COSA comment:Head and neck cancer nutrition guidelines/Nutrition implementation - Pre-treatment/What are the/What are the complications from gastrostomy tube placement and is there a preferred method of placement?

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Public comments - What are the complications from gastrostomy tube placement and is there a preferred method of placement

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Rhonda Cousins12:49, 11 April 2011

In the complications of PEG tubes we need to consider the later complications of infections, both local and systemic and failure to be able to remove the tube. ie. late tube dependence. this is particularly a problem when patients develop failure of swallow due to possible late fibrosis and possible loss of neurological function due to lack of use. Little data in Head and Neck literature that I have been able to find but some in Neurology. Major problems with local reactions around PEG tubes with 5FU either as induction or later. stage IV patients often improve swallowing function after successful induction chemotherapy and thereby avoid the need for enteric feeding.I.e.reconsider need for enteric feeding until after Induction chemotherapy which frequently improves nutritian.

Many cantres use enteric feeding as an alternative to intensive nutritional support which is preferrable.Personal communic Vermorgen.

Joanna Dewar Medical Oncologist Sir Charles Gairdner Hospital WA, 13 April 2011

Thank you for your comments.

We attempted to address the question of late tube dependence, but as you have also found, there is little published data in this area that sufficiently addresses this phenomena, particularly in relation to level of rehabilitation provided to the patient by the allied health team. See further details on this in Q25.

Prophylactic gastrostomy is recommended for certain groups in Q15. We probably need to make this clearer to mean concurrent chemoradiotherapy. With regards to induction chemotherapy, there is again little evidence specifically in this area, and so in Q20 we suggest discussion with the team for the best form of nutritional support depending on the anticipated side effects.

Teresa Brown, on behalf of the authors, 17 June 2011