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Enteral Nutrition in Pediatric High-risk Head and Neck Cancer Patients Receiving Proton Therapy

Identifying Risk Factors and Quality of Life Concerns to Optimize Care

Bechtel, Allison S., DO*; Indelicato, Daniel J., MD; Sandler, Eric, MD*

Journal of Pediatric Hematology/Oncology: May 2019 - Volume 41 - Issue 4 - p e247–e253
doi: 10.1097/MPH.0000000000001364
Online Articles: Original Articles

Background: Radiotherapy for pediatric head and neck tumors often results in mucositis and pain, limiting oral intake and compromising patients’ nutrition. There are little pediatric data available regarding enteral tube use and risk factors. Our objective was to estimate nutrition needs, identify risk factors contributing to nutritional decline and explore quality of life measures regarding enteral nutrition during proton radiotherapy.

Procedure: Nutritional metrics and status were collected throughout radiation treatment for 32 patients. We surveyed patients/caregivers about their perceptions of enteral nutrition. Risk factors for progression to non–oral nutrition or >5% weight loss were evaluated using univariate analysis.

Results: Patients who received any esophageal radiation or >30 Gy mean dose to the pharyngeal constrictors were more likely to experience >5% weight loss. These patients, as well as those who received a mean dose >30 Gy to the oropharynx or concurrent chemotherapy, were also more likely to require non–oral supplementation. Patients expressed the importance of maximizing nutrition and feared pain associated with a tube placement.

Conclusions: Pediatric patients with head and neck cancer can be risk-stratified based on clinical and dosimetric factors. This data, combined with parent and patient perceptions, is key to the development of rational guidelines.

*Nemours Children’s Specialty Care

University of Florida College of Medicine, Jacksonville, FL

Presented at American Society of Pediatric Hematology/Oncology, May 2018, Pittsburgh, PA and University of Florida Jacksonville Research Day, June 2018 (preliminary data).

The authors declare no conflict of interest.

Reprints: Allison S. Bechtel, DO, 807 Children’s Way, Jacksonville, FL 32207 (e-mail:

Received July 11, 2018

Accepted October 24, 2018

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