Smoking, Alcohol Use Affect Feeding Tube Duration in Head and Neck Cancer Patients

A new study has found that 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 who are undergoing radiotherapy or chemoradiotherapy.

The study, published online by JAMA Otolaryngology—Head & Neck Surgery, found that current smoking and current heavy alcohol consumption were significant predictors of GT persistence.

“Our results would support advising patients with head and neck SCC undergoing radiotherapy or chemoradiotherapy to avoid smoking and excess alcohol consumption during treatment,” the authors wrote in the study.

While chemoradiation is a well-established treatment for advanced head and neck cancer, its toxic effects can compromise eating and result in weight loss and malnutrition.

Because of this, many institutions recommend prophylactic GT insertion before starting treatment, according to the study background.

Study authors note that little research has been conducted on the impact of modifiable risk factors on duration of feeding tube use and GT dependence. Patrick Sheahan, MB, MD, FRCSI, of the South Infirmary Victoria University Hospital in Cork, Ireland and coauthors enrolled 104 patients with squamous cell cancer of the head and neck into the study. All of the enrolled patients were undergoing treatment with either chemoradiation (n=84) or radiotherapy alone (n =20).

Results showed that the median duration of GT use was 9 months, and the rate of GT use at 12 months was 35%.

Heavy current alcohol consumption was defined as 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.

Current smoking (hazard ratio [HR] = 0.47; 95% CI, 0.27-0.81; P = .01) and current heavy alcohol consumption (HR = 0.55; 95% CI, 0.32-0.97; P = .04) were significant predictors of GT persistence.

However, on multivariate analysis, only current smoking remained significant (HR = 0.53; 95% CI, 0.30-0.94; P = .03).

The authors speculated that smoking and drinking have an effect on prolonged GT use because nicotine may suppress appetite, causing patients to make less of an effort to resume full eating and smoking, and drinking may cause patients to feel less motivated to resume eating after treatment.

While it seems that these vices can lead to prolonged GT use, “to determine whether stopping smoking and drinking can shorten duration of GT use will require further data from prospective studies,” the authors concluded.