From reactive to proactive tube feeding during chemoradiotherapy for head and neck cancer
| Autor: | Willem M.C. Klop, L.E. Smeele, Rebecca T. Karsten, J.P. de Boer, Martijn M. Stuiver, Arash Navran, Frans J. M. Hilgers, L. van der Molen |
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| Přispěvatelé: | APH - Health Behaviors & Chronic Diseases, APH - Quality of Care, Master Evidence Based Practice, Oral and Maxillofacial Surgery, CCA - Cancer Treatment and Quality of Life, Maxillofacial Surgery (AMC), Amsterdam Movement Sciences - Rehabilitation & Development |
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Male
Patient-Specific Modeling Cancer Research medicine.medical_specialty SDG 16 - Peace Clinical Decision-Making Xerostomia Body Mass Index 03 medical and health sciences Hosmer–Lemeshow test 0302 clinical medicine Enteral Nutrition Weight Loss medicine Humans Precision Medicine 030223 otorhinolaryngology Feeding tube Intubation Gastrointestinal Aged Neoplasm Staging Retrospective Studies Gastrostomy Tube dependency business.industry Patient Selection Head and neck cancer SDG 16 - Peace Justice and Strong Institutions Retrospective cohort study Chemoradiotherapy Nomogram Middle Aged medicine.disease Dysphagia Justice and Strong Institutions Surgery Oncology Head and Neck Neoplasms 030220 oncology & carcinogenesis Female Oral Surgery medicine.symptom business Deglutition Disorders |
| Zdroj: | Oral oncology, 88, 172-179. Elsevier Limited Karsten, R T, Stuiver, M M, van der Molen, L, Navran, A, de Boer, J P, Hilgers, F J M, Klop, W M C & Smeele, L E 2019, ' From reactive to proactive tube feeding during chemoradiotherapy for head and neck cancer : A clinical prediction model-based approach ', Oral Oncology, vol. 88, pp. 172-179 . https://doi.org/10.1016/j.oraloncology.2018.11.031 Oral Oncology, 88, 172-179. Elsevier Limited |
| ISSN: | 1879-0593 1368-8375 |
| DOI: | 10.1016/j.oraloncology.2018.11.031 |
| Popis: | Objectives Feeding tubes are placed unnecessarily in a proportion of head and neck cancer (HNC) patients treated with chemoradiotherapy (CRT) when prophylactic tube placement protocols are used. This may have a negative impact on the risk of long-term dysphagia. Reactive tube placement protocols, on the other hand, might result in weight loss and treatment interruption. The objective of this study is to identify patients at risk for prolonged tube dependency in order to implement a personalized strategy regarding proactive tube placement. Materials and methods A retrospective study was performed in a consecutive cohort of HNC patients treated with primary CRT for whom a reactive tube placement protocol was used. A prediction model was developed to predict prolonged (> 90 days) feeding tube dependency. Model performance and clinical net benefit of the model were assessed. Results Of the 336 included patients, 229 (68%) needed a feeding tube during CRT and 151 (45%) were prolonged feeding tube dependent. The prediction model includes the predictors pretreatment BMI, weight loss, Functional Oral Intake Scale and T-stage. Discriminatory ability is fair (area under the ROC-curve of 0.69) and calibration is adequate (Hosmer and Lemeshow test p = .254). The model shows net benefit over current practice for probability thresholds from 35 to 80%. Conclusion The developed model can be used to select patients for proactive feeding tube placement during primary CRT for HNC. The nomogram with easily obtainable parameters is a useful tool for clinicians to support shared decision making regarding proactive tube placement. |
| Databáze: | OpenAIRE |
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