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5. Role of Percutaneous Endoscopic Gastrostomy for the Nutrition of Head and Neck Cancer Patients before and up to 6 Months after Cancer Treatment.

Author

Kouka, Mussab, Brand, Sophie, Koscielny, Sven, Bitter, Thomas, Pietschmann, Klaus, Ernst, Thomas, and Guntinas-Lichius, Orlando

Subjects
HEAD & neck cancer treatment, PREVENTION of weight loss, REPEATED measures design, SQUAMOUS cell carcinoma, ACADEMIC medical centers, NASOENTERAL tubes, NUTRITIONAL assessment, SMOKING, OROPHARYNGEAL cancer, HEAD & neck cancer, TREATMENT duration, CANCER patients, RETROSPECTIVE studies, TERTIARY care, DESCRIPTIVE statistics, ENTERAL feeding, LONGITUDINAL method, CANCER chemotherapy, ENDOSCOPIC gastrointestinal surgery, MEDICAL records, ACQUISITION of data, STATISTICS, ANALYSIS of variance, ALCOHOL drinking, TUMOR classification, COMPARATIVE studies, FEEDING tubes, HYPOPHARYNGEAL cancer
Abstract

Simple Summary: When we consider nutrition in patients with head and neck cancer (HNC), we mostly focus on the type of nutrition; studies on the type of nutrition at different time points are sparse. This retrospective study analyzed patients with HNC according to their nutritional status and association with percutaneous endoscopic gastrostomy (PEG) from admission to six months after treatment at a tertiary hospital in Germany from 2017 to 2019. Results showed that 14.9% required PEG before starting therapy. The need for PEG increased to 22.7% at six weeks after therapy and remained stable at 23% six months later. PEG placement was more frequently required for alcohol or nicotine use, oropharyngeal and hypopharyngeal carcinoma, squamous cell carcinoma, cancer stage III/IV, chemotherapy and impaired feeding. There has been an increase in the percentage of PEG over the observation period. This retrospective monocentric cohort study analyzed patients with head and neck cancer according their nutritional status and association of percutaneous endoscopic gastrostomy (PEG) from admission to six months after treatment at a tertiary hospital in Germany from 2017 to 2019. A total of 289 patients (76.5% men; median age 62 years; 63.3% stage IV) were included. Univariate analyses and ANOVAs with repeated measures were performed to analyze differences over time. The percentage of patients requiring PEG was 14.9% (43 of 289 patients) before start of treatment (Z0), 14% (40 of 286 patients alive) after one week (Z1), 22.7% (58 of 255 patients) after six weeks (Z2) and 23% (53 of 230 patients) after six months (Z3) from the end of treatment. PEG placement was associated with alcohol or nicotine consumption, in oropharyngeal and hypopharyngeal carcinoma, squamous cell carcinoma, cancer stage III/IV, chemotherapy and impairment of food intake (all p < 0.05). Weight loss between Z1 and Z3 with PEG did not differ from patients without PEG at Z0 (p = 0.074), although patients with PEG at Z0 had a lower mean weight at the beginning. PEG was important for a quarter of the patients alive at Z3 and helped to prevent weight loss. [ABSTRACT FROM AUTHOR]

Published
2024
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46. Early identification of heart failure deterioration through respiratory monitoring with adaptive servo‐ventilation.

Author

Fox, Henrik, Rudolph, Volker, Munt, Oliver, Malouf, Gordon, Graml, Andrea, Bitter, Thomas, and Oldenburg, Olaf

Subjects
VENTILATION, VENTILATION monitoring, HEART failure, HEART failure patients, BODY mass index, VENTRICULAR ejection fraction
Abstract

Summary: Cardiac decompensation is associated with worse prognosis in patients with heart failure. Reliable methods to predict cardiac decompensation events are not yet available. Sleep‐disordered breathing (SDB) is a frequent comorbidity in heart failure, and it has been shown to correlate with heart failure severity. This prospective observational trial investigated SDB characteristics in patients with heart failure with the aim to identify patterns that may predict early cardiac decompensation. Patients with heart failure with diagnosed SDB and hospitalised for cardiac decompensation were prospectively enrolled and treated with adaptive servo‐ventilation (ASV). SDB characteristics, daily body weight and clinical cardiac decompensation events were collected over a 1‐year follow‐up. Clinical events were categorised by an independent clinical event committee. A total of 43 patients were enrolled (81% male, mean [SD] age 71 [11] years, body mass index 30 kg/m2, 95% New York Heart Association function class III or IV, mean [SD] left ventricular ejection fraction 37% [11%], median apnea–hypopnoea index [AHI] of 37 events/h). A total of 48 cardiac decompensation events were recorded during the 1‐year study period. Respiratory rate was found to be significantly lower in patients with cardiac decompensation. The AHI and applied inspiratory pressure ASV‐device support were significantly increased 10 days before a clinical cardiac decompensation event. Device usage was also found to be significantly decreased 2 nights before cardiac decompensation. Device‐derived respiratory data in ASV therapy devices for SDB may therefore serve as a monitoring tool to predict early clinical cardiac decompensation events. Prediction and avoidance of cardiac decompensation, in turn, may attenuate serious health consequences in patients with heart failure. [ABSTRACT FROM AUTHOR]

Published
2023
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