Skip to main content
Log in

Does PEG Use Cause Dysphagia in Head and Neck Cancer Patients?

Dysphagia Aims and scope Submit manuscript

Abstract

Percutaneous endoscopic gastrostomy (PEG) use is common in patients who undergo radiotherapy (RT) for head and neck cancer to maintain weight and nutrition during treatment. However, the true effect of PEG use on weight maintenance and its potential impact on long-term dysphagia outcomes have not been adequately studied. This retrospective study looked at swallowing-related outcomes among patients who received prophylactic PEG vs. those who did not, and among patients who maintained oral diets vs. partial oral diets vs. those who were nil per os (NPO). Outcomes were assessed at the end of RT and at 3, 6, and 12 months post RT. A comprehensive review of patients’ medical charts for a 6-year period yielded 59 subjects with complete data. Results showed no difference in long-term percent weight change between the prophylactic PEG patients vs. all others, or between patients who, during RT, had oral diets vs. partial oral diets vs. NPO. However, those who did not receive prophylactic PEGs and those who maintained an oral or a partial oral diet during RT had significantly better diet outcomes at all times post RT. Dependence on a PEG may lead to adverse swallowing ability in post-irradiated head and neck cancer patients possibly due to decreased use of the swallowing musculature.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

References

  1. Cooper JS, Fu K, Marks J, Silverman S. Late effects of radiation therapy in the head and neck region. Int J Radiat Oncol Biol Phys. 1995;31(5):1141–64.

    Article  PubMed  CAS  Google Scholar 

  2. List MA, Bilir SP. Evaluations of quality of life and organ function. Semin Oncol. 2004;31(6):827–35.

    Article  PubMed  Google Scholar 

  3. National comprehensive cancer network clinical practice guidelines in oncology, 2008. Available at http://www.nccn.org/professionals/physician_gls/f_guidelines.asp (accessed 2010).

  4. Carroll WR, Locher JL, Canon CL, Bohannon IA, McColloch NL, Magnuson JS. Pretreatment swallowing exercises improve swallow function after chemoradiation. Laryngoscope. 2008;118(1):39–43.

    Article  PubMed  Google Scholar 

  5. Beer KT, Krause KB, Zuercher T, Stanga Z. Early percutaneous endoscopic gastrostomy insertion maintains nutritional state in patients with aerodigestive tract cancer. Nutr Cancer. 2005;52(1):29–34.

    Article  PubMed  Google Scholar 

  6. Lee NY, de Arruda FF, Puri DR, Wolden SL, Narayana A, Mechalakos J, et al. A comparison of intensity-modulated radiation therapy and concomitant boost radiotherapy in the setting of concurrent chemotherapy for locally advanced oropharyngeal carcinoma. Int J Radiat Oncol Biol Phys. 2006;66(4):966–74.

    Article  PubMed  Google Scholar 

  7. Morton RP, Crowder VL, Mawdsley R, Ong E, Izzard M. Elective gastrostomy, nutritional status and quality of life in advanced head and neck cancer patients receiving chemoradiotherapy. ANZ J Surg. 2009;79(10):713–8.

    Article  PubMed  Google Scholar 

  8. McLaughlin BT, Gokhale AS, Shuai Y, Diacopoulos J, Carrau R, Heron DE, et al. Management of patients treated with chemoradiotherapy for head and neck cancer without prophylactic feeding tubes: the University of Pittsburgh experience. Laryngoscope. 2010;120(1):71–5.

    PubMed  Google Scholar 

  9. Hearne BE, Dunaj JM, Daly JM, Strong EW, Vikram B, LePorte BJ et al. Enteral nutrition support in head and neck cancer: tube vs. oral feeding during radiation therapy. J Am Diet Assoc. 1985;85(6):669, 674, 677.

    Google Scholar 

  10. Mercuri A, Lim Joon D, Wada M, Rolfo A, Khoo V. The effect of an intensive nutritional program on daily set-up variations and radiotherapy planning margins of head and neck cancer patients. J Med Imaging Radiat Oncol. 2009;53(5):500–5.

    Article  PubMed  CAS  Google Scholar 

  11. Salas S, Baumstarck-Barrau K, Alfonsi M, Digue L, Bagarry D, Feham N, et al. Impact of the prophylactic gastrostomy for unresectable squamous cell head and neck carcinomas treated with radio-chemotherapy on quality of life: prospective randomized trial. Radiother Oncol. 2009;93(3):503–9.

    Article  PubMed  Google Scholar 

  12. Beaver ME, Matheny KE, Roberts DB, Myers JN. Predictors of weight loss during radiation therapy. Otolaryngol Head Neck Surg. 2001;125(6):645–8.

    Article  PubMed  CAS  Google Scholar 

  13. Chang JH, Gosling T, Larsen J, Powell S, Scanlon R, Chander S. Prophylactic gastrostomy tubes for patients receiving radical radiotherapy for head and neck cancers: a retrospective review. J Med Imaging Radiat Oncol. 2009;53(5):494–9.

    Article  PubMed  CAS  Google Scholar 

  14. Chen AM, Li B, Lau DH, Farwell DG, Lu Q, Stuart K, et al. Evaluating the role of prophylactic gastrostomy tube placement prior to definitive chemoradiotherapy for head and neck cancer. Int J Radiat Oncol Biol Phys. 2010;78(4):1026–32.

    Article  PubMed  Google Scholar 

  15. Nguyen NP, North D, Smith HJ, Dutta S, Alfieri A, Karlsson U, et al. Safety and effectiveness of prophylactic gastrostomy tubes for head and neck cancer patients undergoing chemoradiation. Surg Oncol. 2006;15(4):199–203.

    Article  PubMed  Google Scholar 

  16. Foster JM, Filocamo P, Nava H, Schiff M, Hicks W, Rigual N, et al. The introducer technique is the optimal method for placing percutaneous endoscopic gastrostomy tubes in head and neck cancer patients. Surg Endosc. 2007;21(6):897–901.

    Article  PubMed  Google Scholar 

  17. Mekhail TM, Adelstein DJ, Rybicki LA, Larto MA, Saxton JP, Lavertu P. Enteral nutrition during the treatment of head and neck carcinoma: is a percutaneous endoscopic gastrostomy tube preferable to a nasogastric tube? Cancer. 2001;91(9):1785–90.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgment

This work was supported by a grant from the NIH/NCI #RO1CA120950-03.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Susan Langmore.

Additional information

This work was done entirely at Boston University Medical Center.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Langmore, S., Krisciunas, G.P., Miloro, K.V. et al. Does PEG Use Cause Dysphagia in Head and Neck Cancer Patients?. Dysphagia 27, 251–259 (2012). https://doi.org/10.1007/s00455-011-9360-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00455-011-9360-2

Keywords

Navigation