The patient experience of having a feeding tube during treatment for head and neck cancer: A systematic literature review
Hazzard, E., Gulliver, S., Walton, K., McMahon, A.-T., Milosavljevic, M., & Tapsell, L. (2019). PubMed.
Terms within article:
Summary of Article:
This systematic literature review examined HNC patient's experience of having a feeding tube (FT) while undergoing chemotherapy or radiation to combat treatment side effects. Common side effects of treatment include oral mucositis, dysphagia, nausea, and painful swallowing (odynophagia) that can lead to reduced oral intake causing weight loss, malnutrition, and dehydration. In HNC patients undergoing treatment, significant weight loss and malnutrition can be as high as 60-80% of the population. Weight loss, malnutrition, and dehydration can lead to interruptions in treatment, poorer disease control, and reduced quality of life. To combat the side effects of treatment, patients can speak with their healthcare team about using feeding tubes as an alternate way to receive nutrition to support treatment and quality of life during treatment. The two common forms of feeding tubes are the percutaneous endoscopic gastrostomy (PEG) tube and the nasogastric tube (NGT).
This review looked at nine studies that included 159 HNC patient experiences of having feeding tubes during treatment. It was found that many patients may experience reluctance or fear and anxiety about having a feeding tube due to a lack of understanding about the nature of feeding tubes to support treatment. The most commonly reported patient concerns were about pain, comfort, social and activity restrictions, additional challenges and responsibilities, social stigma, diet alteration, feelings of personal failure, and daily routine changes. Concerns were related to a lack of provided patient education about feeding tubes, nutritional side effects of chemotherapy or radiation, and feelings of a lack of choice in the type of feeding tube. It was determined that providing education to patients about feeding tubes and allowing them to be included in the decision-making process helped promote positive patient outlook and understanding and allowed patients to be active participants in their care plan, which enabled better nutritional outcomes.
Overall, the study found that nutritionally vulnerable HNC patients generally perceived having a feeding tube as positive and worthwhile support for undergoing treatment despite their initial reluctance and fear or anxiety. It is recommended that healthcare teams use a patient-centered approach that includes educating the patient about other HNC patient's experiences with feeding tubes to support decision-making processes. Nutrition-related challenges that patients with HNC are faced with during treatment can be addressed and supported by a healthcare team that includes patient education and regular access to dietitians and speech-language pathologists. Consultation and education about feeding tubes should take place before the start of chemotherapy or radiation for HNC.
Possible questions to ask your healthcare team:
Reference: Hazzard, E., Gulliver, S., Walton, K., McMahon, A.-T., Milosavljevic, M., & Tapsell, L. (2019). The patient experience of having a feeding tube during treatment for head and neck cancer: A systematic literature review. Clinical Nutrition ESPEN. doi:10.1016/j.clnesp.2019.07.005
Summary written by Sonya Collins; Edited by Wendy Liang
August 21, 2020
Terms within article:
- Head and Neck Cancer (HNC): cancers in the larynx, throat, lips, mouth, nose, and salivary glands
- Feeding Tube (FT): delivering nutrition, fluids and/or medications directly to the stomach without the manual use of the mouth, throat, and esophagus
- Percutaneous Endoscopic Gastronomy (PEG): flexible feeding tube placed through the abdominal wall and into the stomach to allow nutrition, fluids and/or medications to be put directly into the stomach, without the use of the mouth, throat, or esophagus
- Nasogastric Tube (NGT): flexible feeding tube inserted through the nose, down the esophagus, and into the stomach to allow intake of nutrition, fluids and/or medications without the manual use of the mouth or throat
- oral mucositis: breakdown of the oral mucosal tissue due to chemotherapy and or radiation therapy that can cause issues of oral pain, swelling, sores in the mouth or gums, difficulty swallowing, dryness, reddening of oral cavity, and increased risk of infection due to open sores
- dysphagia: swallowing difficulties that can lead to malnutrition, dehydration, aspiration pneumonia, compromised general health, chronic lung disease, choking, or even death
- odynophagia: medical term for painful swallowing with pain in the mouth, throat, or esophagus
Summary of Article:
This systematic literature review examined HNC patient's experience of having a feeding tube (FT) while undergoing chemotherapy or radiation to combat treatment side effects. Common side effects of treatment include oral mucositis, dysphagia, nausea, and painful swallowing (odynophagia) that can lead to reduced oral intake causing weight loss, malnutrition, and dehydration. In HNC patients undergoing treatment, significant weight loss and malnutrition can be as high as 60-80% of the population. Weight loss, malnutrition, and dehydration can lead to interruptions in treatment, poorer disease control, and reduced quality of life. To combat the side effects of treatment, patients can speak with their healthcare team about using feeding tubes as an alternate way to receive nutrition to support treatment and quality of life during treatment. The two common forms of feeding tubes are the percutaneous endoscopic gastrostomy (PEG) tube and the nasogastric tube (NGT).
This review looked at nine studies that included 159 HNC patient experiences of having feeding tubes during treatment. It was found that many patients may experience reluctance or fear and anxiety about having a feeding tube due to a lack of understanding about the nature of feeding tubes to support treatment. The most commonly reported patient concerns were about pain, comfort, social and activity restrictions, additional challenges and responsibilities, social stigma, diet alteration, feelings of personal failure, and daily routine changes. Concerns were related to a lack of provided patient education about feeding tubes, nutritional side effects of chemotherapy or radiation, and feelings of a lack of choice in the type of feeding tube. It was determined that providing education to patients about feeding tubes and allowing them to be included in the decision-making process helped promote positive patient outlook and understanding and allowed patients to be active participants in their care plan, which enabled better nutritional outcomes.
Overall, the study found that nutritionally vulnerable HNC patients generally perceived having a feeding tube as positive and worthwhile support for undergoing treatment despite their initial reluctance and fear or anxiety. It is recommended that healthcare teams use a patient-centered approach that includes educating the patient about other HNC patient's experiences with feeding tubes to support decision-making processes. Nutrition-related challenges that patients with HNC are faced with during treatment can be addressed and supported by a healthcare team that includes patient education and regular access to dietitians and speech-language pathologists. Consultation and education about feeding tubes should take place before the start of chemotherapy or radiation for HNC.
Possible questions to ask your healthcare team:
- What type of feeding tube (FT) would I need?
- What are the potential complications of use for each type of FT?
- What are the benefits of having a feeding tube?
- How could a FT affect my overall quality of life and healing process?
- Can I go to dinner with friends and eat?
- Does having a feeding tube mean that I cannot eat or drink by mouth anymore?
- Which type of FT would allow me to have the greatest quality of life socially and professionally while being discrete?
- How visible will the tube be? How discrete will it be? Can I cover it?
- Will I be able to bathe?
- How long will I need a FT?
- How is a FT placed and/or removed? Will there be general anesthesia required?
- Will I have any permanent damage from having a FT?
- Will the FT hurt?
- What kind of nutrition will be provided through a FT?
- Will insurance cover the cost of the medical and nutritional supplies?
- How will I take care of the tube? What will I have to do?
- What sort of challenges may I encounter?
- Will I be able to swallow after the tube is removed?
- How will I go back to eating normally once the tube is out?
Reference: Hazzard, E., Gulliver, S., Walton, K., McMahon, A.-T., Milosavljevic, M., & Tapsell, L. (2019). The patient experience of having a feeding tube during treatment for head and neck cancer: A systematic literature review. Clinical Nutrition ESPEN. doi:10.1016/j.clnesp.2019.07.005
Summary written by Sonya Collins; Edited by Wendy Liang
August 21, 2020