Document Detail

Enteral feeding methods for nutritional management in patients with head and neck cancers being treated with radiotherapy and/or chemotherapy.
MedLine Citation:
PMID:  20238358     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: For many patients with head and neck cancer, oral nutrition will not provide adequate nourishment during treatment with radiotherapy or chemoradiotherapy due to the acute toxicity of treatment, obstruction caused by the tumour, or both. The optimal method of enteral feeding for this patient group has yet to be established.
OBJECTIVES: To compare the effectiveness of different enteral feeding methods used in the nutritional management of patients with head and neck cancer receiving radiotherapy or chemoradiotherapy using the clinical outcomes, nutritional status, quality of life and rates of complications.
SEARCH STRATEGY: Our extensive search included the Cochrane ENT Group Trials Register, CENTRAL, PubMed, EMBASE, CINAHL, AMED and ISI Web of Science. The date of the most recent search was May 2009.
SELECTION CRITERIA: Randomised controlled trials comparing one method of enteral feeding with another, e.g. nasogastric (NG) or percutaneous endoscopic gastrostomy (PEG) feeding, for adult patients with a diagnosis of head and neck cancer receiving radiotherapy and/or chemoradiotherapy.
DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data using standardised forms. We contacted study authors for additional information.
MAIN RESULTS: One randomised controlled trial was eligible for inclusion in this review. However, a high degree of bias was identified in the study.Patients diagnosed with head and neck cancer, being treated with chemoradiotherapy, were randomised to PEG or NG feeding. In total only 33 patients were eligible for analysis as the trial was terminated early due to poor accrual.Weight loss was greater for the NG group at six weeks post-treatment than for the PEG group (P = 0.001). At six months post-treatment, however, there was no significant difference in weight loss between the two groups. Anthropometric measurements recorded six weeks post-treatment demonstrated lower triceps skin fold thickness for the NG group compared to the PEG group (P = 0.03). No statistically significant difference was found between the two different enteral feeding techniques in relation to complication rates or patient satisfaction. The duration of PEG feeding was significantly longer than for the NG group (P = 0.0006). In addition, the study calculated the cost of PEG feeding to be 10 times greater than that of NG, though this was not found to be significant. There was no difference in the treatment received by the two groups. However, four PEG fed patients and two NG fed patients required unscheduled treatment breaks of a median of two and six days respectively.We identified no studies of enteral feeding involving any form of radiologically inserted gastrostomy (RIG) feeding or comparing prophylactic PEG versus PEG for inclusion in the review.
AUTHORS' CONCLUSIONS: There is not sufficient evidence to determine the optimal method of enteral feeding for patients with head and neck cancer receiving radiotherapy and/or chemoradiotherapy. Further trials of the two methods of enteral feeding, incorporating larger sample sizes, are required.
Brenda Nugent; Sian Lewis; Joe M O'Sullivan
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Publication Detail:
Type:  Journal Article; Review     Date:  2010-03-17
Journal Detail:
Title:  The Cochrane database of systematic reviews     Volume:  -     ISSN:  1469-493X     ISO Abbreviation:  Cochrane Database Syst Rev     Publication Date:  2010  
Date Detail:
Created Date:  2010-03-18     Completed Date:  2010-04-26     Revised Date:  2013-06-28    
Medline Journal Info:
Nlm Unique ID:  100909747     Medline TA:  Cochrane Database Syst Rev     Country:  England    
Other Details:
Languages:  eng     Pagination:  CD007904     Citation Subset:  IM    
Department of Nutrition and Dietetics, Belfast Health and Social Care Trust, Northern Ireland Cancer Centre, Belfast City Hospital, Lisburn Road, Belfast, Northern Ireland, UK, BT9 7AB.
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MeSH Terms
Combined Modality Therapy
Enteral Nutrition / methods*
Gastrostomy / methods*
Head and Neck Neoplasms / drug therapy*,  radiotherapy*
Intubation, Gastrointestinal / methods*
Nutritional Status
Randomized Controlled Trials as Topic
Update In:
Cochrane Database Syst Rev. 2013;1:CD007904   [PMID:  23440820 ]

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