Consensus-based nutritional recommendations for patients with head-and-neck cancer.

it is unclear if such trials will be able to be undertaken because of ethical concerns with regard to the withholding of tube feeding from those requiring nutrition support before anticancer treatment. Also, patient preference may make it difficult to obtain patient consent and to enroll patients into such a study, as demonstrated by the early closure of a randomized trial comparing percutaneous endoscopic gastrostomy with nasogastric feeding, which came about as a result of the reluctance of the patients to be randomised 4. The issue of prophylactic tube feeding is not without some controversy, given that some clinicians express concerns about feeding-tube dependence and the need to preserve swallowing function 2. However, gastrostomy complications vary according to the tube type, the insertion method, and the skill and expertise of those undertaking the procedure; the procedure mortality rate is itself low at less than 1% 5. The article by Orphanidou and colleagues also discusses practice guidelines from other countries regarding prophylactic tube feeding in patients with head-and-neck cancer 2. Since the completion of their review, another comprehensive guideline, “Evidence based practice guidelines for the nutritional management of adult patients with head and neck cancer,” has been developed in a wiki format 5. With several oncology groups acknowledging the importance of guidelines to help in decision-making, perhaps there will be a move toward international guidelines in the future. The paper from Orphanidou et al. provides a foundation from which future research should be planned and recommendations for practice can be made, helping practitioners to move toward more consistent and evidence-based practice to improve nutrition care and outcomes for patients with headand-neck cancer.