Impact of current smoking and alcohol consumption on gastrostomy duration in patients with head and neck cancer undergoing definitive chemoradiotherapy.

ABSTRACT

IMPORTANCE Prophylactic gastrostomy tube (GT) insertion prior to chemoradiotherapy is a valuable nutritional adjunct in patients with head and neck cancer undergoing nonsurgical treatment. However, concerns have been expressed regarding high rates of GT dependence. There is little information in the literature regarding the impact of modifiable risk factors such as smoking and alcohol consumption on duration of GT use and dependence rates. OBJECTIVE: To study the duration of GT use in patients with head and neck cancer at our institution and to investigate risk factors for prolonged GT duration and dependence, including the impact of smoking and alcohol consumption. DESIGN, SETTING, AND PARTICIPANTS: This retrospective study at an academic teaching hospital included 104 patients with squamous cell carcinoma of the head and neck undergoing definitive treatment with either chemoradiotherapy (n = 84) or radiotherapy alone (n = 20). INTERVENTIONS: Prophylactic GT insertion prior to commencement of treatment. MAIN OUTCOMES AND MEASURES: Duration of GT use after completion of chemoradiotherapy or radiotherapy and the impact of risk factors on same. Duration of GT use was analyzed using Kaplan-Meier survival curves, with censoring of patients who developed cancer recurrence or died. RESULTS: The median duration of GT use was 9 months. The actuarial GT persistence rate at 1 year was 35%. Current smoking (hazard ratio [HR], 0.47; 95% CI, 0.27-0.81; P = .01) and current heavy alcohol consumption (HR, 0.55; 95% CI, 0.32-0.97; P = .04) were significant predictors of GT persistence. On multivariate analysis, only current smoking remained significant (HR, 0.53; 95% CI, 0.30-0.94; P = .03). Age 65 years or older, advanced T classification, larynx and/or hypopharynx primary site, and posttreatment neck dissection were not significant risk factors. CONCLUSIONS AND RELEVANCE Current smoking and current heavy alcohol consumption are predictive of prolonged GT requirement in patients with head and neck cancer undergoing prophylactic GT insertion before definitive radiotherapy or chemoradiotherapy. Further study is required to investigate whether smoking or drinking cessation can reduce GT dependence rates in this population.