The use of prophylactic percutaneous endoscopic gastrostomy and early enteral feeding in patients with advanced head and neck cancer-A prospective longitudinal study

SummaryBackground&aimsThis descriptive study aimed to explore the effect of early nutritional support and enteral feeding using percutaneous endoscopic gastrostomy (PEG) in preventing malnutrition in patients with locally advanced head-neck cancer.MethodSixty-four patients received a prophylactic PEG before treatment. Weight, body mass index (BMI), body composition, fat free mass index (FFMI), dysphagia and use of tube feeding were followed during two years.ResultsThe patients started to use their PEGs on average 30 days after treatment start and used enteral feeding for 180 days. PEG was well tolerated with few side-effects. After one-year 89% had returned to almost normal diet. At the time of inclusion in the study, 42% had lost weight, on average 6% of their normal weight. Despite nutritional advice and early tube feeding the patients continued to lose weight. The largest weight loss was found after six months (average 11.2%). At that follow-up 62% of the patients were malnourished (loss of >10% of their weight at inclusion), however BMI, and more importantly, the fat free-mass remained normal, probably due to the rather slow weight loss progression.ConclusionPatients required nutritional support and enteral feeding for an extended time-period, however a normal body composition was maintained despite weight loss.