Aim: To compare unplanned admissions rates and nutrition outcomes in HNC patients receiving C/RT using either Prophylactic tube feeding (Site A), or Reactive tube feeding (Site B) as per local procedures.
Method: All consecutive HNC patients receiving radiotherapy with curative intent during 6 months in 2015 were included in this prospective comparative cohort study. Patients not seen by a Dietitian were excluded. Weight loss was measured at start, end, and 4-6 weeks post treatment. Hospital admissions data were collected throughout and for 1 month post treatment and mean length of stay (LOS) was calculated (days). Unplanned admissions were coded as either clinical reasons versus those for nutrition impact symptoms (NIS) such as nausea, vomiting and odynophagia.
Results: 217 patients (n = 119 Prophylactic, n = 98 Reactive) were studied. Median age 64 years, 82% male, and 37% oropharyngeal cancer. Patients at Site A had higher radiotherapy dose (p=0.0002) and fractions (p<0.0001), and patients at Site B were heavier at baseline (p=0.013). There was no difference between the groups for % weight loss at any time point, rates of unplanned admissions (clinical or NIS reasons) or LOS. Weight loss ≥5% during treatment, accounted for significantly more unplanned admissions for NIS (p =0.006). Stepwise logistic analysis showed that being male, having high doses of radiotherapy, concurrent chemotherapy and being heavier at the start of treatment, were all highly predictive of having an unplanned admission for NIS.
Conclusion: There is no difference in the rate of unplanned admissions or % weight loss for HNC patients managed under Prophylactic versus Reactive tube feeding approach. This study has identified a number of predictors that can be used to develop targeted treatment care pathways to identify at risk patients and improve nutrition outcomes, reduce healthcare costs from unplanned admissions and thus optimise patient quality of life.