Teresa Brown1, Merrilyn Banks2, Brett G M Hughes3, Charles Lin4, Lizbeth Kenny5, Judith Bauer6. 1. Centre for Dietetics Research (C-DIET-R), School of Human Movement Studies, The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia; Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD 4029, Australia. Electronic address: teresa.brown@uqconnect.edu.au. 2. Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD 4029, Australia. Electronic address: merrilyn.banks@health.qld.gov.au. 3. Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD 4029, Australia; School of Medicine, The University of Queensland, St Lucia, Brisbane, QLD 4029, Australia. Electronic address: brett.hughes@health.qld.gov.au. 4. Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD 4029, Australia; School of Medicine, The University of Queensland, St Lucia, Brisbane, QLD 4029, Australia. Electronic address: charles.lin@health.qld.gov.au. 5. Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD 4029, Australia; School of Medicine, The University of Queensland, St Lucia, Brisbane, QLD 4029, Australia. Electronic address: lizkenny@bigpond.net.au. 6. Centre for Dietetics Research (C-DIET-R), School of Human Movement Studies, The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia. Electronic address: j.bauer1@uq.edu.au.
Abstract
OBJECTIVES: The main aim was to investigate the incidence of patient adherence to nutritional tube feeding recommendations in patients with head and neck cancer and to determine patient barriers to meeting tube feeding prescription. MATERIALS AND METHODS: This was an observational study from a randomised controlled trial in patients with head and neck cancer deemed at high nutritional risk with prophylactic gastrostomy (n=125). Patients were randomised to receive early tube feeding prior to treatment (intervention group) or standard care. All patients in the intervention and standard care groups then commenced clinical tube feeding as required during treatment. Patients maintained a daily record of gastrostomy intake, main nutrition impact symptom necessitating gastrostomy use, and reasons for not meeting nutrition prescription. Adherence was defined as meeting ≥75% of total prescribed intake. RESULTS:Patients were predominantly male (89%), median age 60, with oropharyngeal tumours (78%), stage IV disease (87%) treated with chemoradiotherapy (87%). Primary reasons for gastrostomy use were poor appetite/dysgeusia (week 2-3) and odynophagia/mucositis (week 4-7). Early tube feeding adherence was 51%. Clinical tube feeding adherence was significantly higher in the intervention group (58% vs 38%, p=0.037). Key barriers to both phases of tube feeding were; nausea, early satiety and treatment factors (related to hospital healthcare processes). CONCLUSIONS: Early tube feeding can improve patient adherence to clinically indicated tube feeding during treatment. Low adherence overall is a likely explanation for clinically significant weight loss despite intensive nutrition interventions. Optimising symptom management and strategies to overcome other barriers are key to improving adherence. CLINICAL TRIAL REGISTRATION: This trial has been registered in the Australian New Zealand Clinical Trials registry as ACTRN12612000579897.
RCT Entities:
OBJECTIVES: The main aim was to investigate the incidence of patient adherence to nutritional tube feeding recommendations in patients with head and neck cancer and to determine patient barriers to meeting tube feeding prescription. MATERIALS AND METHODS: This was an observational study from a randomised controlled trial in patients with head and neck cancer deemed at high nutritional risk with prophylactic gastrostomy (n=125). Patients were randomised to receive early tube feeding prior to treatment (intervention group) or standard care. All patients in the intervention and standard care groups then commenced clinical tube feeding as required during treatment. Patients maintained a daily record of gastrostomy intake, main nutrition impact symptom necessitating gastrostomy use, and reasons for not meeting nutrition prescription. Adherence was defined as meeting ≥75% of total prescribed intake. RESULTS:Patients were predominantly male (89%), median age 60, with oropharyngeal tumours (78%), stage IV disease (87%) treated with chemoradiotherapy (87%). Primary reasons for gastrostomy use were poor appetite/dysgeusia (week 2-3) and odynophagia/mucositis (week 4-7). Early tube feeding adherence was 51%. Clinical tube feeding adherence was significantly higher in the intervention group (58% vs 38%, p=0.037). Key barriers to both phases of tube feeding were; nausea, early satiety and treatment factors (related to hospital healthcare processes). CONCLUSIONS: Early tube feeding can improve patient adherence to clinically indicated tube feeding during treatment. Low adherence overall is a likely explanation for clinically significant weight loss despite intensive nutrition interventions. Optimising symptom management and strategies to overcome other barriers are key to improving adherence. CLINICAL TRIAL REGISTRATION: This trial has been registered in the Australian New Zealand Clinical Trials registry as ACTRN12612000579897.
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