Some Head and Neck Cancer Survivors May Be at Greater Risk for Long-Term Gastrostomy Tube Use

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A small subset of patients who have undergone treatment for head and neck cancer may require a gastrostomy tube many years into survivorship, according to a new study published by Galloway et al in the International Journal of Radiation Oncology, Biology, and Physics. The findings were also presented at the 2022 American Society for Radiation Oncology (ASTRO) Annual Meeting (Abstract 282).

“In the context of head and neck cancer, a gastrostomy tube is used when a patient cannot swallow effectively, either as a consequence of the tumor itself or of the intensity of the treatment,” said Thomas J. Galloway, MD, Associate Professor in the Department of Radiation Oncology, Chief of the Division of Head and Neck Radiation Oncology, and Medical Director of Clinical Research at Fox Chase Cancer Center. A temporary gastrostomy tube is typically inserted during treatment and removed a handful of weeks or months later, said Dr. Galloway; however, in some situations, a long-term gastrostomy tube may be placed during or after treatment and is not removed.

“[W]e do not want to take a patient who was otherwise healthy and doing well and give them treatment that is so intense that we cure the cancer but permanently damage their ability to eat for the rest of their lives,” Dr. Galloway emphasized.

Factors Contributing to Long-Term Use

In order to identify what factors might be associated with an increased likelihood of long-term gastrostomy tube use, Dr. Galloway and his colleagues pooled data from three large studies involving 2,389 patients who were treated with chemotherapy and radiation for head and neck cancer. Among these patients, the gastrostomy tube rate at treatment initiation was 14%. At 1 year posttreatment, the rate was 19%, and at 9 years posttreatment, the rate was 8%.

Patients treated with three-dimensional conformal radiotherapy regimens had significantly higher rates of gastrostomy tubes at baseline, 6 months, 1 year, and 2 years posttreatment compared with patients treated with accelerated regimens. No differences were seen in tube rates for years 3 to 9.

Predictors of long-term feeding tube use more than 5 years posttreatment included older age, larger primary tumors, and a smoking history greater than 10 pack-years.

“The majority of patients being treated are doing fine [at] 3 [to] 5 years posttreatment, but a small subset of those patients will develop problems deep into survivorship,” Dr. Galloway explained. “Clinicians need to be mindful of that,” he stressed.

Ongoing studies are looking at less intensive radiation treatment strategies and attempting to identify the minimum effective dose vs the maximum tolerated dose.

“The idea is to be able to give the lowest dose possible to provide [a] cure, with the hope that this will also result in fewer feeding tubes [in use] 7 years later,” Dr. Galloway said. “We want to see that a dose reduction translates into a meaningful decrease in long-term feeding tubes in patients.”

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