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Gastrostomy Tube Dependence in Patients with Oropharyngeal Cancer Treated with Chemoradiation Therapy
was as painful as, or worse than, previous biopsies. There was no significant change in AUA prostate symptom score after IPM insertion. 23% to 30% of patients reported hematochezia, hematuria or hematospermia over a few days. Fever was reported by 8% of the patients, requiring a visit to their family doctor (6%) or the emergency department (2%) after which they were admitted to hospital for parenteral antibiotic therapy for Cipro-resistant infection. There were no detectable associations between pain during IPM insertion and pain later on, or between use of anticoagulants and bleeding events. Conclusion/Impact/Outcomes: IPM are a valuable tool for daily imageguidance during prostate radiotherapy but their utility must be balanced with the clinical safety of their implantation. The trans-rectal ultrasoundguided IPM insertion was well tolerated by most patients. Any bleeding or pain experienced was self-limiting. IPM insertion was however, associated with infrequent, but severe infections.
Gastrostomy Tube Dependence in Patients with Oropharyngeal Cancer Treated with Chemoradiation Therapy Anishka Saldanhaa, Lilian Doerwald-Munozb, Karen Biggsb, Tom Farrellb and Cici Lianga a - McMaster University b - Juravinski Cancer Centre Purpose/Aim: The purpose of this study is to determine a baseline for length of gastrostomy tube (GT) usage at the Juravinski Cancer Centre (JCC). We also test to see whether there is a difference in GT dependence between patients with HPV-positive (HPV+) and HPV-negative (HPV-) tumours. Method/Process: The medical charts of 304 consecutive patients referred to the JCC between 2012 and 2015, diagnosed with an oropharyngeal cancer (OPC) primary, were reviewed. Only patients who received concurrent chemoradiation therapy (CRT) were considered. Patients who were not treated with 7000 cGy in 35 fractions, did not have a GT, had the GT removed prior to the end of radiation, did not use the GT for nutritional supplementation, or were lost to follow-up, were excluded, resulting in 136 patients used in analysis. GT dependence was defined as the time between the completion of radiation therapy and removal of the GT. Results/Benefits/Challenges: The median GT dependence in this cohort was 50.5 days. The rate of GT dependence at 3 months was 22.8%, and at 6 months was 7.4%. All patients (except one) had their GT removed within one year of completion of radiation therapy. At the Memorial Sloan Kettering Cancer Centre, patients treated with CRT for OPC had a PEG dependence of four months (or 122 days). At the Massachusetts General Hospital (MGH), OPC patients treated with CRT had a median usage of 2.5 months (or 76 days). A study undertaken in a UK hospital of patients who received prophylactic gastrostomy had a median dependence of 181 days. The MGH had the lowest gastrostomy tube dependence amongst all studies assessed in this report. Compared to our institution, their patients’ dependence on GT’s was still higher (76 days vs. 50.5 days). Of patients with HPV- disease, eight were dependent on their gastrostomy tube, with a median of 42 days. Of patients with HPV+ disease, 65 were dependent on their gastrostomy tube, with a median of 57 days. There has been a call for studies to investigate the effect of tumour HPV-status on the use of GT and swallowing outcomes, as HPVrelated head and neck cancers are being recognized as a distinct subgroup of their own that act and react to treatment differently than their HPV- counterpart. On average, HPV-patients had the GT in place for 6 weeks (42 days), whereas HPV+ patients had the GT for just over 8 weeks (57 days). Feeding tube dependence is a common reported clinical outcome used to represent the prevalence of dysphagia. If further studies are able to demonstrate that there is a difference in median GT dependence between these groups, we can then investigate strategies, such as prophylactic swallowing therapy, which can reduce the severity of dysphagia in the group with greater dependence. Conclusion/Impact/Outcomes: In summary, this study reported a baseline of GT dependence in OPC patients treated with CRT at the JCC in a four-year period. With a baseline of GT dependence, we can evaluate the
effectiveness of future interventions that aim to reduce the length of time that patients require a GT. MODERATED POSTER SESSION
Improving Ergonomics in Radiation Therapy Carol Burnie Ottawa Hospital Cancer Centre Purpose/Aim: Radiation Therapists position patients at an isocentre (represented by lasers), which is 127 cm from the floor, for daily treatments on Linear Accelerators. The ideal ergonomic working height is 101.6 cm (standing waist-elbow height of the average female) thus the current isocentre height creates repeated awkward postures of the upper body and back. There were 61 Radiation Therapist injuries over 5 year period from 2010-2014 to in the department (102 FTE) that were actually reported to Occupational Health and Safety. The purpose of this pilot study was to install a lower secondary set of positioning lasers on three Linear Accelerators to determine if the opportunity to work at a more ergonomic height will reduce injury to staff. Method/Process: Staff involved in the trial were given a questionnaire and a Baseline Musculoskeletal Discomfort level survey using a validated tool. Secondary lasers were installed on three machines for a six week period, at either 15cm or 20cm below isocentre. A post- trial Musculoskeletal Discomfort Survey and questionnaire were given to staff involved in the trial and the benefit of the secondary lasers was evaluated. Results/Benefits/Challenges: Pre-trial survey of 20 respondents noted 65% had a work-related injury in past year. 85% of those injured were under 5’8’’ height. 92% of the injuries were attributed to patient setup. Post-trial surveys noted overall upper body injury frequency and intensity decreased with secondary laser use. 82% of staff used the secondary lasers often to always. Lasers provided the most benefit to staff under 5’8’’. 94% would like to see secondary lasers installed on all Linear Accelerators within department. Conclusion/Impact/Outcomes: Lower Secondary lasers provide staff with the opportunity to work at a more ergonomically appropriate height thereby improving body mechanics and risk of injury. May reduce cost to hospital through decreased injury to staff, and may improve health and wellness of staff.
Assessing Preference of Nasogastric vs. Gastrostomy Feeding Tubes in Chemoradiation Patients with Oropharyngeal Cancer Cici Lianga, Tom Farrellb, Karen Biggsb, Lilian Doerwald-Munozb and Anishka Saldanhaa a - McMaster University b - Juravinski Cancer Centre Purpose/Aim: To prevent malnutrition and the interruption of curative treatment, prophylactic feeding tube insertions are recommended for head and neck (HN) cancer patients receiving concurrent chemoradiation Enteral feeding tubes include gastrostomy (G) or nasogastric (NG). Presently, gastrostomies have largely replaced NG procedures without existing knowledge on what the patients themselves would actually prefer. Patient compliance to nutritional support is important to the successful completion of treatment, and thus the purpose of this study was to determine patient tube site preference and to identify the main factors that may influence their decision. Method/Process: Following informed consent, newly diagnosed oropharyngeal cancer patients participated in an unbiased interview that educated each patient about the purpose of enteral nutrition in chemoradiation treatment. The aim of the study was to approach new patients who have not yet discussed enteral feeding with their health care team, as a means to eliminate bias from their decision in tube preference. The interview reviewed the insertion procedure, advantages and disadvantages of both NG and G tubes through an instructional video. A questionnaire was used to collect each patient’s preference and to assess different decision-making factors on a scale of
Conference Proceedings from RTi3 2017/Journal of Medical Imaging and Radiation Sciences 48 (2017) S1-S22
S15
Gastrostomy Tube Dependence in Patients with Oropharyngeal Cancer Treated with Chemoradiation Therapy Anishka Saldanhaa, Lilian Doerwald-Munozb, Karen Biggsb, Tom Farrellb and Cici Lianga a - McMaster University b - Juravinski Cancer Centre Purpose/Aim: The purpose of this study is to determine a baseline for length of gastrostomy tube (GT) usage at the Juravinski Cancer Centre (JCC). We also test to see whether there is a difference in GT dependence between patients with HPV-positive (HPV+) and HPV-negative (HPV-) tumours. Method/Process: The medical charts of 304 consecutive patients referred to the JCC between 2012 and 2015, diagnosed with an oropharyngeal cancer (OPC) primary, were reviewed. Only patients who received concurrent chemoradiation therapy (CRT) were considered. Patients who were not treated with 7000 cGy in 35 fractions, did not have a GT, had the GT removed prior to the end of radiation, did not use the GT for nutritional supplementation, or were lost to follow-up, were excluded, resulting in 136 patients used in analysis. GT dependence was defined as the time between the completion of radiation therapy and removal of the GT. Results/Benefits/Challenges: The median GT dependence in this cohort was 50.5 days. The rate of GT dependence at 3 months was 22.8%, and at 6 months was 7.4%. All patients (except one) had their GT removed within one year of completion of radiation therapy. At the Memorial Sloan Kettering Cancer Centre, patients treated with CRT for OPC had a PEG dependence of four months (or 122 days). At the Massachusetts General Hospital (MGH), OPC patients treated with CRT had a median usage of 2.5 months (or 76 days). A study undertaken in a UK hospital of patients who received prophylactic gastrostomy had a median dependence of 181 days. The MGH had the lowest gastrostomy tube dependence amongst all studies assessed in this report. Compared to our institution, their patients’ dependence on GT’s was still higher (76 days vs. 50.5 days). Of patients with HPV- disease, eight were dependent on their gastrostomy tube, with a median of 42 days. Of patients with HPV+ disease, 65 were dependent on their gastrostomy tube, with a median of 57 days. There has been a call for studies to investigate the effect of tumour HPV-status on the use of GT and swallowing outcomes, as HPVrelated head and neck cancers are being recognized as a distinct subgroup of their own that act and react to treatment differently than their HPV- counterpart. On average, HPV-patients had the GT in place for 6 weeks (42 days), whereas HPV+ patients had the GT for just over 8 weeks (57 days). Feeding tube dependence is a common reported clinical outcome used to represent the prevalence of dysphagia. If further studies are able to demonstrate that there is a difference in median GT dependence between these groups, we can then investigate strategies, such as prophylactic swallowing therapy, which can reduce the severity of dysphagia in the group with greater dependence. Conclusion/Impact/Outcomes: In summary, this study reported a baseline of GT dependence in OPC patients treated with CRT at the JCC in a four-year period. With a baseline of GT dependence, we can evaluate the
effectiveness of future interventions that aim to reduce the length of time that patients require a GT. MODERATED POSTER SESSION
Improving Ergonomics in Radiation Therapy Carol Burnie Ottawa Hospital Cancer Centre Purpose/Aim: Radiation Therapists position patients at an isocentre (represented by lasers), which is 127 cm from the floor, for daily treatments on Linear Accelerators. The ideal ergonomic working height is 101.6 cm (standing waist-elbow height of the average female) thus the current isocentre height creates repeated awkward postures of the upper body and back. There were 61 Radiation Therapist injuries over 5 year period from 2010-2014 to in the department (102 FTE) that were actually reported to Occupational Health and Safety. The purpose of this pilot study was to install a lower secondary set of positioning lasers on three Linear Accelerators to determine if the opportunity to work at a more ergonomic height will reduce injury to staff. Method/Process: Staff involved in the trial were given a questionnaire and a Baseline Musculoskeletal Discomfort level survey using a validated tool. Secondary lasers were installed on three machines for a six week period, at either 15cm or 20cm below isocentre. A post- trial Musculoskeletal Discomfort Survey and questionnaire were given to staff involved in the trial and the benefit of the secondary lasers was evaluated. Results/Benefits/Challenges: Pre-trial survey of 20 respondents noted 65% had a work-related injury in past year. 85% of those injured were under 5’8’’ height. 92% of the injuries were attributed to patient setup. Post-trial surveys noted overall upper body injury frequency and intensity decreased with secondary laser use. 82% of staff used the secondary lasers often to always. Lasers provided the most benefit to staff under 5’8’’. 94% would like to see secondary lasers installed on all Linear Accelerators within department. Conclusion/Impact/Outcomes: Lower Secondary lasers provide staff with the opportunity to work at a more ergonomically appropriate height thereby improving body mechanics and risk of injury. May reduce cost to hospital through decreased injury to staff, and may improve health and wellness of staff.
Assessing Preference of Nasogastric vs. Gastrostomy Feeding Tubes in Chemoradiation Patients with Oropharyngeal Cancer Cici Lianga, Tom Farrellb, Karen Biggsb, Lilian Doerwald-Munozb and Anishka Saldanhaa a - McMaster University b - Juravinski Cancer Centre Purpose/Aim: To prevent malnutrition and the interruption of curative treatment, prophylactic feeding tube insertions are recommended for head and neck (HN) cancer patients receiving concurrent chemoradiation Enteral feeding tubes include gastrostomy (G) or nasogastric (NG). Presently, gastrostomies have largely replaced NG procedures without existing knowledge on what the patients themselves would actually prefer. Patient compliance to nutritional support is important to the successful completion of treatment, and thus the purpose of this study was to determine patient tube site preference and to identify the main factors that may influence their decision. Method/Process: Following informed consent, newly diagnosed oropharyngeal cancer patients participated in an unbiased interview that educated each patient about the purpose of enteral nutrition in chemoradiation treatment. The aim of the study was to approach new patients who have not yet discussed enteral feeding with their health care team, as a means to eliminate bias from their decision in tube preference. The interview reviewed the insertion procedure, advantages and disadvantages of both NG and G tubes through an instructional video. A questionnaire was used to collect each patient’s preference and to assess different decision-making factors on a scale of
Conference Proceedings from RTi3 2017/Journal of Medical Imaging and Radiation Sciences 48 (2017) S1-S22
S15