From reactive to proactive tube feeding during chemoradiotherapy for head and neck cancer: A clinical prediction model-based approach

R. T. Karsten, M. M. Stuiver, L. van der Molen, A. Navran, J. P. de Boer, F. J. M. Hilgers, W. M. C. Klop, L. E. Smeele

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Objectives: Feeding tubes are placed unnecessarily in a proportion of head and neck cancer (HNC) patients treated with chemoradiotherapy (CRT) when prophylactic tube placement protocols are used. This may have a negative impact on the risk of long-term dysphagia. Reactive tube placement protocols, on the other hand, might result in weight loss and treatment interruption. The objective of this study is to identify patients at risk for prolonged tube dependency in order to implement a personalized strategy regarding proactive tube placement. Materials and methods: A retrospective study was performed in a consecutive cohort of HNC patients treated with primary CRT for whom a reactive tube placement protocol was used. A prediction model was developed to predict prolonged (> 90 days) feeding tube dependency. Model performance and clinical net benefit of the model were assessed. Results: Of the 336 included patients, 229 (68%) needed a feeding tube during CRT and 151 (45%) were prolonged feeding tube dependent. The prediction model includes the predictors pretreatment BMI, weight loss, Functional Oral Intake Scale and T-stage. Discriminatory ability is fair (area under the ROC-curve of 0.69) and calibration is adequate (Hosmer and Lemeshow test p =.254). The model shows net benefit over current practice for probability thresholds from 35 to 80%. Conclusion: The developed model can be used to select patients for proactive feeding tube placement during primary CRT for HNC. The nomogram with easily obtainable parameters is a useful tool for clinicians to support shared decision making regarding proactive tube placement.
Original languageEnglish
Pages (from-to)172-179
JournalOral Oncology
Volume88
DOIs
Publication statusPublished - 2019

Cite this

Karsten, R. T. ; Stuiver, M. M. ; van der Molen, L. ; Navran, A. ; de Boer, J. P. ; Hilgers, F. J. M. ; Klop, W. M. C. ; Smeele, L. E. / From reactive to proactive tube feeding during chemoradiotherapy for head and neck cancer: A clinical prediction model-based approach. In: Oral Oncology. 2019 ; Vol. 88. pp. 172-179.
@article{a4deb29c67854e2888c1d85c8e5fe266,
title = "From reactive to proactive tube feeding during chemoradiotherapy for head and neck cancer: A clinical prediction model-based approach",
abstract = "Objectives: Feeding tubes are placed unnecessarily in a proportion of head and neck cancer (HNC) patients treated with chemoradiotherapy (CRT) when prophylactic tube placement protocols are used. This may have a negative impact on the risk of long-term dysphagia. Reactive tube placement protocols, on the other hand, might result in weight loss and treatment interruption. The objective of this study is to identify patients at risk for prolonged tube dependency in order to implement a personalized strategy regarding proactive tube placement. Materials and methods: A retrospective study was performed in a consecutive cohort of HNC patients treated with primary CRT for whom a reactive tube placement protocol was used. A prediction model was developed to predict prolonged (> 90 days) feeding tube dependency. Model performance and clinical net benefit of the model were assessed. Results: Of the 336 included patients, 229 (68{\%}) needed a feeding tube during CRT and 151 (45{\%}) were prolonged feeding tube dependent. The prediction model includes the predictors pretreatment BMI, weight loss, Functional Oral Intake Scale and T-stage. Discriminatory ability is fair (area under the ROC-curve of 0.69) and calibration is adequate (Hosmer and Lemeshow test p =.254). The model shows net benefit over current practice for probability thresholds from 35 to 80{\%}. Conclusion: The developed model can be used to select patients for proactive feeding tube placement during primary CRT for HNC. The nomogram with easily obtainable parameters is a useful tool for clinicians to support shared decision making regarding proactive tube placement.",
author = "Karsten, {R. T.} and Stuiver, {M. M.} and {van der Molen}, L. and A. Navran and {de Boer}, {J. P.} and Hilgers, {F. J. M.} and Klop, {W. M. C.} and Smeele, {L. E.}",
year = "2019",
doi = "10.1016/j.oraloncology.2018.11.031",
language = "English",
volume = "88",
pages = "172--179",
journal = "Oral Oncology",
issn = "1368-8375",
publisher = "Elsevier Limited",

}

From reactive to proactive tube feeding during chemoradiotherapy for head and neck cancer: A clinical prediction model-based approach. / Karsten, R. T.; Stuiver, M. M.; van der Molen, L.; Navran, A.; de Boer, J. P.; Hilgers, F. J. M.; Klop, W. M. C.; Smeele, L. E.

In: Oral Oncology, Vol. 88, 2019, p. 172-179.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - From reactive to proactive tube feeding during chemoradiotherapy for head and neck cancer: A clinical prediction model-based approach

AU - Karsten, R. T.

AU - Stuiver, M. M.

AU - van der Molen, L.

AU - Navran, A.

AU - de Boer, J. P.

AU - Hilgers, F. J. M.

AU - Klop, W. M. C.

AU - Smeele, L. E.

PY - 2019

Y1 - 2019

N2 - Objectives: Feeding tubes are placed unnecessarily in a proportion of head and neck cancer (HNC) patients treated with chemoradiotherapy (CRT) when prophylactic tube placement protocols are used. This may have a negative impact on the risk of long-term dysphagia. Reactive tube placement protocols, on the other hand, might result in weight loss and treatment interruption. The objective of this study is to identify patients at risk for prolonged tube dependency in order to implement a personalized strategy regarding proactive tube placement. Materials and methods: A retrospective study was performed in a consecutive cohort of HNC patients treated with primary CRT for whom a reactive tube placement protocol was used. A prediction model was developed to predict prolonged (> 90 days) feeding tube dependency. Model performance and clinical net benefit of the model were assessed. Results: Of the 336 included patients, 229 (68%) needed a feeding tube during CRT and 151 (45%) were prolonged feeding tube dependent. The prediction model includes the predictors pretreatment BMI, weight loss, Functional Oral Intake Scale and T-stage. Discriminatory ability is fair (area under the ROC-curve of 0.69) and calibration is adequate (Hosmer and Lemeshow test p =.254). The model shows net benefit over current practice for probability thresholds from 35 to 80%. Conclusion: The developed model can be used to select patients for proactive feeding tube placement during primary CRT for HNC. The nomogram with easily obtainable parameters is a useful tool for clinicians to support shared decision making regarding proactive tube placement.

AB - Objectives: Feeding tubes are placed unnecessarily in a proportion of head and neck cancer (HNC) patients treated with chemoradiotherapy (CRT) when prophylactic tube placement protocols are used. This may have a negative impact on the risk of long-term dysphagia. Reactive tube placement protocols, on the other hand, might result in weight loss and treatment interruption. The objective of this study is to identify patients at risk for prolonged tube dependency in order to implement a personalized strategy regarding proactive tube placement. Materials and methods: A retrospective study was performed in a consecutive cohort of HNC patients treated with primary CRT for whom a reactive tube placement protocol was used. A prediction model was developed to predict prolonged (> 90 days) feeding tube dependency. Model performance and clinical net benefit of the model were assessed. Results: Of the 336 included patients, 229 (68%) needed a feeding tube during CRT and 151 (45%) were prolonged feeding tube dependent. The prediction model includes the predictors pretreatment BMI, weight loss, Functional Oral Intake Scale and T-stage. Discriminatory ability is fair (area under the ROC-curve of 0.69) and calibration is adequate (Hosmer and Lemeshow test p =.254). The model shows net benefit over current practice for probability thresholds from 35 to 80%. Conclusion: The developed model can be used to select patients for proactive feeding tube placement during primary CRT for HNC. The nomogram with easily obtainable parameters is a useful tool for clinicians to support shared decision making regarding proactive tube placement.

UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85057730835&origin=inward

UR - https://www.ncbi.nlm.nih.gov/pubmed/30616790

U2 - 10.1016/j.oraloncology.2018.11.031

DO - 10.1016/j.oraloncology.2018.11.031

M3 - Article

VL - 88

SP - 172

EP - 179

JO - Oral Oncology

JF - Oral Oncology

SN - 1368-8375

ER -