3600 - Less is More: Long Term Gastrostomy Tube Dependence in Head and Neck Cancer

N. Almeida¹, T. V. Schrand¹, A. Pepin², H. Yu¹, M. Fang¹, A. J. Iovoli³, M. K. Farrugia¹, V. Gupta¹, K. E. Wooten¹, M. Markiewicz¹, A. Al Afif¹, R. Mcspadden¹, W. L. Hicks¹, and A. K. Singh³; ¹Roswell Park Comprehensive Cancer Center, Buffalo, NY, ²Department of Radiation Oncology, Abramson Cancer Center, Hospital of University of Pennsylvania, Philadelphia, PA, ³Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY

Purpose/Objective(s): Reports are conflicting regarding impact of prophylactic PEG tube placement in head and neck cancer patients; we add to the paucity of literature of risk factors for long term PEG tube placement and weight loss in this patient cohort. The objective is to evaluate the impact of prophylactic PEG tube and risk factors for long term PEG tube placement and weight loss in patients undergoing treatment of head and neck cancer Materials/

Methods: This retrospective study included a total of 502 patients with head and neck cancer who were treated at a single institution. Univariate analyses, such as logistic regression or Cox regression, were performed to determine risk factors for long term PEG tube and weight loss. Outcomes that were significantly associated with prophylactic PEG were selected for a multivariate analysis. The Kaplan-Meier method was used to estimate the time to PEG completion, which was compared between acute and late PEG groups using log-rank tests. The proportion of patients who did not receive acute PEG, but received late PEG was estimated using exact binomial confidence interval.
Results: Of the 502 patients examined, median overall survival was measured to be 65.8 months, with a 95% confidence interval of 45.9 – 94.3. Progression free survival, which was measured to be the time from diagnosis to local/distant failure, or death, was found to have a median of 42.5 months, with a 95% CI of 31.9 – 64.6. The univariate analysis suggests higher risk of long-term feeding tube in patients received prophylactic PEG tube (p < 0.0001), with higher age (p = 0.0165), and with a cancer site of larynx compared to sites other than pharynx and lip/oral cavity (p = 0.0364). Multivariate tests confirmed that prophylactic PEG tube and the higher age are significantly associated with higher risk of long-term feeding tube, with p < 0.0001 and p=0.0082, respectively. For weight loss, univariate analysis suggests patients tend to have higher percentage of weight loss if they did not receive prophylactic PEG tube (p < 0.00001) or they are in the lower age (p = 0.0034). In addition, patients also tend to have higher weight loss if they received CCRT treatment relative to Surgery+CCRT (p < 0.0001). Mostly consistent with the univariate analysis, the multivariable analysis suggests no prophylactic PEG tube (p < 0.00001), lower age (p = 0.0032), and surgery+CCRT treatment (p = 0.0005) were found to be significantly associated with higher weight loss. Prophylactic PEG tube was not found to be associated with quality-of-life overall health overall survival, or progression-free survival on univariate analysis.
Conclusion: This retrospective study found that prophylactic PEG tube and higher age are significantly associated with higher risk of long-term feeding tube. Lower age, no prophylactic PEG tube, and surgery+CCRT treatment were found to be significant associated with higher weight loss. Future studies are necessary to further elucidate optimizing weight loss and outcomes in this tenuous patient population.