Validation of an updated evidence-based protocol for proactive gastrostomy tube insertion in patients with head and neck cancer

Brown, T. E., Getliffe, V., Banks, M. D., Hughes, B. G. M., Lin, C. Y., Kenny L. M. and Bauer, J. (2016) Validation of an updated evidence-based protocol for proactive gastrostomy tube insertion in patients with head and neck cancer. European Journal of Clinical Nutrition, 70 5: 1-8. doi:10.1038/ejcn.2015.230


Author Brown, T. E.
Getliffe, V.
Banks, M. D.
Hughes, B. G. M.
Lin, C. Y.
Kenny L. M.
Bauer, J.
Title Validation of an updated evidence-based protocol for proactive gastrostomy tube insertion in patients with head and neck cancer
Journal name European Journal of Clinical Nutrition   Check publisher's open access policy
ISSN 1476-5640
0954-3007
Publication date 2016-02-10
Year available 2016
Sub-type Article (original research)
DOI 10.1038/ejcn.2015.230
Open Access Status Not Open Access
Volume 70
Issue 5
Start page 1
End page 8
Total pages 8
Place of publication London, United Kingdom
Publisher Nature Publishing Group
Collection year 2017
Language eng
Formatted abstract
Background/Objectives:  Evidence-based practice guidelines are available to assist in the decision making for nutrition interventions in patients with head and neck cancer. Re-assessment of guideline recommendations is important with changing demographics, new treatment regimens, advancing radiotherapy techniques, such as helical intensity-modulated radiotherapy, and the emergence of new literature. The aim of this study was to validate the updated high-risk category definition in our local hospital protocol for the swallowing and nutrition management of patients with head and neck cancer to determine the ongoing predictive ability for identifying proactive gastrostomy requirement in a new cohort.

Subjects/Methods:  Patients attending a major tertiary hospital for head and neck cancer treatment from 2010 to 2011 were included (n=270). Data were collected on patient demographics (age and gender), clinical factors (tumour site, staging and treatment), nutrition outcome measures (weight, enteral feeding) and protocol adherence. Sensitivity and specificity were calculated and compared with the original validation study.

Results:  Proactive gastrostomy tubes were inserted in 86 patients. Overall protocol adherence was 93%. Sensitivity improved to 72% (increase of 18%) and specificity improved to 96% (increase of 3%) compared with the original validation study where patients received three-dimensional (3-D) conformal radiotherapy.

Conclusions:
 The results of this study confirm that the updated high-risk category in the protocol for the swallowing and nutrition management of patients with head and neck cancer remains valid to predict proactive gastrostomy in a mixed population receiving helical intensity-modulated radiotherapy and 3-D conformal radiotherapy. The protocol has an improved sensitivity and specificity and hence remains just as relevant for advanced techniques of radiation treatment delivery.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

 
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Created: Mon, 15 Feb 2016, 09:29:36 EST by Sandrine Ducrot on behalf of School of Human Movement and Nutrition Sciences