Enteral Feeding with Nasogastric Tube in Advanced Head and Neck Cancer Patients-A Cross-sectional Study of Denial and Preferences

Introduction: Difficulty in swallowing, aspiration symptoms, trismus, and a fungating mass in advanced head and neck cancer (HNC) together compromise nutrition, and thereby the patient’s quality of life (QoL). Enteral feeding through a nasogastric (NG) tube is inexpensive and can be easily placed and managed at home. However, patients find it uncomfortable and are reluctant initially. We did a retrospective survey on issues related to NG placement. The aim was to study the impact of NG feeding in patients with advanced HNCs. Patients and Methods: Fifty patients with advanced HNC were taken on accrual in whom NG tube was placed. We looked into the reasons of NG tube placement, reasons of resistance from the patient, and the subjective benefit achieved, once the tube was placed. Results: The patients belonged to stage IV HNC. Median age was 47 years (41–58 years); 90% males; Median karnofsky performance status (KPS) - 70. NG tube was advised in patients with swallowing difficulty – 22 (40%) cases; trismus – 18 (36%); aspiration – 5 (10%); and large fungating mass +/− fistula – 5 (10%) cases. Initial denial for NG placement was due to social stigma – 5 (10%) cases; physical discomfort – 18 (36%) cases; and 10 (20%) denied any problem. Following counseling, the tube was placed and training was given. A survey was conducted thereafter – 30 (60%) patients experienced weight gain; 33 (65%) felt subjectively better; 12 (24%) felt their cancer had a greater response; and 15 (30%) completed cancer treatment. Conclusions: NG tube enteral feeding is easy to place; patients may hesitate initially, due to looks or discomfort. Once placed, the patients experience improvement in their QoL, weight gain, and overall sense of well-being.