IMPACT OF PROPHYLACTIC NASOGASTRIC TUBE FEEDING IN HEAD AND NECK CANCER PATIENTS DURING CONCURRENT CHEMORADIOTHERAPY

Dr. Mohammad Rahmat Ullah Bhuiyan*, Prof. Dr. Qazi Mushtaq Hussain, Prof. Dr. Golam Mohiuddin Faruque, Dr. Mamun OR Rashid, Dr. Golam Zel Asmaul Hosna, Dr. Sharifuddin Hasnat, Dr. Noor Esrate, Dr. Altaf Hossain Riad, Dr. Mohammad Arifur Rahman

ABSTRACT

Background: Worldwide, head and neck cancer (HNC) was the 6th most common cancer in 2020 in all ages and both sexes. In Bangladesh, lip and oral cavity cancer was the 2nd most common cancer in 2020. Up to 60% of HNC patients presents with locally advanced disease. Concurrent chemoradiotherapy (CCRT) is the standard of care in locally advanced stage disease but it increases toxicity and worsens nutritional status of the patients. HNC patients are frequently malnourished at presentation prior to treatment due to feeding difficulty which deteriorates later because of CCRT. Maintaining proper nutrition and completing treatment become a challenge for these patients. Aim and Objective: To determine the impact of prophylactic nasogastric tube feeding in head and neck cancer patients during concurrent chemoradiotherapy. Materials and Method: A quasi-experimental study was performed in Radiation Oncology Department of National Institute of Cancer Research & Hospital from 1st January 2020 to 31st December 2020. A total number of 68 Patients (34 patients in each arm) was included in this study according to inclusion and exclusion criteria by purposive Sampling technique. All patients in Arm A and Arm B were planned for total 66 Gray in 33 daily fractions, 2 Gray per fraction, 1 fraction per day, 5 fractions per week over 6½ weeks and inj. Cisplatin 40mg/m² was given intravenously 2 hours before radiotherapy on 1st day and then weekly. Arm A received prophylactic nasogastric tube prior to CCRT and Arm B did not receive any prophylactic tube but nasogastric tube was introduced during treatment whenever needed. Patients were evaluated from the beginning of CCRT up to 24 weeks of end of CCRT. All the information’s were recorded in a pre-tested and semi-structured questionnaire. The analysis was done by using independent sample t test for continuous variables and chi-square test for categorical variables and data were presented in tables and graphs. Results: In this study, mean age was 52.5 ± 8.5 years and male: female ratio was 4.2: 1 among all patients. Pretreatment baseline characteristics and anthropometric measurements were almost similar in both arms; differences were not statistically significant (p > 0.05). Patients in Arm A lost significantly less weight during CCRT compared to Arm B (mean weight loss at the end of CCRT was -2.9 ± 1.3 in Arm A and -5.3 ± 1.3 in arm B of pre-treatment weight, p < 0.05). Mean BMI decreased between diagnosis and treatment completion in both arms, after that moderately increased in Arm A (18.74) and slightly decreased in Arm B (17.12), (p < 0.05 between two arms). There were no significant differences in treatment response and toxicities between the two groups. Conclusion: Prophylactic nasogastric tube feeding at the beginning of CCRT in head and cancer patients is beneficial in terms of minimizing weight loss.

Keywords: Head and neck cancer, Prophylactic Nasogastric Tube, Chemoradiotherapy, impact.