Predictors of time to feeding-tube independence in locally advanced head and neck cancer
- 1Division of Radiation Oncology, McGill University Health Centre
- 2Division of Radiation Oncology, Joseph Fishman Oncology Center, Rambam Health Care Campus
- 3Department of Ophthalmology, Carmel Medical Center
Abstract
Background: Prophylactic gastrostomy is widely used during definitive chemoradiotherapy for locally advanced head and neck cancer (LAHNC), yet some patients remain tube-dependent long after treatment. Whether prolonged dependence carries prognostic weight of its own, or simply mirrors tumour burden and performance status, is unclear. We examined predictors of time to feeding-tube independence and the association between persistent dependence and overall survival (OS).
Methods: We reviewed 213 consecutive patients with LAHNC treated at a single institution (2015–2022) with definitive chemoradiotherapy to 70 Gy and prophylactic PEG/RIG placement. Nine patients with an inconsistent extraction date were excluded, leaving 204. Time to independence was analysed with Kaplan–Meier estimates and cause-specific multivariable Cox regression, treating death as a competing risk, with a Fine–Gray sensitivity model. Dosimetric variables and baseline Karnofsky performance status (KPS) were modelled continuously. To avoid immortal-time bias, OS was assessed with landmark analyses at 3, 6 and 12 months. Patients were classified by tube status at each landmark, with adjustment for KPS, T and N classification, smoking history and age.
Results: Median time to independence was 3.2 months. Any smoking history predicted slower independence (HR 0.60, 95% CI 0.42–0.84; p=0.004), and higher KPS predicted faster independence (HR 1.02 per point, 95% CI 1.01–1.04; p=0.006). Higher middle pharyngeal constrictor dose was associated with slower recovery (HR 0.98 per Gy, 95% CI 0.96–1.00; p=0.048), and oral cavity dose showed a similar trend (p=0.067). In unadjusted landmark analyses, patients still dependent had worse OS at 6 months (HR 1.78, 95% CI 1.01–3.13) and 12 months (HR 2.53, 95% CI 1.30–4.91). After adjustment, the association was attenuated and non-significant at 3 months (aHR 1.35, 95% CI 0.76–2.42) and 6 months (aHR 1.48, 95% CI 0.81–2.70), but persisted at 12 months (aHR 2.20, 95% CI 1.05–4.58; p=0.036).
Conclusions: Early tube dependence largely reflects baseline disease burden and performance status. Dependence persisting to one year, however, identifies patients with worse survival that these factors do not explain, and they may merit closer follow-up. Smoking history and middle constrictor dose are potentially modifiable contributors to slower recovery, supporting structured smoking-cessation care and dysphagia-optimised planning. Prospective validation is warranted.
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BibTeX
@article{salman2026predictors,
title = {{Predictors of time to feeding-tube independence in locally advanced head and neck cancer}},
author = {Saeed Salman and Nancy Heppell and Nadin Dabbah Salman and Natali Shirron and Acheem Joseph and Christina Tsien and George Shenouda},
journal = {Frontiers in Oncology},
year = {2026},
month = oct,
doi = {10.3389/fonc.2026.1956034},
url = {https://www.frontiersin.org/articles/10.3389/fonc.2026.1956034/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Predictors of time to feeding-tube independence in locally advanced head and neck cancer
AU - Saeed Salman
AU - Nancy Heppell
AU - Nadin Dabbah Salman
AU - Natali Shirron
AU - Acheem Joseph
AU - Christina Tsien
AU - George Shenouda
PY - 2026
DA - 2026/10/20
JO - Frontiers in Oncology
DO - 10.3389/fonc.2026.1956034
UR - https://www.frontiersin.org/articles/10.3389/fonc.2026.1956034/full
AB - Background: Prophylactic gastrostomy is widely used during definitive chemoradiotherapy for locally advanced head and neck cancer (LAHNC), yet some patients remain tube-dependent long after treatment. Whether prolonged dependence carries prognostic weight of its own, or simply mirrors tumour burden and performance status, is unclear. We examined predictors of time to feeding-tube independence and the association between persistent dependence and overall survival (OS). Methods: We reviewed 213 consecutive patients with LAHNC treated at a single institution (2015–2022) with definitive chemoradiotherapy to 70 Gy and prophylactic PEG/RIG placement. Nine patients with an inconsistent extraction date were excluded, leaving 204. Time to independence was analysed with Kaplan–Meier estimates and cause-specific multivariable Cox regression, treating death as a competing risk, with a Fine–Gray sensitivity model. Dosimetric variables and baseline Karnofsky performance status (KPS) were modelled continuously. To avoid immortal-time bias, OS was assessed with landmark analyses at 3, 6 and 12 months. Patients were classified by tube status at each landmark, with adjustment for KPS, T and N classification, smoking history and age. Results: Median time to independence was 3.2 months. Any smoking history predicted slower independence (HR 0.60, 95% CI 0.42–0.84; p=0.004), and higher KPS predicted faster independence (HR 1.02 per point, 95% CI 1.01–1.04; p=0.006). Higher middle pharyngeal constrictor dose was associated with slower recovery (HR 0.98 per Gy, 95% CI 0.96–1.00; p=0.048), and oral cavity dose showed a similar trend (p=0.067). In unadjusted landmark analyses, patients still dependent had worse OS at 6 months (HR 1.78, 95% CI 1.01–3.13) and 12 months (HR 2.53, 95% CI 1.30–4.91). After adjustment, the association was attenuated and non-significant at 3 months (aHR 1.35, 95% CI 0.76–2.42) and 6 months (aHR 1.48, 95% CI 0.81–2.70), but persisted at 12 months (aHR 2.20, 95% CI 1.05–4.58; p=0.036). Conclusions: Early tube dependence largely reflects baseline disease burden and performance status. Dependence persisting to one year, however, identifies patients with worse survival that these factors do not explain, and they may merit closer follow-up. Smoking history and middle constrictor dose are potentially modifiable contributors to slower recovery, supporting structured smoking-cessation care and dysphagia-optimised planning. Prospective validation is warranted.
SN - 2234-943X
ER -