Impact of baseline patient-reported dysphagia on acute gastrostomy placement in patients with head and neck squamous cell carcinoma undergoing definitive radiation

Miriam N. Lango, Thomas J. Galloway, Ranee Mehra, Barbara Ebersole, Jeffrey Chang Jen Liu, Kathleen Moran, John A. Ridge

Research output: Contribution to journalArticlepeer-review

Abstract

Background Dysphagia-related symptoms in patients with head and neck cancer are common before treatment. We hypothesized greater self-reported baseline dysphagia would predict gastrostomy placement during primary radiation. Methods Swallowing-specific/general surveys (SwalQOL/EuroQOL) collected prospectively before definitive radiation were analyzed for associations with gastrostomy placement. Prophylactic gastrostomy was recommended at the discretion of a multidisciplinary team blinded to the surveys. Results Of 84 patients in the cohort, 42 patients (50%) received feeding tubes. Eleven patients (13%) who underwent prophylactic feeding tube placement reported the greatest pretreatment dysphagia, whereas those who avoided gastrostomies reported the least. Prophylactic gastrostomy was more strongly associated with patient-reported measures than other clinical criteria. Controlling for stage IV, T3 to T4 classification, smoking, chemotherapy, and pretreatment weight loss, baseline dysphagia remained an independent predictor of feeding tube placement (odds ratio [OR] = 0.12; 95% confidence interval [CI] = 0.05-0.55; p =.01). Patients without gastrostomies during treatment avoided persistent gastrostomy dependence. Conclusion Baseline dysphagia-related symptoms before radiation are independent predictors of gastrostomy placement.

Original languageEnglish (US)
Pages (from-to)E1318-E1324
JournalHead and Neck
Volume38
DOIs
StatePublished - Apr 1 2016

Keywords

  • dysphagia
  • head and neck squamous cell carcinoma
  • patient reported outcomes
  • radiation

ASJC Scopus subject areas

  • Otorhinolaryngology

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