S1437 Prophylactic Endoscopic Gastrostomy in Patients With Head and Neck Cancer: A Canadian Experience in an Academic Oncology Center From 2003-2019
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.002 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".