Reactive versus prophylactic percutaneous endoscopic gastrostomy in patients with head and neck cancer: A multicenter real-world propensity score–matched analysis.

Abstract

e18130 Background: Nutritional compromise is common among patients with head and neck cancer undergoing treatment, often necessitating placement of a percutaneous endoscopic gastrostomy (PEG) tube. Whether prophylactic PEG placement confers clinical benefit compared with reactive placement after treatment initiation remains uncertain. We compared clinical outcomes associated with reactive versus prophylactic PEG placement in a large, real-world cohort. Methods: We conducted a multicenter, retrospective real-world cohort study of adults with head and neck cancer who underwent percutaneous endoscopic gastrostomy (PEG) placement. Patients were classified as receiving prophylactic PEG (prior to treatment initiation) or reactive PEG (after treatment initiation). To minimize confounding, 1:1 propensity score matching was performed using demographic characteristics, race, and major comorbidities. Covariate balance was assessed using standardized mean differences, with values <0.1 indicating adequate balance. Clinical outcomes were compared using time-to-event analyses, and results are reported as hazard ratios (HRs) with 95% confidence intervals (CIs). Results: After propensity score matching, baseline demographic and clinical characteristics were well balanced between the prophylactic and reactive PEG cohorts. There were no significant differences in the risk of acute kidney injury (14.0% vs 13.9%; HR 1.03, 95% CI 0.91–1.17) or aspiration pneumonia (7.7% vs 6.9%; HR 1.13, 95% CI 0.95–1.34). Patients receiving reactive PEG had a significantly higher risk of 90-day hospitalization compared with those receiving prophylactic PEG (49.9% vs 41.8%; HR 1.37, 95% CI 1.28–1.46). Conversely, reactive PEG placement was associated with a lower risk of dehydration (25.3% vs 30.1%; HR 0.85, 95% CI 0.78–0.93). Conclusions: In this large, multicenter, real-world analysis, prophylactic PEG placement was associated with significantly lower 90-day hospitalization rates than reactive PEG, without increased risk of acute kidney injury or aspiration pneumonia. These findings indicate that earlier nutritional intervention may mitigate downstream healthcare utilization and underscore the importance of strategic, individualized PEG timing as part of comprehensive supportive care for patients with head and neck cancer.