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January 2015

Feeding Tube Placement in Patients With Advanced Cancer: A Teachable Moment

Author Affiliations
  • 1Department of Medicine, University of California, San Francisco
JAMA Intern Med. 2015;175(1):15-16. doi:10.1001/jamainternmed.2014.5449

A woman in her 70s presented to our hospital with progressive pain and weight loss after having recently received a diagnosis of widely metastatic lung adenocarcinoma. At admission, it was noted that she was frail and cachectic with a body mass index (calculated as weight in kilograms divided by height in meters squared) of 16. Her hospital course focused on pain control and an extensive evaluation for etiologies of dysphagia that yielded unremarkable results. She was evaluated by the oncology service and determined not to be a chemotherapy candidate given her poor functional status. The patient requested that the family make medical decisions, and family meetings were held to determine goals of care. Family preferred that the patient be comfortable and return home if possible and to extend life to allow for visiting family to arrive. She continued to have poor oral intake, and a decision was made to pursue percutaneous endoscopic gastrostomy (PEG) tube placement for enteral nutrition in the belief that it would extend life by weeks to months and allow the patient to survive to see visiting family. She had no immediate procedural complications and was discharged to a skilled nursing facility with outpatient oncology follow-up.