S1437 Prophylactic Endoscopic Gastrostomy in Patients With Head and Neck Cancer: A Canadian Experience in an Academic Oncology Center From 2003-2019
Notice bibliographique
Résumé
Introduction: Head and neck cancer (HNC) is the sixth commonest cancer in the world. It is associated with high morbidity and mortality due to malnutrition. To avoid the effect of tumor-related anatomical obstruction and systemic therapy toxicity, enteral nutrition support through Percutaneous Endoscopic Gastrostomy (PEG) can be inserted prophylactically. The aim of our study is to report our experience of prophylactic PEG insertion for HNC patients. This is an observational study over 16-year conducted in a single, urban academic oncology center with a focus of nutritional outcome, morbidity and mortality. Methods: Retrospective electronic medical records of a total of 346 patients were accessed. The inclusion criteria were patients with HNC above 18 years old from 2003-2019 who underwent prophylactic endoscopic gastrostomy. Gastrostomy tubes that were inserted surgically or by fluoroscopic guidance were excluded. Results: A total of 346 patients were identified, of whom 237 were included. The average age was 60.5 years, and the majority were male (80%). Malignancies were categorized based on anatomical location. (Table 1) Cases were also distributed according to TNM staging. Most patients underwent targeted radiotherapy and to which chemotherapy was added. The average weight lost was 5.8 kg, which accounts for an average of 7% total body weight loss. PEG related complications were identified in 12%. (Table 2) Calculated 5-years mortality for patients diagnosed in from 2003 to 2015 was 20.6%, and 2-year mortality when including patients from 2003-2019 was 19%. Conclusion: HNC mortality is not only disadvantaged by tumor size or location but also by significant malnutrition. The commonest accepted definition for malnutrition in HNC is defined as weight loss exceeding 10% above 6 months. Our cohort mirrored a large representative pool of HNC patients who are mainly male, smokers, diagnosed with advanced stage and the majority underwent neoadjuvant chemoradiotherapy. The average weight loss in our population is less than what is expected in malnourished patients. Approximately 41% of subjects went on to develop malnutrition despite prophylactic PEG. Study limitations include lack of a control group and the non-standardized measurement of follow up weight. Regardless, our study, does add to the body of evidence and emphasize the importance of prophylactic PEG insertion in HNC patients as an effective practice to decreased malnutrition associated mortality.Table 1.: Subjects characteristics, complications, and mortality.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,003 |
| Études des sciences et des technologies | 0,002 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».