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Enteral feeding practices during head and neck cancer treatment: A retrospective chart review

This retrospective chart review of 846 adult head and neck cancer patients across six BC Cancer centres reveals that 20.5% required feeding tubes, with usage rates varying significantly by location and a predominance of reactive placement during or after radiation therapy, highlighting the need for standardized practices to improve patient counselling.

Original authors: Katie Tsoupatkis, Janet Ho, Jaeli Ibbetson, Lindsay Van der Meer, Eleah Stringer

Published 2026-07-01

📖 4 min read☕ Coffee break read

CC BY 4.0

Original authors: Katie Tsoupatkis, Janet Ho, Jaeli Ibbetson, Lindsay Van der Meer, Eleah Stringer

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

Imagine your body is a high-performance car. When a head and neck cancer diagnosis happens, it's like a major engine problem that makes it hard to get fuel (food) into the tank through the usual intake valve (your mouth). Sometimes, the treatment (radiation or chemotherapy) is so intense that it swells the intake valve or makes it too painful to use.

This study is like a mechanic looking back at the repair logs of 846 cars (patients) that came into six different BC Cancer garages (hospitals) over the course of one year. The mechanics wanted to know: How often did these cars need a backup fuel line (a feeding tube) installed? What kind of line did they use? And when did they install it?

Here is the breakdown of what they found, using simple comparisons:

1. The "Backup Fuel Line" (Feeding Tubes)

When the main intake isn't working, doctors can install a tube to feed the patient directly into their stomach or intestine. The study looked at three main types of tubes:

The "Temporary Straw" (Nasogastric tube): Goes through the nose. It's like a quick, temporary straw you use when you're sick for a few days.
The "Permanent Port" (Gastrostomy tube): Goes through the skin into the stomach. It's like installing a dedicated fuel port on the side of the car for longer-term use.
The "Specialized Line" (Jejunostomy tube): Goes deeper into the small intestine. This is a less common, specialized option.

2. The Big Surprise: The Garages Were Different

The most important finding is that every garage had different rules. Even though they are all part of the same provincial system (BC Cancer), the rate at which they installed these backup tubes varied wildly.

The "High-Use" Garage: In Prince George, almost 43% of patients got a tube. It was like every third car needing a backup line.
The "Low-Use" Garage: In Victoria, only 8% of patients got a tube. It was like only one in ten cars needing one.
The Middle Ground: Other cities like Vancouver and Surrey fell somewhere in between.

The study suggests this isn't just because the patients were different; it's because the doctors and teams in each city had different habits and preferences about when to install these tubes.

3. When Did They Install the Tube?

The study looked at the timing of the installation, which is like deciding when to install that backup fuel line:

Before the race starts (Before treatment): About 1 in 3 patients got the tube before they started their main treatment. This is a "prophylactic" approach—installing the line just in case it's needed later.
During the race (During treatment): Nearly half of the patients got the tube while they were already undergoing treatment. This is a "reactive" approach—waiting until the car actually starts sputtering before installing the line.
After the race (After treatment): About 1 in 5 patients got the tube only after treatment was finished.

Again, this varied by city. Prince George tended to install tubes before treatment, while places like Kelowna and Vancouver mostly installed them during treatment.

4. What Kind of Tube Was Used?

Overall, the teams were split almost evenly between the "Temporary Straw" (Nasogastric) and the "Permanent Port" (Gastrostomy).

Vancouver loved the "Temporary Straw" (Nasogastric).
Surrey and Kelowna preferred the "Permanent Port" (Gastrostomy).

The Main Takeaway

The authors conclude that because the rules change depending on which city you are in, patients might get very different advice. One patient might be told, "You will almost certainly need a tube," while another patient in a different city might be told, "We'll wait and see."

The study doesn't say which method is "better" for the patient's survival or health outcomes. Instead, it acts like a mirror, showing that the current system is inconsistent. The goal of sharing this data is to help doctors and patients have better, more consistent conversations so that everyone knows what to expect, regardless of which garage they visit.

In short: The study found that while feeding tubes are a common tool for head and neck cancer patients, how and when they are used depends entirely on which hospital you go to, and the authors want to fix that inconsistency to make care fairer for everyone.

Technical Summary: Enteral Feeding Practices During Head and Neck Cancer Treatment

Problem Statement
Head and neck cancer (HNC) is frequently associated with malnutrition at diagnosis, a condition that often deteriorates during treatment due to impaired oral intake caused by tumor proximity, inflammation, and treatment toxicities (e.g., dysphagia, mucositis). While feeding tubes (FTs) are critical for maintaining nutritional status when oral intake is insufficient, there is a lack of consensus regarding optimal timing and tube selection for this population. Reported rates of enteral nutrition (EN) use vary widely (7%–88%), reflecting differences in treatment modalities and institutional practices. Specifically, Canadian data describing centre-specific EN practices are limited. Within the British Columbia (BC) Cancer (BCC) system, despite a provincially coordinated model of care, variations in resource availability and institutional practice patterns have led to inconsistent approaches to prophylactic versus reactive FT placement. This variability complicates patient counseling and decision-making, as patients lack reliable baseline data regarding their likelihood of requiring a tube.

Methodology
This study employed a retrospective chart review design to evaluate FT utilization among adult HNC patients treated across six BCC regional centres between January 1 and December 31, 2024.

Study Population: The initial cohort included 2,415 unique patient records identified via electronic health records (Cerner and CAIS). After applying inclusion criteria (adults ≥19 years, new oncology consultation in 2024, HNC diagnosis, and receipt of cancer-related intervention) and exclusion criteria (non-HNC malignancies, treatment outside BCC, or surveillance-only follow-up), the final cohort consisted of 846 patients.
Data Collection: Researchers extracted demographic data (age, sex, ethnicity, Indigenous identity), clinical data (tumor site, treatment modality), and FT-specific variables (type, timing relative to radiation therapy or surgery). FT timing was categorized as prior to, during, or after treatment.
Statistical Analysis: Descriptive statistics were used to summarize incidence, type, and timing of FT use. Analysis of variance was conducted using RStudio to identify significant differences across centres.

Key Contributions and Results
The study provides the first province-wide overview of FT practices for HNC patients within the BCC system, establishing baseline data for future patient counseling and quality improvement.

Incidence Variability: A total of 173 patients (20.5% of the cohort) received a feeding tube. There was a statistically significant variation in FT incidence across the six regional centres ( $p < 0.005$ ). Rates ranged from a low of 8.1% in Victoria to a high of 42.5% in Prince George. Other centres reported rates of 12.9% (Kelowna), 22.5% (Abbotsford), 24.5% (Vancouver), and 33.9% (Surrey).
Tube Type Distribution: Among those receiving FTs, gastrostomy tubes were the most common (51.4%), followed by nasogastric tubes (45.7%) and jejunostomy tubes (2.9%). The distribution of tube types varied significantly by centre ( $p < 0.005$ ). For instance, Surrey and Kelowna predominantly utilized gastrostomy tubes (81.1% and 68.4%, respectively), whereas Vancouver primarily utilized nasogastric tubes (67.8%).
Timing of Placement: FT placement occurred prior to radiation therapy (RT) in 33.5% of cases, during RT in 46.2%, and after RT in 20.3%. The timing of placement also differed significantly across centres ( $p = 0.012$ ). Prince George had the highest proportion of pre-treatment placement (53.0%), while Kelowna, Surrey, Vancouver, and Victoria predominantly placed tubes during RT. Abbotsford demonstrated the highest proportion of post-treatment placement (44.0%).

Significance and Claims
The authors claim that the substantial variability in FT incidence and timing across BCC centres indicates significant differences in institutional practice patterns, despite the system's coordinated care model. The paper posits that this inconsistency may expose patients to unnecessary risks (in the case of indiscriminate prophylactic placement) or delay necessary support (in the case of reactive-only approaches), while simultaneously creating uncertainty for patients during decision-making.

The study concludes that these findings establish a necessary foundation for:

Patient Counseling: Providing evidence-based, local data to support informed decision-making regarding the likelihood of requiring a feeding tube.
Practice Harmonization: Highlighting the need for clearer, evidence-informed frameworks to guide FT decision-making and promote consistent, equitable, and patient-centred nutrition care across all regions.
Future Research: Identifying the need for improved predictive tools to identify high-risk patients and further qualitative research to understand patient perspectives on FT decision-making.

The authors explicitly note that while the study provides important preliminary insights, limitations exist regarding the inconsistency of available demographic data across centres and the scope of the data extraction, which was constrained by the project's timeframe.