The patient experience of having a feeding tube during treatment for head and neck cancer: A systematic literature review

Background and aims: Patients undergoing treatment for head and neck cancer (HNC) can experience severe weight loss, malnutrition and dehydration which can cause treatment delays. Enteral feeding can reduce the risk of these. However, the use of feeding tubes (FT), including FT type and placement timing is debated. This paper aimed to describe the patient experience of having a FT during treatment for HNC. Methods: A systematic literature review of qualitative studies was undertaken in the databases Web of Science, CINAHL, Scopus and Science Direct using Prospero and Joanna Brigg's Institute guidelines. Results: Nine studies were included providing the perspectives of 159 patients who had a FT during treatment for HNC. 150 findings and 183 illustrations which were primarily patient quotes were extracted. Analysis resulted in 42 categories from which nine synthesized findings were produced. These are summarized as: initial reluctance and fear; different understandings and expectations; individual preferences around choice; physical discomfort; restrictions to social life and daily living; new challenges and responsibilities; gradual acceptance; a challenging but rewarding transition process; and overall a worthwhile decision. Conclusion: These findings highlight the nutrition-related burden patients with HNC experience and support the need for interdisciplinary healthcare teams that integrate dietetics and speech pathology. This review supports individualized approaches to FT placement decisions. Further well-designed studies are needed to better understand patient and cancer-service structural factors that may influence the experience of having a FT, to ensure that decisions are evidence-based and patient-centered for best outcomes. (C) 2019 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.