal rates over 12 months (p = 0.181). In patients free of disease (n = 99), the intervention had higher tube use at 4 months (p = 0.003) and slower removal rates (p = 0.047). Overall ten patients had their tube in-situ at 12 months (8%) but five were awaiting removal (4% true dependency rate). Of the five patients legitimately using the tube, only one (<1%) was from severe dysphagia post definitive chemoradiotherapy.ConclusionPGT use is high in the acute phase post-treatment. Encouraging early use may prolong time to tube removal but it does not increase long term dependency rates beyond four months post treatment. Monitoring tube use is important to prevent over-estimation of dependency rates.Clinical trial registrationThis trial has been registered in the Australian New Zealand Clinical Trials registry as ACTRN12612000579897. Available at http://www.anzctr.org.au.