Dear OncoLink "Ask The Experts,"
My husband is a 54 year-old non-smoker or drinker with stage I moderately differentiated squamous cell cancer of the tonsil. He is about to begin radiation therapy. He is 6 feet tall and 210 pounds and strong - is a PEG tube really needed?
Pinaki R. Dutta, MD, PhD, Resident in the Department of Radiation Oncology at the Hospital of the University of Pennsylvania, responds:
A PEG tube is almost always recommended for patients undergoing radiation therapy for a head and neck cancer. Although your husband sounds well-developed and well-nourished, the side effects from radiation can make chewing and swallowing quite difficult, thereby taking a potentially significant toll on his nutrition. The PEG tube is there for “insurance” and does not necessarily have to be used. However, if he begins to have significant pain with eating, starts losing weight, or becomes at risk of aspiration (food goes down the air pipe instead of the esophagus), the PEG is there as a back up for feeding. Weight loss during cancer treatment can not only compromise a patient’s ability to tolerate treatment, but it can also alter the anatomical position of head and neck structures such that the benefit of customized radiation planning (i.e. dose conformality with IMRT) would be lost.
We encourage all of our patients to maintain normal swallowing function throughout treatment for as long as possible, as these muscles can atrophy without use (”use it or lose it” applies here). But it is best to have the PEG in place, just in case, as it is much more difficult and disruptive to try and have it placed in the middle of radiation therapy.
While it is true that some patients can become permanently PEG-dependent after completion of the radiation therapy, prompt and active speech and swallow therapy and good overall nutritional status can help avoid this possible risk.