How do you manage a patient who finished chemoRT for head and neck cancer and loses >10% body weight within 2 weeks post-treatment?

Very contextual question.

We are all mostly taught that we should avoid feeding tubes at all costs. And this teaching comes from our beloved head and neck attendings at tertiary centers, with inpatient oncology, infusion on site, nutritionists, speech and swallowing specialists, and IR/GI on demand ...

Consider PEG but try to avoid if possible.

I think there are a lot of factors that go in. And not all H&N require feeding tubes, even outside of the academic center. I cover some rural community cancer centers as well, and I think the biggest factors tend to be overall health (smoking-related heart/lung disease for example), pre-treatment we...

With contemporary contouring and IMRT planning techniques, not all patients getting bilateral neck radiation (presumably with chemotherapy) should by default end up with a feeding tube, and thus I would be against doing prophylactic G-tubes on all patients. There is certainly a fraction of patients ...

Consider temporary NGT.

I recently went through our database of oropharyngeal cancer patients treated definitively with chemoRT and was surprised that 30% required PEG feeding tubes; I thought the number would be far less. Unless a patient presents with significant weight loss due to their tumor and a BMI below 25, I gener...