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Patterns of prophylactic gastrostomy tube placement in head and neck cancer patients: A consideration of the significance of social support and practice variation

Authors

  • Julie L. Locher PhD, MSPH,

    Corresponding author
    1. Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
    2. Center for Aging, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
    3. Lister Hill Center for Health Policy, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
    4. Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
    • Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
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  • James A. Bonner MD,

    1. Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
    2. Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
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  • William R. Carroll MD,

    1. Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
    2. Department of Surgery, Division of Otolaryngology, Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
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  • Jimmy J. Caudell MD, PhD,

    1. Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
    2. Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
    3. Department of Radiation Oncology, Tampa, Florida, U.S.A
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  • Jeroan J. Allison MD, MSPH,

    1. Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, U.S.A
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  • Meredith L. Kilgore PhD, RN,

    1. Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
    2. Center for Aging, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
    3. Lister Hill Center for Health Policy, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
    4. Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
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  • Christine S. Ritchie MD, MSPH,

    1. Department of Medicine, University of California, San Francisco, San Francisco, California, U.S.A
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  • Gabriel S. Tajeu MSPH,

    1. Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
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  • Ya Yuan MSPH,

    1. Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
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  • David L. Roth PhD

    1. Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland, U.S.A
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  • This work was supported by the American Cancer Society (grant No.: RSGHP CPHPS-116828). j.l.l. serves on an advisory board for Nestlé Nutrition Institute.

  • The authors have no other funding, financial relationships, or conflicts of interest to disclose.

Send correspondence to Julie L. Locher, PhD, MSPH; CH19, Room 218F; 1530 3rd Avenue South; Birmingham, Al 35294-2041. E-mail: jlocher@uab.edu

Abstract

Objectives/Hypothesis

The purpose of this study was to examine factors associated with prophylactic placement of feeding tubes in head and neck cancer patients receiving radiation therapy as a part of treatment using multilevel models that account for patient-, physician-, and institution-level sources of variation.

Study Design

A retrospective analysis using binary logistic regression and hierarchical linear models was run to evaluate independent predictors of prophylactic feeding tube placement.

Methods

Surveillance, Epidemiology, and End Results–Medicare data were used. Head and neck cancer patients diagnosed with locoregionally advanced stage disease from 2000 to 2005 were included in this study (N = 8,306).

Results

Across all models, prophylactic gastrostomy tube placement was found to be more likely in patients who had cancer of the larynx or oropharynx compared with those with cancer of the nasopharynx or oral cavity; who had regional instead of local cancer; who did not receive surgery as a part of treatment, but did receive chemotherapy; and who were divorced, separated, or widowed. Additionally, although practice variation was observed to occur, its overall contribution in predicting prophylactic gastrostomy tube placement was minimal.

Conclusions

As health care enters an era of patient-centered care, further investigation of the potential role of social support (or lack of social support) in influencing treatment decisions of head and neck cancer patients and providers is warranted.

Level of Evidence

2b Laryngoscope, 123:1918–1925, 2013

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