Swallowing outcomes for patients with oropharyngeal squamous cell carcinoma treated with primary (chemo)radiation therapy receiving either prophylactic gastrostomy or reactive nasogastric tube: A prospective cohort study

Clin Otolaryngol. 2017 Dec;42(6):1135-1140. doi: 10.1111/coa.12836. Epub 2017 Mar 10.

Abstract

Objectives: There is currently no consensus on the optimal feeding route for an oropharyngeal squamous cell cancer (OPSCC) patient without pre-existing dysphagia undergoing chemoradiotherapy. This study aimed to compare the swallowing outcomes for OPSCC patients fed via either prophylactic RIG (pRIG) or reactive nasogastric tube (rNGT).

Design: A prospective cohort study.

Setting: Four head and neck cancer centres in the North of England Cancer Network.

Participants: Fifty-three participants with OPSCC, on a normal diet pre-(chemo) radiotherapy.

Main outcome measure: Swallowing outcomes for patients with rNGT and pRIG were compared using the following outcome measures administered prospectively at pre-treatment, three and 12 months post-treatment: MD Anderson Dysphagia Inventory (MDADI), Performance Status Scales (Normalcy of Diet), timed water swallow test.

Results: Twenty-three patients received pRIG while 30 were planned for a rNGT. No differences in demographics were found between the groups. The rNGT group had a clinically significant higher score on MDADI at 12 months post-treatment. No significant difference was found on a timed water swallow test or diet texture scale.

Conclusions: There is no statistical difference for swallowing outcomes in either group. However, patients' in the rNGT group reported a clinically meaningful difference at 1 year, with a trend for them to do better across all measures. Neither group returned to their baseline swallowing function. Further research with a larger sample size is indicated.

Keywords: chemoradiotherapy; dysphagia; gastrostomy; head and neck cancer; nasogastric tube.

MeSH terms

  • Aged
  • Carcinoma, Squamous Cell / complications
  • Carcinoma, Squamous Cell / pathology
  • Carcinoma, Squamous Cell / therapy*
  • Chemoradiotherapy*
  • Cohort Studies
  • Deglutition / physiology*
  • Deglutition Disorders / diagnosis
  • Deglutition Disorders / epidemiology*
  • Deglutition Disorders / prevention & control*
  • Female
  • Gastrostomy*
  • Humans
  • Intubation, Gastrointestinal*
  • Male
  • Middle Aged
  • Oropharyngeal Neoplasms / complications
  • Oropharyngeal Neoplasms / pathology
  • Oropharyngeal Neoplasms / therapy*
  • Treatment Outcome