Scientists have known that impairment of oral intake occurs in the majority of patients with head and neck cancer (HNC) receiving chemoradiotherapy.
Placement of prophylactic percutaneous endoscopic gastrostomy (PEG) tube in asymptomatic newly diagnosed HNC before chemoradiation is a common practice in some centers. In some studies, PEG has been associated with a decrease in treatment related weight loss in patients with HNC, but no studies have examined the utilization rate.
A research article published on February 28, 2011 in the World Journal of Gastroenterology addresses this question. The authors have observed anecdotally that a number of HNC patients who received a prophylactic PEG tube in fact never used them. They performed a retrospective database study of all patients in whom PEG tube was placed for HNC to determine the prevalence of unused prophylactically placed PEG tubes. Data were also analyzed for possible factors predictive of unused PEGs or PEGs used for less than 2 wk.
The study suggests prophylactic PEG placement prior to HNC therapy is associated with a high rate of non use or limited use. Further prospective studies evaluating specific selection criteria for prophylactic PEG in this setting are needed. Similarly, additional studies are needed to assess the impact of prophylactic PEG tube placement on the cost-effectiveness of cancer care, quality of life, hospital admission rate, and, most importantly, survival.