Managing malnutrition and maintaining nutritional status is an integral component of a patient's cancer journey and requires proactive decisions within the multidisciplinary team (MDT) regarding appropriate placement of enteral feeding tubes. National Institute of Clinical Excellence (NICE) guidelines state that gastrostomy feeding should be considered in people likely to need long term (4 weeks or more) enteral tube feeding(1); and that there should be specific guidelines on the use, placement and management of gastrostomy tubes in HNC patients(2). There are no clinical guidelines on enteral feeding tube routes following HNC surgery and so in our centre there were inconsistencies in tube feeding routes used by the surgical teams. The aim of this audit was to establish length of tube feeding following surgery in order provide evidence-based guidelines on appropriate post-operative enteral tube feeding routes.
Baseline data on diagnosis, tumour staging, surgery and length of tube feeding were collected for 150 HNC patients tube fed post-operatively between 1 April 2006 and 31 March 2008. Patients that were tube fed prior to cancer diagnosis or as a result of a complication such as osteoradionecrosis were excluded. The data was entered onto an analytical database (ChironTM), stringently verified and extensively analysed in order to recommend appropriate feeding routes following HNC surgery. These guidelines were implemented and data collected for a further two year period until 31 March 2010 (181 patients) to determine changes in clinical practice.
After implementation of the guidelines shown below, the number of patients PEG fed for less than 28 days reduced from 22 to 13 and the number of patients NG fed for more than 28 days fell from 6 to 1.
We have produced evidence based post-operative tube feeding guidelines for HNC patients in line with NICE guidance. These have been implemented in Oxford resulting in improved selection of tube feeding routes according to length of post-operative enteral feeding.
