Effect of smoking, alcohol on feeding tube duration in head/neck cancer patients

Current smoking and heavy alcohol consumption appear to be risk factors for prolonged use of a gastrostomy tube (GT, feeding tube) in patients with head and neck cancer undergoing radiotherapy or chemoradiotherapy, according to a report published online by JAMA Otolaryngology-Head & Neck Surgery.

Chemoradiotherapy is a well-established treatment for advanced cancer of the head and neck. But its toxic effects can compromise eating and result in weight loss and malnutrition. Consequently, many institutions recommend prophylactic GT insertion before starting treatment, according to the study background.

Patrick Sheahan, M.B., M.D., F.R.C.S.I., of the South Infirmary Victoria University Hospital, Cork, Ireland, and coauthors studied smoking and alcohol consumption as potentially modifiable risk factors for increased duration of GT use.

The study included 104 patients at an academic teaching hospital with squamous cell cancer of the head and neck and undergoing treatment with either chemoradiation (84 patients) or radiotherapy alone (20 patients).

The authors found the median (midpoint) duration of GT use was nine months. The rate of GT use at 12 months was 35 percent.

Risk factors for prolonged GT use appeared to be current heavy alcohol consumption (someone who drank every day, drank more than a specified amount per week, or had a history of alcoholism or alcohol-related illness and was still drinking) and current smoking, but only current smoking remained an independent risk factor in multivariable analyses, according to the results.

The authors speculate there are several reasons why smoking and drinking might have an effect, including that nicotine may suppress appetite so patients make less of an effort to resume full eating by mouth and that smoking and drinking may lead to poor patient motivation to resume eating after treatment.

"Our results would support advising patients with head and neck SCC [squamous cell carcinoma] undergoing radiotherapy or chemoradiotherapy to avoid smoking and excess alcohol consumption during treatment. However, to determine whether stopping smoking and drinking can shorten duration of GT use will require further data from prospective studies," the study concludes.