Improving guideline sensitivity and specificity for the identification of proactive gastrostomy placement in patients with head and neck cancer

Background. Swallowing and nutrition guidelines for patients with head and neck cancer are available for identification of proactive gastrostomy placement in patients with high nutritional risk. The purpose of this study was to investigate improvements to the validity of these guidelines. Methods. A multivariate analysis was fitted to the original dataset (n=501) to examine the variables that may predict gastrostomy placement (eg, tumor site, treatment, sex, and age). Using these factors, the high risk category was modified and retrospectively validated in the same cohort to provide new measures of sensitivity and specificity. Results. The following were positive predictors of gastrostomy placement: T3 (p=.01), T4 (p<.001), and chemoradiotherapy (p<.001). Laryngeal (p=.02) and skin cancer (p<.001) were negative predictors. Modification of the high risk definition improved sensitivity to 58% and maintained specificity at 92%. Conclusion. Minor modifications to the high risk definition in the guidelines have improved the guideline sensitivity for future use. (C) 2015 Wiley Periodicals, Inc.