Variables associated with feeding tube placement in head and neck cancer

Objective: To identify clinical factors associated with enteral feeding tube placement in a head and neck cancer population. Design: A self-administered survey was given to patients being treated for head and neck cancer while they were waiting to be seen in 1 of 4 otolaryngology clinics. The post hoc analysis presented here combines survey and chart review data to determine clinical and demographic variables associated with feeding tube placement. Setting: Four otolaryngology clinics. Patients: Otolaryngology clinic patients being treated for head and neck cancer. Main Outcome Measure: Enteral feeding tube placement. Results: Of the 724 patients eligible for this study, 14% (n = 98) required enteral feeding tube placement. Multi-variate analysis found the following variables to be independently associated with feeding tube placement: oropharynx/hypopharynx tumor site (odds ratio [OR], 2.4; P = .01), tumor stage III/IV (OR, 2.1; P = .03), flap reconstruction (OR, 2.2; P = .004), current tracheotomy (OR, 8.0; P < .001), chemotherapy (OR, 2.6; P < .001), and increased age (OR, 1.3; P = .02). In addition, there was a curvilinear relationship between time since treatment and feeding tube placement, with about 30% having a feeding tube at 1 month posttreatment, tapering down during the first 3 years to about 8% and leveling off thereafter. Conclusions: Identification of factors associated with an increased risk of feeding tube placement may allow physicians to better counsel patients regarding the possibility of feeding tube placement during treatment. Since feeding tube placement has been linked to decreased quality of life in head and neck cancer, such counseling is an integral part of the clinical management of these patients.