Pretreatment factors associated with functional oral intake and feeding tube use at 1 and 6 months post-radiotherapy (+/− chemotherapy) for head and neck cancer

详细信息    查看全文

• 作者：Molly K. Barnhart ; Elizabeth C. Ward…
• 关键词：Oral intake ; Feeding tube ; Predictors ; Dysphagia ; Chemoradiotherapy
• 刊名：European Archives of Oto-Rhino-Laryngology
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：274
• 期：1
• 页码：507-516
• 全文大小：
• 刊物类别：Medicine
• 刊物主题：Otorhinolaryngology; Neurosurgery; Head and Neck Surgery;
• 出版者：Springer Berlin Heidelberg
• ISSN：1434-4726
• 卷排序：274

文摘

A proportion of patients with head and neck cancer (HNC) experience significant swallowing difficulty during and post-radiotherapy/chemoradiotherapy (RT/CRT). Identifying patients during the pretreatment period who are anticipated to have compromised oral intake would allow for early and accurate patient education, and prioritisation of their management. Ascertaining a clear set of pretreatment predictors from the literature is challenging due to heterogeneity in study designs and patient cohorts, with minimal prospective data available (especially at 1-month post-treatment). The objectives of this study were to investigate which pretreatment factors predicted compromised oral intake and feeding tube use at 1 and 6 months post-RT/CRT. Prospective data were collected on 80 consecutive HNC patients receiving RT/CRT from 2011 to 2014. The primary outcome was to identify predictors of a modified diet at 1 and 6 months post-RT/CRT. Secondary outcomes were to identify predictors of feeding tube use at these time intervals, and <6 vs. >6 week duration of feeding tube use. Multivariate analysis revealed bilateral neck radiotherapy treatment was a strong predictor of modified diets at 1 month (p < 0.001), and T-stages T3/T4 a predictor of modified diets at 6 months (p = 0.03). Patients treated with concurrent CRT (p = 0.02) and bilateral neck treatment (p = 0.02) predicted feeding tube use at 1 month, and concurrent CRT predicted feeding tube use for >6 weeks (p = 0.04). Therefore, patients receiving bilateral neck treatment and/or CRT are at greatest risk of requiring modified diets and feeding tube use early post-treatment, and should be prioritised for intervention and ongoing support.