Percutaneous Endoscopic Gastrostomy Dependence in Head and Neck Cancer Patients: A 7-Year Retrospective Cohort Study
Vihas Patel*, Xiaoxia Liu, Danielle Margalit, Robert Haddad and Guilherme Rabinowits
Abstract:
Aim: Percutaneous endoscopic gastrostomy (PEG) use in head and neck cancer (HNC) patients undergoing surgery followed by adjuvant or definitive concurrent chemo radiation therapy (AD-CRT) is controversial due to concerns of tube-related complications including long-term dependence. We sought to determine the predictors of PEG dependency at 6 months and 1 year in HNC patients undergoing multimodality therapy (MT).
Methods: Retrospective cohort study, 2005-2011
Results: PEG was considered early if inserted prior to or within 2 weeks of radiation therapy (RT) initiation. The 223 (87%) patients who received early PEG were younger (57.3 versus 61.6 years) and had a higher body mass index (27.2 versus 25.3 kg/m2). Both groups were comparable in terms of tobacco and alcohol exposure and disease stage. Oral cavity tumors as well as oncologic resection were more commonly seen in the late PEG group. After adjusting for covariates, early PEG was associated with a lower PEG dependency rate (OR 3.5 [95% CI 1.3, 9.3]) and overall infection rate (OR 5.7 [95% CI, 1.7 to 19.1]).
Conclusions: We found that early PEG in HNC patients undergoing MT was associated with decreased PEG dependency and overall infection rates. These findings need to be confirmed prospectively.
Aim: Percutaneous endoscopic gastrostomy (PEG) use in head and neck cancer (HNC) patients undergoing surgery followed by adjuvant or definitive concurrent chemo radiation therapy (AD-CRT) is controversial due to concerns of tube-related complications including long-term dependence. We sought to determine the predictors of PEG dependency at 6 months and 1 year in HNC patients undergoing multimodality therapy (MT).
Methods: Retrospective cohort study, 2005-2011
Results: PEG was considered early if inserted prior to or within 2 weeks of radiation therapy (RT) initiation. The 223 (87%) patients who received early PEG were younger (57.3 versus 61.6 years) and had a higher body mass index (27.2 versus 25.3 kg/m2). Both groups were comparable in terms of tobacco and alcohol exposure and disease stage. Oral cavity tumors as well as oncologic resection were more commonly seen in the late PEG group. After adjusting for covariates, early PEG was associated with a lower PEG dependency rate (OR 3.5 [95% CI 1.3, 9.3]) and overall infection rate (OR 5.7 [95% CI, 1.7 to 19.1]).
Conclusions: We found that early PEG in HNC patients undergoing MT was associated with decreased PEG dependency and overall infection rates. These findings need to be confirmed prospectively.
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