Aims
To audit current prophylactic and reactive enteral feeding practices in high-risk patients against the Clinical Oncology Society of Australia’s (COSA) best practice guidelines for the nutritional management of adult patients with head and neck cancer (v1.1 published January 2024).
Methods
An audit of 49 random dietetics and clinical records of patients between 01/2022 to 12/2023 was performed. Demographic information, chemoradiation therapy commencement date, and records of enteral feeding via NGT, PEG or RIG were collected. This data was compared to sections 3.5 and 3.7 of the COSA guidelines. Benchmarks were agreed upon by the authors as:
1.) 70% will have been offered/recommended or received prophylactic enteral feeding through the insertion of a PEG, RIG or nasogastric tube prior to commencement of treatment;
2.) Of the patients who receive any enteral feeding, 85% of these patients will have received enteral feeding prophylactically.
Results
15 of the 49 patients (31%) received prophylactic enteral feeding, resulting in the threshold of 70% for standard 1 not being met.
Of the 24 patients who received enteral feeding during or immediately after their treatment, 15 patients (63%) received this feeding prophylactically, resulting in the threshold of 85% for standard 2 not being met.
Conclusions
Prophylactic enteral feeding is not offered or implemented at this health service in line with best practice guidelines. Recommendations to improve compliance include updates to proformas for initial dietetics consults and MDT meetings, provision of new education materials to patients at initial dietetics consults, education sessions on enteral feeding guidelines for oncology team members, and commencing a research project completing further examination of outcomes data for patients in this cohort to improve evidence for the audit standards.