A Multidisciplinary Approach to the Reactive Placement of Nasogastric Feeding Tubes in Clinic During Treatment for Head and Neck Cancer

Document Type

Conference Proceeding

Publication Date

11-1-2021

Publication Title

Int J Radiat Oncol Biol Phys

Abstract

Purpose/Objective(s): Radiation therapy (RT) associated oral mucositis, xerostomia and loss of taste may result in significantly compromised oral intake in patients undergoing treatment for head and neck cancers (HNC). We sought to determine if reactive nasogastric tube (NGT) placement was an effective strategy for nutritional support in these patients and if invasive percutaneous endoscopic gastrostomy (PEG) tube insertion could be avoided.

Materials/Methods: This is an IRB- approved study of patients treated for HNC using definitive or adjuvant RT with or without concurrent chemotherapy between June 2017 and December 2020. We evaluated the indications for NGT (Dobhoff) placement, time of placement during the course of RT, patient tolerance of NGT and median duration of NGT placement. In addition, we followed weight loss during treatment, treatment interruptions, and treatment related toxicities. Complications associated with having the NGT, if the NGT needed to be replaced during treatment, and if the patient had any hospitalization during the course of treatment was tracked. The indication for NGT placement is weight loss > 10% of baseline during the course of treatment, most often due to dysphagia and/or odynophagia unrelieved by pain medication. NGT placement is done in the radiation oncology outpatient clinic by the attending physician and/or nurse practitioner.

Results: Of the 441 patients treated during the time period of this study, 47 required reactive NGT placement for nutritional support. Patients included 40 with primary oropharynx, 3 oral cavity, 2 larynx, 1 nasopharyngeal, and 1 unknown. Chemotherapy was given concurrently with radiation in 87.2% (41/47) patients. The median time of NGT placement was during week 5.0 of the 6–7-week course of RT. The median percentage weight loss from baseline to the date of NGT placement was 12.9%. The median duration of NGT placement was 29 days (range, 5 to 151 days). There were no serious medical complications associated with having the NGT in place during treatment. 27.6% (13/47) of patients had the NGT dislodged or displaced and needed replacement. 4.3% (2/47) of patients had the NGT replaced due to clogging. 38.3% (18/47) of patients with an NGT had to be hospitalized during the course of RT, with the predominant symptoms being failure to thrive 22.2% (4/18) and nausea/vomiting 22.2% (4/18). 6.4% (3/47) of patients requested removal of the NGT due to local irritation. 76.6% (36/47) of patients did not require further nutritional support with the placement of a percutaneous endoscopic gastrostomy (PEG) tube.

Conclusion: This study indicates clinic placement of an NGT for patients receiving RT for head and neck cancer is a safe and effective way to maintain nutrition during treatment. The rate of weight loss decreased after the patient had an NGT placed. The placement procedure is well tolerated and there were no complications associated with having the NGT during treatment. PEG tube insertion was avoided in 76.6% of the patients.

Volume

111

Issue

3

First Page

e154

Last Page

e155

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