Early percutaneous endoscopic gastrostomy and nutritional supplementation for patients with head and neck cancer: an Italian survey of head and neck radiation oncologists

The aim of this paper is to survey among Italian radiation oncologists about the role of nutritional supplementation and an early placement of endoscopic percutaneous gastrostomy in head and neck cancer patients treated with radiotherapy or chemo-radiotherapy. The survey was carried out in 106 Italian centers of radiation oncology through a SurveyMonkey online interface questionnaire. The response rate to the survey was of 63 %, with 67 analyzable questionnaires. The majority of the respondents do not use preventive nutritional supplement. In 73.1 % of the cases, percutaneous endoscopic gastrostomy (PEG) is positioned only in case of necessity. The 82.1 % of the interviewed physicians, indeed, argued that the preventive placement of the endoscopic percutaneous gastrostomy should not be a standard procedure. Nutritional counseling before starting a treatment is not a routine, but 88.1 % of the respondents stated that this should represent a standard procedure. Although some studies agree that a reactive approach should be preferred to an early endoscopic percutaneous gastrostomy placement, firm evidences and a clear consensus are still lacking. This survey shows a wide agreement about both timing and criteria for endoscopic percutaneous gastrostomy placement; however, the management of nutritional supplementation in head and neck cancer patients appears to be still widely variable and to deserve more focused studies.