Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2026

10 year survival outcomes following early feeding via a prophylactic gastrostomy – a randomised controlled trial in patients with head and neck cancer (145993)

Teresa Brown 1 2 , Brett G.M. Hughes 1 3 , Sean Gannon 4 , Lisa Lee 4 , Charles Lin 1 , Lizbeth Kenny 3 , Merrilyn Banks 1 , Judy Bauer 5
  1. METRO NORTH HOSPITAL AND HEALTH SERVICE, Brisbane, QLD, Australia
  2. School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, QLD, Australia
  3. School of Medicine, University of Queensland, Brisbane, QLD, Australia
  4. QIMR Berghofer, Brisbane, QLD, Australia
  5. Department of Nutrition, Dietetics and Food, Monash University, Melbourne, VIC, Australia

Aim

Prophylactic gastrostomy tubes are often placed in patients with locally advanced head and neck squamous cell cancer (HNSCC) to ensure adequate nutritional intake during treatment, however weight loss and malnutrition remain problematic. A randomised controlled trial of proactive early nutrition support via the prophylactic gastrostomy tube prior to treatment was compared to standard care. The aim of this study was to assess long term survival outcomes.

Methods

Patients with HNSCC referred for prophylactic gastrostomy prior to curative intent treatment at a tertiary hospital were eligible. Patients were randomly assigned to either intervention or standard care. The intervention group commenced supplementary tube feeding immediately following tube placement. Survival outcomes were reported at 1, 3, 5 and 10 years. Disease free survival (DFS) and overall survival (OS) were evaluated using Kaplan-Meir Curves and Cox proportional hazard modelling using an intention-to-treat approach.

Results

The study had 68 patients randomised to standard care and 61 to intervention, with 10-year follow up completed in June 2025. Following intention-to-treat analysis, the OS probability for the intervention group was 67% (95%CI: 55% to 80%) compared to 48% (95%CI: 37% to 63%) in the standard care group. The risk of all-cause mortality in the intervention group was approximately half that of the standard care group (HR 0.53; 95%CI: 0.30-0.94; p=0.030). DFS in the intervention group was constantly higher than the standard care group at all timepoints past 12 months, but no statistically significant difference between groups (HR: 0.62; 95%CI: 0.37-1.05; p=0.077).

Conclusions

This study has demonstrated that an early proactive nutrition intervention via a prophylactic gastrostomy in patients undergoing chemoradiotherapy for HNSCC has improved long-term survival outcomes. This study reinforces the importance of nutrition therapy as part of cancer treatment and suggests this early proactive nutrition intervention should be implemented routinely to optimise patient outcomes, including survival.