Page 177 - Functional impairment and cues for rehabilitation of head and neck cancer patients -

RESULTS
Patient, tumor and treatment characteristics
Between January 2008 and October 2016, 449 patients were treated with cisplatin-based chemoradiotherapy for head and neck cancer in the Netherlands Cancer Institute. Of this consecutive cohort, 113 were excluded (postoperative CRT (n = 34), history of head and neck cancer (n = 30), more than one primary tumor (n = 28), induction chemotherapy (n = 14) and distant metastases (n = 7)). Of the final cohort (n = 336), most had stage IV disease (87%) and a pharyngeal tumor (86%). In 145 patients (43%), weight loss (less or more than 10%) was present before CRT. Problems with swallowing were reported by 150 patients (45%). Baseline FOIS was normal (7) in 231 patients (69%). The remaining 31% had FOIS 6 (n = 35), 5 (n = 39), 4 (n = 21) or 2 (n = 1). The FOIS was scored retrospectively in 226 patients (67%) according to structured and complete reporting of the speech language pathologist (SLP) and/or dietitian. Patient, tumor and treatment characteristics are presented in Table 1a and 1b.
Tube feeding
Of the 336 patients, 229 (68%) received tube feeding during CRT with dependencies ranging from 3–2185 days. Of these 229 patients, 161 patients (70%) received an NGT, of which 112 were converted to a PRG, and 68 patients (30%) only received a PRG. Median dependency was 59 days (range 3–216 days) for patients who only received an NGT, 161 days (range 56–2185 days) for who received an NGT with conversion to a PRG, and 171 days (range 6–1142 days) for who directly received a PRG. In 151 patients (45%) prolonged (> 90 days) tube feeding was needed and 81 patients (24%) needed the tube longer than 180 days. At 90 days post CRT 11 patients (7 (64%) with a tube in situ) had died of pneumonia (n = 2), oral bleeding (n = 1), multi-organ failure (n = 1), progressive disease (n = 2), diverticulitis/sepsis (n = 1), and in four cases cause of death was unknown.
Figure 1 shows the number of tube placements per week of CRT and the percentage prolonged placements. Of the 41 and 18 patients who started tube feeding before and in the first week of CRT respectively, 55 (93%) became prolonged dependent. Of these 55 patients, 28 (51%) initially received an NGT, which was later converted to a PRG. Most patients received their tube in the fourth week of CRT (n = 47) of whom 62% became prolonged dependent.
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Prediction model for tube feeding during CRT
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