Main Session
Sep
29
PQA 07 - Head and Neck Cancer, Lung Cancer/Thoracic Malignancies, and Nursing and Supportive Care
3636 - Independent Association of Baseline Pain with Reactive Feeding Tube Placement during Radiation Therapy for Head and Neck Squamous Cell Carcinoma
Presenter(s)
Reeny Thomas, MD, MS - University of Pittsburgh Medical Center, Pittsburgh, PA
R. M. Thomas1, C. T. Wilke2, M. L. Nilsen3, and Y. M. Mowery4; 1Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, 2Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, 3Department of Otolaryngology–Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 4Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA
Purpose/Objective(s):
To identify predictors of reactive percutaneous feeding tube (FT) tube placement during curative-intent radiation therapy (RT) for head and neck squamous cell carcinoma (HNSCC). We hypothesized that tumor site, T-category, PTV size, & baseline pain scores would be associated with reactive FT placement.Materials/Methods:
Adults enrolled in the single-institution Enhanced Care Coordination for Head and Neck Survivors trial (NCT04813172) were evaluated. This unplanned post hoc analysis included HNSCC patients undergoing definitive or adjuvant RT for stage I-IVB HNSCC, excluding stage I-II glottic larynx cancer and patients without baseline pain scores (Brief Pain Inventory [BPI] & MDASI). Reactive FT placement was defined as FT insertion during or within 30 days of RT completion. Continuous variables were compared for no FT vs. reactive FT groups by Mann-Whitney test, and associations with categorical variables were evaluated by Fisher’s exact test (significance threshold p<0.05). Variables significantly associated with reactive FT placement on univariate analysis were included in multiple logistic regression (MLR) models.Results:
A total of 87 patients (1/2020 – 1/2024) met inclusion criteria: 69 oropharynx (79.3%; n=64 p16+), 16 larynx/hypopharynx (18.4%), & 2 unknown primary (2.3%; n=2 p16+). Only 4 patients (4.6%) underwent surgery before RT. Most patients (n=59) did not undergo FT placement, with 4 (4.6%) & 24 (27.6%) receiving proactive & reactive FTs, respectively. Median (IQR) time from RT start to reactive FT placement was 33 days (23 – 43). Tumor site, surgery, N category, baseline BMI, neck RT laterality (ipsilateral vs. bilateral), & PTV sizes (low, intermediate, & high dose) were not significantly associated with reactive FT placement. T category was significantly associated with reactive FT placement (p = 0.04), as were baseline BPI average pain score (median 1 vs. 3.5; p = 0.02) & MDASI pain score (median 0 vs. 3.5; p = 0.02). On multivariate analysis, baseline BPI average pain score was significantly associated with reactive FT placement (OR 1.26; 95% CI 1.02 – 1.58), while T category was not (OR 1.04; 95% CI 0.71 – 1.51). Similarly, baseline MDASI pain score was significantly associated with reactive FT placement (OR 1.23; 95% CI 1.05 – 1.46), but T category again lost its significance (OR 1.05; 95% CI 0.71 – 1.53).Conclusion:
FT placement occurred frequently during curative-intent RT for HNSCC in this clinical trial. Baseline pain scores were associated with reactive FT placement on univariate & multivariate analyses, suggesting that routine pre-treatment pain assessment may identify patients most likely to benefit from proactive nutritional intervention during RT. Multi-institutional prospective validation with larger sample size is warranted.