Enteral feeding methods for nutritional management in patients with head and neck cancers being treated with radiotherapy and/or chemotherapy

  • Review
  • Intervention

Authors

  • Brenda Nugent,

    Corresponding author
    1. Belfast Health and Social Care Trust, Northern Ireland Cancer Centre, Department of Nutrition and Dietetics, Belfast, Northern Ireland, UK
    • Brenda Nugent, Department of Nutrition and Dietetics, Belfast Health and Social Care Trust, Northern Ireland Cancer Centre, Belfast City Hospital, Lisburn Road, Belfast, Northern Ireland, BT9 7AB, UK. Brenda.nugent@belfasttrust.hscni.net.

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  • Sian Lewis,

    1. Velindre Cancer Centre, Department of Nutrition and Dietetics, Cardiff, UK
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  • Joe M O'Sullivan

    1. Queen's University of Belfast and the Northern Ireland Cancer Centre, Centre for Cancer Research and Cell Biology, Belfast, Northern Ireland, UK
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Abstract

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 methods

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.

摘要

背景

正在接受放射線治療和/或化學治療之頭頸癌患者之腸道餵食營養提供方式

許多頭頸癌患者在接受放射線治療或放射線治療併化學治療過程中因治療發生急性毒性、腫瘤阻塞或是上述兩種因素而使口服營養無法提供足夠的營養。對此類患者最佳腸道營養餵食方法尚未被建立

目標

以臨床結果、營養狀況,生活品質和併發症發生率來比較使用不同的腸道餵養方法提供接受放射線治療或放射線治療併化學治療之頭頸癌患者營養的效果。

搜尋策略

我們廣泛搜索了包括Cochrane ENT Group Trials Register, CENTRAL, PubMed, EMBASE, CINAHL, AMED and ISI Web of Science。最近期搜尋日為2009年5月。

選擇標準

隨機對照試驗比較接受放射線治療和/或放射線治療併化學治療成人頭頸癌患者以不同腸道餵食方式,例如鼻胃管(NG)或經皮內鏡下胃造口術(PEG)餵食之差異。

資料收集與分析

兩位作者使用標準化格式獨立評估試驗品質和擷取資料。我們與研究作者聯繫以了解更多訊息。

主要結論

有一個隨機對照試驗符合納入標準而收入於本回顧文章。然而,此研究具高度偏差。正在接受治療的放射線治療併化學治療的頭頸癌患者,隨機分配為PEG 或 NG餵食。總共只分析33位符合資格的病患,此試驗因NG組在6週治療後體重流失大於PEG組(P = 0.001)而提前中止。在治療6個月後,兩組之體重減輕無顯著差異。治療6個星期後人體測量記錄顯示NG組之三頭肌皮脂厚度較PEG組低 (P = 0.03) 。兩組不同腸道餵食方法之併發症發生率和病人滿意度無顯著差異。PEG組餵食時間明顯長於NG組(P = 0.0006)。此外,此研究計算PEG的餵養費用為NG餵食的10倍以上,雖然此結果不具顯著意義。此二組之治療並無差異,然而,4位PEG餵食病人和2位NG餵食病人需要中斷治療計劃 (中位數分別是2天和6天) 。我們無發現任何radiologically inserted gastrostomy (RIG) 餵養方式的研究或包括比較預防性PEG與PEG的研究。

作者結論

沒有足夠的證據來決定頭頸癌放射線治療和/或放射線治療併化學治療患者最佳腸道餵食方式。大樣本數的這兩種腸道餵食方式的進一步的試驗是需要的。

翻譯人

本摘要由奇美醫院林聖凱翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

人工灌食方法用於正在接受放射線治療、化學治療或放射線治療併化學治療之頭頸癌患者:頭頸癌症患者在接受化療期間容易因治療的副作用而造營養不良而需使用管灌方式來達到營養所需。管灌餵食可以由一種經由過鼻子進入胃部的細管稱為鼻胃管給予,或由腹部皮膚直接進入胃部的胃管給予。這兩種方法都可直接將營養送至胃部。管灌方式是滿足頭頸癌患者營養需求必要的方式,因營養不良可導致這群患者預後較差。但何種管灌方式對病患來說,可以提供病患較好的臨床結果如營養效益和生活品質及避免延誤放射治療仍無定論。我們分析現有文獻,只有一個臨床試驗合適進行這次回顧。這個回顧的作者們發現沒有任何證據支持何種管灌方法較好。

Plain language summary

Artificial tube feeding methods for use with patients with head and neck cancer who are receiving treatment with radiotherapy, chemotherapy or both

Patients with cancer of the head and neck are at risk of malnutrition during radiotherapy treatment due to the side effects of this treatment and they may need tube feeding to meet their nutritional needs.

Tube feeding can either be delivered via a nasogastric feeding tube, which is a fine tube inserted through the nose into the stomach, or a gastrostomy tube which is inserted through the skin of the abdomen directly into the stomach. Both of these methods allow the delivery of nutrients directly into the stomach.

Tube feeding is essential to meet the nutritional needs of head and neck cancer patients as malnutrition can lead to a poorer prognosis for this patient group. There is debate over which method of tube feeding provides the most benefit to the patient for outcomes such as nutritional benefit and quality of life, as well as avoiding delays in radiotherapy treatment.

Following our analysis of the available literature, only one clinical trial was eligible to be included in this review. The authors of this review found no evidence to support the use of any one method of tube feeding over another.

Ancillary