Gastrostomy tubes (G-tubes) are instrumental devices frequently used in the palliative care for patients with end-stage cancers.^1-3 Despite their routine utilization, there is a gap in the scientific literature of their efficacy, placement and clinical outcomes.¹ Recent findings published in the Journal of the National Comprehensive Cancer Network suggest that G-tubes, employed for enteral nutrition and gastric decompression, play a salient role in the palliation for a mixed population of patients with cancers.¹ Additional findings show that patients who received palliative care and/or social work consults resulted in higher frequency for hospice, suggesting their impact on the decision-making processes for cancer patients.¹

Indications for G-tube usage are primarily for enteral nutrition when oral intake is no longer feasible upon cancer diagnoses or for gastric decompression in the cases of malignant bowel obstruction (MBO).^1,3,4 G-tube placement can be performed by percutaneous endoscopic gastrostomy (PEG), interventional radiology (IR)-guided and surgical procedures.^1,4

A study examined 242 cancer patients, with average age of diagnosis of 61 years, from a tertiary referral cancer center.¹ The patients were then divided into two groups: 76% underwent G-tube placement for nutrition and 22.7% underwent G-tube placement for decompression for MBO.¹ Clinical data were obtained retrospectively from patient records from the time period of January 2013 through December 2017.¹

In their investigation, evaluation of clinical variables after G-tube placement included, but not limited to, major and minor complications, survival rates, provision of palliative consultations, discharge options, and pain assessments.¹ The nutrition group consisted of additional measurements of serum and pre-albumin concentrations and weight measurement recordings.¹   

In the nutrition group (n=185), 88.1%, 8.1% and 3.8% of patients with average age of 64.5 years received G-tube placement by IR, surgery and endoscopy, respectively, compared with 81.8%, 14.5% and 3.6% in the MBO group (n=55) (p=0.36). Active treatment within 3 months of G-tube insertion was seen in 38.3% of the nutrition group versus 29.1% in the MBO group (p=0.22).

Patients in chemotherapy displayed a 51.4% rate for minor complications as compared to 49.6% in the non-treatment group (p=0.426).¹ A decrease in pain scores by 1.4 points (p<0.001) for both groups was shown.¹ Survival outcomes were studied at 30-day, 1-year and 3-year intervals, no significant difference was found between the chemotherapy treatment and non-treatment groups.¹ The mean weight for both treatment and non-treatment groups decreased by 2.3 kg one month post placement of the G-tubes (p<0.001).¹ Similarly after one month of G-tube placement, no significant changes in serum albumin (p=0.48) and prealbumin (p=0.69) were observed in both groups.¹ 

In the MBO group, the average age of patients was 59.5 years.¹ A high mortality rate was recorded at 90.6%.¹ Of those 55 patients, just 45.5% of the patients were provided with palliative care consults; 56.4% were seen by a social worker; and 46.3% were discharged to hospice.¹ Patients who received consults chose discharge to hospice more frequently than those who did not, 53.7% and 23.1% respectively (p=0.01).¹

On the other hand, a significant increase (p<0.001) in minor complications was observed in the nutrition group (50.3%) versus MBO group (20.0%).¹ Major post-placement complications were comparable between the two groups.¹ This is possibly due to a better survival rate in the nutrition group because approximately half (54.8%) of the patients in MBO group died within one month of G-tube placement.¹

The studies for G-tube placement are limited and the existing literatures place an emphasis on PEG tubes predominantly for nutrition, mostly in head and neck and gynecologic cancers only.¹ This study helps us better understand the risks, benefits and practices of G-tube placement and provides better generalizations in the mixed cancer populations by including patients with esophageal, gastrointestinal, pancreatic, hepatic, and genitourinary cancers. Findings also illustrated that the provision of palliative care and social worker consults resulted in higher rates of patients opting for hospice care.^1,2 This suggests multidisciplinary approaches may influence the end-of care decisions for better quality of life in cancer patients.^1,2