Effect of Smoking and Alcohol Consumption on Feeding Tube Duration in Head and Neck Cancer Patients


Key Points

  • Median duration of feeding tube use after completion of treatment was 9 months.
  • Significant risk factors for prolonged gastrostomy use were current heavy alcohol consumption and current smoking.
  • Patients should be advised to avoid smoking and excess alcohol consumption during radiotherapy or chemotherapy.

Current smoking and heavy alcohol consumption appear to be risk factors for prolonged use of a gastrostomy tube in patients with head and neck cancer undergoing radiotherapy or chemoradiotherapy. The findings were published in a report by O’Shea et al in JAMA Otolaryngology-Head & Neck Surgery.

Study Details

Chemoradiotherapy is a well-established treatment for advanced cancer of the head and neck. However, its toxic effects can compromise eating, and result in weight loss and malnutrition. Consequently, many institutions recommend prophylactic gastrostomy before starting treatment.

Patrick Sheahan, MB, MD, FRCSI, of the South Infirmary Victoria University Hospital, in Cork, Ireland, and colleagues studied smoking and alcohol consumption as potentially modifiable risk factors for increased duration of gastrostomy tube use.

This retrospective study included 104 patients with squamous cell cancer of the head and neck undergoing treatment with either chemoradiation (84 patients) or radiotherapy alone (20 patients).

The authors found the median duration of gastrostomy tube use was 9 months. The rate of gastrostomy tube use at 12 months was 35%.

Risk factors for prolonged gastrostomy tube use appeared to be current heavy alcohol consumption (someone who drank every day, drank more than a specified amount per week, or had a history of alcoholism or alcohol-related illness and was still drinking) and current smoking. Only current smoking remained an independent risk factor in multivariable analyses, according to the study.

Possible Causes

The authors speculate there are several reasons why smoking and drinking might have an effect on prolonged gastrostomy use. Nicotine may suppress appetite so patients make less of an effort to resume full eating by mouth, and smoking and drinking may lead to poor patient motivation to resume eating after treatment.

“Our results would support advising patients with head and neck squamous cell carcinoma undergoing radiotherapy or chemoradiotherapy to avoid smoking and excess alcohol consumption during treatment. However, to determine whether stopping smoking and drinking can shorten duration of gastronomy tube use will require further data from prospective studies,” the study concluded.

Dr. Sheahan is the corresponding author for the JAMA Otolaryngology–Head & Neck Surgery article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.