1. REGIONAL GASTROSTOMY AUDIT FOR HEAD AND NECK CANCER D Bailey 1 (diana.bailey@swpho.nhs.uk), D Baldwin 2, S Caldera 3 Cancer Intelligence Service, South West Public Health Observatory (SWCIS) 1, North Bristol Hospitals Trust 2, Portsmouth Hospitals Truist 3 on behalf of the SWCIS Head and Neck Tumour Panel www.swpho.nhs.uk Aims To highlight current usage of gastrostomies for head and neck cancer patients across five Cancer Networks. To identify factors associated with poor outcomes, and propose and implement guidelines that will lead to a reduction in morbidity and mortality. Methodology Twelve hospital Trusts in the region treating head and neck cancers were invited to participate. Head and neck cancer cases, primary or recurrent, having a gastrostomy inserted between 1 April 2004 and 31 March 2005 were included. Data on follow-up and outcome were collected up to six months after insertion. Data were collected by dieticians, head and neck specialist nurses and nutrition nurses. Conclusions There was wide variation between Trusts in both the type of gastrostomy used and whether for anticipated or current severe dysphagia. There was a significantly higher complication rate for RIGs and, at 6 months, a low swallowing rate with high long-term gastrostomy use, with cost implications. Recommendations To develop pathways for the management of nutrition, including follow-up care, dependant on services available (as recommended by the 2004 NICE guidelines). In one Trust: to audit head and neck patients who have been nasogastrically fed to determine complications, swallowing outcome at 6 months, and whether they subsequently had to have a gastrostomy. Results 9/12 Trust participated 178 Cases received Ascertainment 178/235 (76%) Introduction Appropriate feeding is a major concern for head and neck cancer patients. The complication rate for gastrostomies is high, with major complications >22%, minor complications >17% and the mortality rate ranging from 1.8%–47%. Follow-up is variable with some patients receiving none. With research showing that 7–28% of gastrostomies could have been removed, and with a feed cost of £75,000 a year, appropriate follow-up is both a quality of life and a cost issue. Head and Neck clinicians throughout South West England were concerned about the outcomes from gastrostomy feeding. In June 2003 the Head and Neck Tumour Panel coordinated a study day of evidence-based presentations on gastrostomy feeding, at which data items for the audit were agreed. The audit started in April 2004. In November 2004, the NICE Improving Outcomes Guidance, was published, which recommended development of the Network-wide guidelines on use, placement and management of gastrostomy tubes. Demographics 123 Male, 55 female (ratio 2:1) 147 Primary tumours (83%) 31 Recurrent tumours (17%) Site Oral cavity 68 (38%) Oropharynx 35 (20%) Hypopharynx 23 (13%) Larynx 20 (11%) Other 32 (18%) Gastrostomy type 121 PEGs (68%) Percutaneous Endoscopic Gastrostomy 51 RIGs (29%) Radiographically Inserted Gastrostomy 4 open gastrostomies 1 PEJ Jejunostomy Reason for choice of RIG /open gastrostomy over PEG n = 53 (2 nk) Reason for inserting Gastrostomy n = 173 (5 nk) Reason for inserting Gastrostomy (anticipated or present severe dysphagia) by Trust Nutitional status at 6 months for those alive n=126 Known state of swallowing at 6 months for full or modified oral intake or partial feeding n=55 (24 nk) Complications within 1 week Summary of results Ascertainment 76% 9/12 Trusts 2/3 PEGs and 1/3 RIGs 2/3 of PEGs inserted by gastroenterologists, 1/4 by surgeons Complications RIGs had significantly more complications than PEGs with Major 16% vs 2% at 1 week and Minor 32% vs 17% at 1 week. Being given a prophylaxis or chemotherapy treatment did not significantly affect complication rate. Follow-up and outcome at 6 months 167 cases were followed up and 70% were followed up by a gastrostomy care specialist 18% had no follow-up by gastrostomy care specialist (for 12% follow-up care not known NK) Of those followed up 2/3 were by dieticians and 1/3 by nutrition nurses At 6 months 36% were on full oral intake Only 20% had normal swallowing South West Cancer Intelligence Service