Validated swallowing and nutrition guidelines for patients with head and neck cancer: Identification of high-risk patients for proactive gastrostomy

• Published in: Head & neck Vol. 35; no. 10; pp. 1385 - 1391
• Main Authors: Brown, Teresa E., Spurgin, Ann-Louise, Ross, Lynda, Tripcony, Lee, Keller, Jacqui, Hughes, Brett G. M., Hodge, Rob, Walker, Quenten, Banks, Merrilyn, Kenny, Lizbeth Moira, Crombie, Jane
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01-10-2013; Wiley Subscription Services, Inc
• Subjects: Adult; Aged; Aged, 80 and over; Cohort Studies; Decision Making; Deglutition Disorders - etiology; Deglutition Disorders - therapy; dysphagia; enteral feeding; Female; Gastrostomy - methods; Guideline Adherence; head and neck cancer; Head and Neck Neoplasms - pathology; Head and Neck Neoplasms - therapy; Humans; Male; Malnutrition - prevention & control; Middle Aged; Neck Dissection - adverse effects; Neck Dissection - methods; Nutritional Requirements; Nutritional Support - methods; Nutritional Support - standards; Postoperative Care - methods; Practice Guidelines as Topic; prophylactic gastrostomy; Prospective Studies; Quality of Life; Risk Assessment; swallowing; Time Factors; Young Adult; dysphagia; enteral feeding; swallowing; head and neck cancer; prophylactic gastrostomy
• ISSN: 1043-3074; 1097-0347
• DOI: 10.1002/hed.23146

Background
The “Swallowing and Nutrition Guidelines for Patients with Head and Neck Cancer” were developed to guide early identification and management of dysphagia and nutritional risk before, during, and after cancer treatment. The purpose of this study was to validate these guidelines.
Methods
Patients attending a Combined Head and Neck Clinic at a major tertiary hospital in 2007 to 2008 were assessed using the guidelines, with high‐risk category patients recommended for proactive gastrostomy. Data were collected on guideline adherence, gastrostomy tube insertion, and weight. Sensitivity, specificity, and positive predictive value were calculated for validation.
Results
Proactive gastrostomy tubes were inserted in 173 of 501 patients (25%). Overall guideline adherence was 87%. High‐risk category adherence was 75%. Validation outcomes were sensitivity 54%, specificity 93%, and positive predictive value 82%.
Conclusion
The risk categories in the guidelines are valid to assist early identification of swallowing and nutritional risk and guide decision‐making on proactive gastrostomy tube insertion. © 2012 Wiley Periodicals, Inc. Head Neck 35: 1385–1391, 2013