Background: Many head and neck cancer patients suffer from side effects of chemoradiotherapy that can result in reduced oral intake, and weight loss. To prevent this malnutrition they often undergo preventative percutaneous endoscopic gastrostomy (PEG) placement. We aim to determine whether PEG placement is necessary for successful patient performace during treatment. Methods: We compared 2 groups: patients that underwent PEG (Gp-1=P) (n=20), and those that did not undergo PEG (GP-2=NP) (n=47). All patients were treated with chemoradiotherapy. All were assessed at baseline (BL), and wk 5 of tx. WHO variables including weight loss, mucositis, dysphagia, and odynophagia ratings, along with patient-rated modified “distress thermometers”, were analyzed. Results: Patients with no PEGs had higher weights at BL (NP=193 vs P= 171, p=0.073) and at wk 5 (NP=179 vs P= 160, p=0.056). Weight loss in these groups were 8.09 % - P (p=0.000), 8.25% - NP (p=0.000) respectively from BL - wk 5. The median distress level of each group was 0-P and 1-NP at BL (p=0.302) and 6-P and 3-NP at wk 5 (p=0.086). 27 patients had a distress level of > = 4 at wk 5. Of these 27, 12 were PEG’d and 15 were not (p=0.008). 86 % of patients in the PEG group had distress >=4 and 44 % in the NP group had distress levels >=4. Patients that underwent PEG had slightly higher odds (NS) of associating their distress to nausea, fatigue and/or eating than patients that were not PEG’d. The wk 5 WHO toxicity scale assessment showed 15 PEG’d patients had Grade 1 (n=5), Grade 2 (n=9) & Grade 3 (n=1) dysphagia and 28 NP patients had Grade 1 (n=23) & Grade 2 (n=5) dysphagia (CHI square =11.66, p=0.009). Conclusions: Patients that underwent PEG placement before or during treatment performed worse in every assessment (weight loss, distress thermometer & toxicity scale) as compared to the no PEG group. Patients who have a normal or above average BMI are candidates to be monitored for PEG placement. However, both groups examined were able to complete treatment without significant treatment breaks. Close multidisciplinary monitoring and more intensive supportive care are needed when determining need for PEG placement during treatment.