Prophylactic Versus Reactive Gastrostomy Tubes in Head and Neck Cancer: Making Joint Decisions

Purpose Patients undergoing chemoradiation for treatment of head and neck cancer often develop swallowing problems that necessitate a percutaneous gastrostomy (PEG) tube. Studies comparing various outcomes related to timing of PEG tubes placed either prophylactically or reactively do not show a clear advantage to either method; however, pertinent patient factors may help determine an educated and evidence-based decision. Additionally, patients may not be included in decision making regarding PEG placement and may not receive adequate education regarding PEG tubes, resulting in fears and concerns. Thus, patients may wish to avoid or at least delay PEG tube placement until necessary. The purpose of this viewpoint article is to review relevant literature and describe patient concerns to better facilitate joint decision making of PEG tube timing with the patient and care team. Conclusion Patient counseling and inclusion can be useful in helping patients understand why and when a PEG tube may be beneficial or necessary during treatment. A simplified decision tree is introduced that incorporates several relevant patient factors based on the current literature and can be used jointly by clinicians and patients to reach a mutual decision by incorporating clinical factors while being mindful of patient values.