So Paul, since you mentioned the PEG� here we go, PEG WAR TIME!!!!
The latest data shows that some individuals definitely have to have a PEG tube, they just can't get through things without it. That's just a FACT. New data - patients that get them ahead of time, or patients that wait till their doctors decide that they have just lost too much body weight to go without it any longer, (usually about the end of week three of treatment) have the same outcomes as it related to survival, though obviously one group had greater weight loss during treatment. Apparently in the long view that weight loss did not impact ultimate outcome. Now the really new stuff, PEG users had slightly higher rates of dysphasia than no PEG users. Yup, I actually said it.
There are some caveats to that. The first is that IF the PEG user did swallowing exercises / physical throat therapy during PEG time, they had the same rate of dysphasia as non PEG users. Validating the "if you don't use it you can lose it" school of thought. So if you are going to have to PEG because of weight loss, then you better keep up with swallowing exercises, even though they are a pain in the rear (throat). My personal belief is that like me some people HAVE TO GO THE PEG ROUTE, but I am totally convinced they can offset any swallowing issues if they will just do the swallowing exercise protocol. Data now supports that. I personally think there is a big issue here, and that is patient compliance. I didn't want to do so many things during the worst parts of my treatment and this is one more MUST DO thing on the list. Staying after oral hygiene, hydration, swallowing exercises, taking meds on time, record keeping, and the list goes on� no just sleeping the days away during treatment if you want to avoid some QOL issues when it is all said and done.
It was well established that IMRT has the potential (in another study that was discussed in private conversations but not presented here) to reduce radiation to the nerves that control the swallowing reflex, reducing the post treatment dysphagia issues. Radiated nerves = swallowing issues regardless of PEG or no PEG. So tumor location and how the treatment radiation is mapped can cause dysphagia regardless of PEG or not.
