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Emanuel A, Rosenberger F, Krampitz J, Decker-Baumann C, Märten A, Jäger D, Rötzer I. Effects of parenteral nutrition + best supportive nutritional care vs. best supportive nutritional care alone on quality of life in patients with pancreatic cancer-a secondary analysis of PANUSCO. Support Care Cancer 2024; 32:466. [PMID: 38935156 PMCID: PMC11211116 DOI: 10.1007/s00520-024-08666-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE Parenteral nutrition (PN) can be an effective treatment to improve the nutritional status of patients with pancreatic cancer, but the effects of PN on quality of life (QoL) are still understudied. Therefore, we aimed at investigating whether the best supportive nutritional care (BSNC) in combination with PN at home compared to BSNC alone changed QoL in patients with advanced pancreatic cancer undergoing chemotherapy over a period of 7 weeks. METHODS n = 12 patients in the PANUSCO study received nutritional counseling only (control group (CG)) and n = 9 patients were also given supportive PN (intervention group (IG)). The primary endpoint was the change of QoL (EORTC-QLQ-C30 and QLQ-PAN26) over 7 weeks between the groups. RESULTS There was a significant worsening in social functioning in IG (p = 0.031) and a significant difference between groups in change of social functioning (p = 0.020). In all other domains of QoL, there was no significant difference between groups. Within groups, there was a significant improvement in the domain weight loss in IG (p = 0.031), showing that patients were less worried about their weight being too low. Furthermore, there was a significant difference in the change of BW over time between groups (p < 0.001) with IG showing an increase (p = 0.004) and CG showing no change (p = 0.578). CONCLUSION The administration of PN had in one of five domains negative consequences on QoL. The decision to administer PN should always be made individually and together with the patient, and the impact on QoL should be included in the decision to administer PN.
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Affiliation(s)
- Aline Emanuel
- Division of Nutrition Sciences, German University of Applied Sciences for Prevention and Health Management (DHfPG), 66123, Saarbruecken, Germany
| | - Friederike Rosenberger
- Division of Health Sciences, German University of Applied Sciences for Prevention and Health Management (DHfPG), 66123, Saarbruecken, Germany
| | - Julia Krampitz
- Division of Psychology and Pedagogy, German University of Applied Sciences for Prevention and Health Management (DHfPG), 66123, Saarbruecken, Germany
| | - Christiane Decker-Baumann
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Angela Märten
- Boehringer Ingelheim International GmbH, Ingelheim Am Rhein, Germany
| | - Dirk Jäger
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Ingeborg Rötzer
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120, Heidelberg, Germany.
- Clinic for Oncology and Haemotology, Northwest Hospital, UCT-Cancer University Center, 60488, Frankfurt Am Main, Germany.
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2
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Løhre ET, Solheim TS, Jakobsen G, Vagnildhaug OM, Schmidberger Karlsen TL, Habberstad RH, Balstad TR, Thronæs M. Parenteral Nutrition in Palliative Cancer Care: Detrimental, Futile, or Beneficial? Curr Oncol 2024; 31:2748-2757. [PMID: 38785489 PMCID: PMC11120543 DOI: 10.3390/curroncol31050208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/07/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024] Open
Abstract
Palliative cancer care patients may live for a long time, but malnutrition worsens the prognosis. Parenteral nutrition (PN) is suitable for replenishing a calorie deficit, but its advantages and tolerance late in the cancer trajectory are debated. We examined symptom development in hospitalized patients with and without PN. A total of 21 palliative cancer care patients receiving PN and 155 palliative cancer care patients not receiving PN during hospitalization in a specialized unit were retrospectively compared. We studied symptom intensity at admission, symptom relief during the hospital stay, and survival. The patients had locally advanced or metastatic cancer, a mean age of 70 years, and their median ECOG performance status was III. Symptom burden at admission was similar in the compared groups. Symptom relief during hospitalization was also similar. However, patients already on PN at admission reported more nausea and patients receiving PN during hospitalization reported better nausea relief compared to patients not receiving this intervention. Overall median survival was less than two months and similar in the compared groups. Based on a limited number of observations and a suboptimal study design, we were not able to demonstrate an increased symptom burden for palliative cancer care patients receiving PN late in the disease trajectory.
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Affiliation(s)
- Erik Torbjørn Løhre
- Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, 7030 Trondheim, Norway
- Centre for Crisis Psychology, Faculty of Psychology, University of Bergen, 5007 Bergen, Norway
| | - Tora Skeidsvoll Solheim
- Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, 7030 Trondheim, Norway
| | - Gunnhild Jakobsen
- Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, 7030 Trondheim, Norway
| | - Ola Magne Vagnildhaug
- Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, 7030 Trondheim, Norway
| | - Terese Louise Schmidberger Karlsen
- Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, 7030 Trondheim, Norway
| | | | - Trude Rakel Balstad
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, 7030 Trondheim, Norway
- Department of Clinical Medicine, Clinical Nutrition Research Group, UiT, The Arctic University of Norway, 9019 Tromsø, Norway
| | - Morten Thronæs
- Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, 7030 Trondheim, Norway
- Centre for Crisis Psychology, Faculty of Psychology, University of Bergen, 5007 Bergen, Norway
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3
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Salonen BR, Mundi MS, Hurt RT, Bonnes SL. The Role of Parenteral Nutrition for Incurable Cancer: Bridging Expectations and Reality. Curr Nutr Rep 2021; 10:226-231. [PMID: 34047939 DOI: 10.1007/s13668-021-00361-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW In this review, we examine the role for parenteral nutrition (PN) for nutritional support of patients with advanced, incurable cancer with an emphasis on bridging the divide between expectations and reality. RECENT FINDINGS As the rates of cancer have continued to rise worldwide, the utility of PN has continued to be studied. Due to multiple reasons, high-quality research studies have been scarce, and much of the data is based on observational studies. The recent trend appears to support the use of PN in carefully selected patients. Importantly, the effect on quality of life also should be considered when deciding to initiate PN. PN can be a supportive lifeline for patients with advanced, incurable cancer. The medical team should consider each patient individually to decide if PN should be offered. It is of paramount important for the medical team to engage in shared decision-making with the patient and caregiver(s) to ensure that PN is aligned with their goals and wishes.
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Affiliation(s)
- Bradley R Salonen
- Division of General Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Manpreet S Mundi
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Ryan T Hurt
- Division of General Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA.,Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.,Division of Gastroenterology, Hepatology and Nutrition, University of Louisville, Louisville, KY, USA
| | - Sara L Bonnes
- Division of General Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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4
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Cozzi G, Musi G, Milani M, Jemos C, Gandini S, Mazzoleni L, Ferro M, Luzzago S, Bianchi R, Omodeo Salé E, de Cobelli O. Impact of Perioperative Immunonutrition on Complications in Patients Undergoing Radical Cystectomy: A Retrospective Analysis. Integr Cancer Ther 2021; 20:15347354211019483. [PMID: 34027701 PMCID: PMC8142230 DOI: 10.1177/15347354211019483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Radical cystectomy (RC) is the gold standard treatment for patients with
muscle-invasive or refractory non-muscle invasive bladder cancer. It is
estimated that approximately 64% and 13% of RC patients experience any
complication and major complications, respectively. Specialized
immunonutrition (SIM) aims to reduce the rates of complications after RC. We
reported surgical complication rates in RC patients who received (SIM group)
versus who did not receive (no-SIM group) perioperative SIM. Moreover, we
investigated factors associated with complications after RC. Material and Methods: This is a retrospective cohort study of 52 patients who underwent RC between
April 2016 and December 2017. Overall, 26 (50%) patients received
perioperative SIM. We recorded age, gender, Charlson Comorbidity Index
(CCI), body mass index (BMI), Malnutrition Universal Screening Tool (MUST)
score, unintentional weight loss (UWL), SIM drinks consume, surgical
approach, urinary diversion, neoadjuvant chemotherapy (NAC), use of total
parenteral nutrition (TPN), final pathology, length of stay (LOS), and
complications. Results: SIM was associated with higher rates of documented infections
(P = .03). Conversely, post-operative ileus was
associated with higher rates of overall infections
(P = .03). Median LOS was comparable within the 2 groups.
Overall, 4 (15.38%) versus 0 (0%) patients in SIM versus no-SIM group were
readmitted to hospital (P = .03). Age, CCI, NAC, and TPN
were not associated with complication rates. Conclusions: SIM is not associated with lower rates of post-operative complications in RC
candidates. Moreover, higher rates of documented infections were observed in
the SIM group. Patients with post-operative ileus experienced more
infections. Age, CCI, NAC, and TPN were not predictive of complications.
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Affiliation(s)
| | - Gennaro Musi
- European Institute of Oncology, IRCCS, Milan, Italy.,Università degli Studi di Milano, Milan, Italy
| | | | | | - Sara Gandini
- European Institute of Oncology, IRCCS, Milan, Italy.,Università degli Studi di Milano, Milan, Italy
| | | | - Matteo Ferro
- European Institute of Oncology, IRCCS, Milan, Italy
| | - Stefano Luzzago
- European Institute of Oncology, IRCCS, Milan, Italy.,Università degli Studi di Milano, Milan, Italy
| | | | | | - Ottavio de Cobelli
- European Institute of Oncology, IRCCS, Milan, Italy.,Università degli Studi di Milano, Milan, Italy
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5
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Goodrose-Flores C, Schedin A, Nelander J, Almerud A, Trolle-Lagerros Y, Bonn S, Björkhem-Bergman L. High-protein compared with standard parenteral nutrition in palliative cancer care. BMJ Support Palliat Care 2020; 12:332-338. [DOI: 10.1136/bmjspcare-2019-002139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 03/27/2020] [Accepted: 05/02/2020] [Indexed: 12/24/2022]
Abstract
ObjectivesHigh-protein parenteral nutrition (PN) has been developed to counteract muscle loss in patients with cancer treated with PN. Nevertheless, it is not clear if high-protein PN is as safe as standard PN in patients with palliative cancer. Our primary aim was to compare the proportion of patients with elevated liver enzymes between high-protein and standard PN in patients with palliative cancer enrolled to Medical Home Care. Our secondary aim was to compare the two treatments with regard to weight and albumin levels during treatment.MethodsMedical records from 2016 to 2018 were retrospectively reviewed to identify palliative cancer patients that had received PN for more than 3 weeks. Data on weight, height, albumin, liver enzymes, socioeconomic factors and dietitian consultations were collected at baseline and after 3–8 weeks of PN treatment. The odds of having elevated liver enzymes or having a maintained weight and/or stable albumin levels were calculated using logistic regression.Results20 patients treated with high-protein PN were compared with 104 patients treated with standard PN. Patients treated with high-protein PN had a significantly higher weight at follow-up compared with patients treated with standard PN (p<0.05). There was no significant difference in the proportion of patients with elevated liver enzymes (OR 0.20; 95% CI 0.02 to 1.86), or maintained weight and/or albumin levels (OR 1.62; 95% CI 0.46 to 5.76) between high-protein and standard PN.ConclusionHigh-protein PN was as safe, and at least as effective, as standard PN to patients with palliative cancer.
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6
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Patel PS, Fragkos KC, Keane N, Cauldwell K, O'Hanlon F, Rogers J, Obbard S, Barragry J, Sebepos-Rogers G, Neerkin J, Mehta S, Rahman F, Di Caro S. Clinical and Nutritional Care Pathways of Patients with Malignant Bowel Obstruction: A Retrospective Analysis in a Tertiary UK Center. Nutr Cancer 2020; 73:572-587. [PMID: 32434435 DOI: 10.1080/01635581.2020.1767165] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We describe a retrospective cohort study of patients with malignant bowel obstruction to examine their nutritional care pathways between 1.1.16 and 31.12.16 with readmissions until 31.12.17. Data were analyzed by comparing patients who were referred (R) and not referred (NR) for PN. We identified 72 patients with 117 MBO admissions (mean ± SD age:63.1 ± 13.1yrs, 79% female). 24/72 patients were in R group. Predominant primary malignancies were gynaecological and lower-gastrointestinal cancers (76%). 83% patients had metastases (61% sub-diaphragmatically). All patients were at high-risk of malnutrition and baseline mean weight loss was 7%. Discussion of PN at multidisciplinary team meeting (MDT) (22% vs.5%, P = 0.02) and dietetic contact (94% vs. 41%, P < 0.0001) were more likely to occur in the R group. In 13/69 MBO admissions in NR group, reasons for non-referral were unclear. Median baseline and follow-up weight was similar (55-55.8 kg). Overall survival was 4.7 (1.4-15.2)months, with no differences by referral groups. We compared a sub-sample of patients who 'may have' required PN (n = 10) vs. those discharged on home PN (n = 10) and found greater survival in the HPN group (323vs.91 day, P < 0.01). Our findings highlight disparity in care pathways suggesting that nutritional care should be integrated into clinical management discussion(s) at MDT to ensure equal access to nutritional services.
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Affiliation(s)
- Pinal S Patel
- Dietetics Department, University College London Hospitals, London, UK
| | | | - Niamh Keane
- Dietetics Department, University College London Hospitals, London, UK
| | - Katrine Cauldwell
- Palliative Care Department, University College London Hospitals, London, UK
| | - Francis O'Hanlon
- Intestinal Failure Service, University College London Hospitals, London, UK
| | - Jennifer Rogers
- Intestinal Failure Service, University College London Hospitals, London, UK
| | - Sarah Obbard
- Intestinal Failure Service, University College London Hospitals, London, UK
| | - John Barragry
- Intestinal Failure Service, University College London Hospitals, London, UK
| | | | - Jane Neerkin
- Palliative Care Department, University College London Hospitals, London, UK
| | - Shameer Mehta
- Intestinal Failure Service, University College London Hospitals, London, UK
| | - Farooq Rahman
- Intestinal Failure Service, University College London Hospitals, London, UK
| | - Simon Di Caro
- Intestinal Failure Service, University College London Hospitals, London, UK
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7
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Cotogni P, Monge T, Passera R, Brossa L, De Francesco A. Clinical characteristics and predictive factors of survival of 761 cancer patients on home parenteral nutrition: A prospective, cohort study. Cancer Med 2020; 9:4686-4698. [PMID: 32412178 PMCID: PMC7333857 DOI: 10.1002/cam4.3064] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/14/2020] [Accepted: 03/31/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Robust data reporting the survival of cancer patients on home parenteral nutrition (HPN) are lacking. The aim of this prospective, cohort study was to investigate clinical characteristics, predictive factors, and overall survival (OS) of adult-malnourished cancer patients eligible for HPN according to the European guideline recommendations. METHODS During the study period, 1658 cancer patients were consecutively evaluated in a tertiary university hospital. Of these, 761 who received HPN were grouped into four cohorts according to the provision of supplemental PN (SPN) or total (TPN) and whether they received chemotherapy (CT+ or CT- ): SPN/CT+ (n = 376), TPN/CT+ (n = 99), SPN/CT- (n = 191), and TPN/CT- (n = 95). Patient demographics, nutritional status, cancer-related characteristics, and prognostic scores assessed at HPN start. The primary outcome was OS. RESULTS Median OS was 8.9, 4.3, 5.7, and 2.2 months for the SPN/CT+ , TPN/CT+ , SPN/CT- , and TPN/CT- cohorts, respectively. In multivariable analysis, predictors showing significant association with decreased survival were patient cohorts, modified Glasgow Prognostic Score (1 and 2 scores), weight loss (>15%) in the 3 months before HPN start, and TNM IV stage while protective factors of survival were Karnofsky Performance Status (>50), albumin level (>3.5 g/dL), oral protein intake, BMI (>20.5), and weight at HPN start. CONCLUSION For the first time, in four different cohorts of cancer patients on HPN, clinical characteristics and survival were compared. This large study showed that survival is significantly correlated with patient characteristics at HPN start and that the presence of favorable factors may determine even a fourfold increase in survival. These data are expected to assist physicians in the appropriate prescription of HPN.
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Affiliation(s)
- Paolo Cotogni
- Unit of Parenteral Nutrition in Oncology, Department of Internal Medicine, Molinette Hospital, Turin, Italy
| | - Taira Monge
- Unit of Parenteral Nutrition in Oncology, Department of Internal Medicine, Molinette Hospital, Turin, Italy.,Clinical Nutrition, Department of Internal Medicine, Molinette Hospital, Turin, Italy
| | - Roberto Passera
- Nuclear Medicine Division, Department of Radiology, Molinette Hospital, Turin, Italy
| | - Laura Brossa
- Unit of Parenteral Nutrition in Oncology, Department of Internal Medicine, Molinette Hospital, Turin, Italy.,Clinical Nutrition, Department of Internal Medicine, Molinette Hospital, Turin, Italy
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8
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Bouleuc C, Anota A, Cornet C, Grodard G, Thiery‐Vuillemin A, Dubroeucq O, Crétineau N, Frasie V, Gamblin V, Chvetzoff G, Favier L, Tournigand C, Grach M, Raynard B, Salas S, Capodano G, Pazart L, Aubry R. Impact on Health-Related Quality of Life of Parenteral Nutrition for Patients with Advanced Cancer Cachexia: Results from a Randomized Controlled Trial. Oncologist 2020; 25:e843-e851. [PMID: 32212354 PMCID: PMC7216468 DOI: 10.1634/theoncologist.2019-0856] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 02/07/2020] [Indexed: 02/06/2023] Open
Abstract
Background Malnutrition worsens health‐related quality of life (HRQoL) and the prognosis of patients with advanced cancer. This study aimed to assess the clinical benefits of parenteral nutrition (PN) over oral feeding (OF) for patients with advanced cancer cachexia and without intestinal impairment. Material and Methods In this prospective multicentric randomized controlled study, patients with advanced cancer and malnutrition were randomly assigned to optimized nutritional care with or without supplemental PN. Zelen's method was used for randomization to facilitate inclusions. Nutritional and performance status and HRQoL using the European Organization for Research and Treatment of Cancer QLQ‐C15‐PAL questionnaire were evaluated at baseline and monthly until death. Primary endpoint was HRQoL deterioration‐free survival (DFS) defined as a definitive deterioration of ≥10 points compared with baseline, or death. Results Among the 148 randomized patients, 48 patients were in the experimental arm with PN, 63 patients were in the control arm with OF only, and 37 patients were not included because of early withdrawal or refused consent. In an intent to treat analysis, there was no difference in HRQoL DFS between the PN arm or OF arm for the three targeted dimensions: global health (hazard ratio [HR], 1.31; 95% confidence interval [CI], 0.88–1.94; p = .18), physical functioning (HR, 1.58; 95% CI, 1.06–2.35; p = .024), and fatigue (HR, 1.19; 95% CI, 0.80–1.77; p = .40); there was a negative trend for overall survival among patients in the PN arm. In as treated analysis, serious adverse events (mainly infectious) were more frequent in the PN arm than in the OF arm (p = .01). Conclusion PN improved neither HRQoL nor survival and induced more serious adverse events than OF among patients with advanced cancer and malnutrition. Clinical trial identification number. NCT02151214 Implications for Practice This clinical trial showed that parenteral nutrition improved neither quality of life nor survival and generated more serious adverse events than oral feeding only among patients with advanced cancer cachexia and no intestinal impairment. Parenteral nutrition should not be prescribed for patients with advanced cancer, cachexia, and no intestinal failure when life expectancy is shorter than 3 months. Further studies are needed to assess the useful period with a potential benefit of artificial nutrition for patients with advanced cancer. Malnutrition impairs clinical outcome in patients with advanced cancer. This study compared parenteral nutrition with oral feeding for malnourished patients with advanced cancer and functional gastrointestinal tract.
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Affiliation(s)
- Carole Bouleuc
- INSERM Centre d'Investigation Clinique (CIC) 1431, Centre Hospitalier Universitaire (CHU) BesançonFrance
| | - Amélie Anota
- Methodology and Quality of Life in Oncology Unit (INSERM Unité Mixte de Recherche [UMR] 1098), Centre Hospitalier Universitaire (CHU) BesançonFrance
- French National Platform Quality of Life and CancerBesançonFrance
| | - Cécile Cornet
- INSERM Centre d'Investigation Clinique (CIC) 1431, Centre Hospitalier Universitaire (CHU) BesançonFrance
| | - Ghislain Grodard
- INSERM Centre d'Investigation Clinique (CIC) 1431, Centre Hospitalier Universitaire (CHU) BesançonFrance
- Medical Oncology Department, Centre Hospitalier Universitaire (CHU) BesançonFrance
| | | | | | - Nathalie Crétineau
- Department of Supportive Care, Institut de cancérologie de LorraineVandoeuvre‐lès‐NancyFrance
| | - Véronique Frasie
- Department of Supportive Care, Centre Paul StraussStrasbourgFrance
| | - Vincent Gamblin
- Department of Supportive Care, Centre Oscar LambretLilleFrance
| | | | - Laure Favier
- Medical Oncology Department, Centre Georges‐François LeclercDijonFrance
| | - Christophe Tournigand
- Medical Oncology Department, Hôpital Henri Mondor, Assistance Publique–Hôpitaux de Paris (APHP)CréteilFrance
| | | | - Bruno Raynard
- Tranversal Unit of Nutrition, Institut Gustave RoussyVillejuifFrance
| | - Sébastien Salas
- Medical Oncology Department, Centre Hospitalier (CH) La TimoneMarseilleFrance
| | | | - Lionel Pazart
- INSERM Centre d'Investigation Clinique (CIC) 1431, Centre Hospitalier Universitaire (CHU) BesançonFrance
| | - Régis Aubry
- INSERM Centre d'Investigation Clinique (CIC) 1431, Centre Hospitalier Universitaire (CHU) BesançonFrance
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9
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Yalcin S, Gumus M, Oksuzoglu B, Ozdemir F, Evrensel T, Sarioglu AA, Sahin B, Mandel NM, Goker E. Nutritional Aspect of Cancer Care in Medical Oncology Patients. Clin Ther 2019; 41:2382-2396. [PMID: 31699437 DOI: 10.1016/j.clinthera.2019.09.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 09/04/2019] [Accepted: 09/05/2019] [Indexed: 01/07/2023]
Abstract
PURPOSE Awareness of advances in the nutritional aspects of cancer care and translation of this information into clinical practice are important for oncology practitioners to effectively couple oncologic and nutritional approaches throughout the cancer journey. The goal of this consensus statement by a panel of medical oncologists was to provide practical and implementable guidance addressing nutritional aspects of cancer care from the perspective of the medical oncologist. METHODS A panel of medical oncologists agreed on a series of statements supported by scientific evidence and expert clinical opinion. FINDINGS Participating experts emphasized that both poor nutritional intake and metabolic alterations underlie cancer-related malnutrition. The use of liquid and high energy-dense oral nutritional supplements may enable better patient compliance, whereas higher efficacy is more likely with the use of pharmaconutrient-enriched oral nutritional supplements in terms of improved weight, lean body mass, functional status, and quality of life, as well as better tolerance to antineoplastic treatment. A multimodal approach is currently believed to be the best option to counteract the catabolism leading to cancer-related malnutrition; this treatment is scheduled in parallel with anticancer therapies and includes nutritional interventions, multitarget drug therapies, and exercise and rehabilitation programs. Participating experts emphasized the role of the oncologist as a reference professional figure in the coordination of nutritional care for patients with cancer within the context of complex and different clinical scenarios, particularly for permissive-adjunctive nutritional support. IMPLICATIONS This review article provides practical guidance addressing major nutritional aspects of cancer care from the medical oncologist's perspective. Thus, this document is expected to assist oncology practitioners in terms of awareness of advances in the nutritional aspects of cancer care and translation of this information into their clinical practice to effectively couple oncologic and nutritional approaches as part of the continuum of care for patients with cancer.
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Affiliation(s)
- Suayib Yalcin
- Hacettepe University Institute of Cancer, Ankara, Turkey.
| | - Mahmut Gumus
- Medeniyet University Faculty of Medicine, Istanbul, Turkey
| | - Berna Oksuzoglu
- Health Sciences University, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Feyyaz Ozdemir
- Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | | | | | - Berksoy Sahin
- Çukurova University Faculty of Medicine, Adana, Turkey
| | | | - Erdem Goker
- Ege University Faculty of Medicine, Izmir, Turkey
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10
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Ozcelik H, Gozum S, Ozer Z. Is home parenteral nutrition safe for cancer patients? Positive effects and potential catheter-related complications: A systematic review. Eur J Cancer Care (Engl) 2019; 28:e13003. [PMID: 30739373 DOI: 10.1111/ecc.13003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 12/30/2018] [Accepted: 01/08/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE Total Parenteral Nutrition began to be applied frequently in the houses of patients starting from the 1990s and is stated in literature as Home Parenteral Nutrition (HPN). The purpose of this review is to answer the question of whether or not HPN is safe for cancer patients. METHODS Searches were conducted in Cochrane, CINAHL, PubMed, Springer, Google Scholar, and the Web of Science databases. RESULTS The 1,949 articles were accessed in the total, and 20 articles have been included in the review. In the studies being evaluated, it can be determined that HPN has influenced the quality of life, performance status, and the nutrition level of cancer patients positively. Most frequently seen complications were infections relating to the catheter, the mechanical obstruction in the catheter and venous thrombosis. For each 1,000 days with HPN or a catheter, infections in the interval of 0.05 and 3.08, mechanical problems in the interval of 0.07 and 2.13, and thrombosis in the interval of 0.05 and 0.20 were determined. CONCLUSIONS While HPN influenced quality of life, nutrition, and the personal performance of cancer patients positively, the rate of complications is at a level that can be managed at home.
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Affiliation(s)
- Habibe Ozcelik
- Oncology Clinic, Akdeniz University Hospital, Antalya, Turkey.,Department of Public Health Nursing, Faculty of Nursing, Akdeniz University, Antalya, Turkey
| | - Sebahat Gozum
- Department of Public Health Nursing, Faculty of Nursing, Akdeniz University, Antalya, Turkey
| | - Zeynep Ozer
- Department of Internal Diseases Nursing, Faculty of Nursing, Akdeniz University, Antalya, Turkey
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11
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Integral nutritional approach to the care of cancer patients: results from a Delphi panel. Clin Transl Oncol 2018; 20:1202-1211. [DOI: 10.1007/s12094-018-1846-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 02/15/2018] [Indexed: 12/12/2022]
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12
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Keane N, Fragkos KC, Patel PS, Bertsch F, Mehta SJ, Di Caro S, Rahman F. Performance Status, Prognostic Scoring, and Parenteral Nutrition Requirements Predict Survival in Patients with Advanced Cancer Receiving Home Parenteral Nutrition. Nutr Cancer 2017; 70:73-82. [PMID: 29111787 DOI: 10.1080/01635581.2018.1380206] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
We describe a cohort of Home Parenteral Nutrition (HPN) patients with advanced cancer in order to identify factors affecting prognosis. Demographic, anthropometric, biochemical and medical factors, Karnofsky Performance Status (KPS), Glasgow Prognostic Score (GPS), and PN requirements were recorded. Univariate and multivariate analyses were performed including Kaplan-Meier curves, Cox Regression, and correlation analyses. In total, 107 HPN patients (68 women, 39 men, mean age 57 yr) with advanced cancer were identified. The main indications for HPN were bowel obstruction (74.3%) and high output ostomies (14.3%). Cancer cachexia was present in 87.1% of patients. The hazard ratio (HR) for upper gastrointestinal and "other" cancers vs. gynaecological malignancy was 1.75 (p = 0.077) and 2.11 (p = 0.05), respectively. KPS score, GPS, PN volume, and PN potassium levels significantly predicted survival (HRKPS ≥50 vs <50 = 0.47; HRGPS = 2 vs. GPS = 0 = 3.19). In multivariate analysis, KPS and GPS remained significant predictors (p < 0.05), whilst PN volume reached borderline significance (p = 0.094). Survival was not significantly affected by the presence of metastatic disease, previous or concurrent surgery, chemo-radiotherapy, or indication for HPN (p > 0.05). Most patients passed away in their homes or hospice (77.9%). Performance status, prognostic scoring, and PN requirements may predict survival in patients with advanced cancer receiving HPN.
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Affiliation(s)
- Niamh Keane
- a Intestinal Failure Service, Gastrointestinal (GI) Services , University College London Hospitals NHS Foundation Trust , London , UK
| | - Konstantinos C Fragkos
- a Intestinal Failure Service, Gastrointestinal (GI) Services , University College London Hospitals NHS Foundation Trust , London , UK
| | - Pinal S Patel
- a Intestinal Failure Service, Gastrointestinal (GI) Services , University College London Hospitals NHS Foundation Trust , London , UK
| | - Friderike Bertsch
- a Intestinal Failure Service, Gastrointestinal (GI) Services , University College London Hospitals NHS Foundation Trust , London , UK
| | - Shameer J Mehta
- a Intestinal Failure Service, Gastrointestinal (GI) Services , University College London Hospitals NHS Foundation Trust , London , UK
| | - Simona Di Caro
- a Intestinal Failure Service, Gastrointestinal (GI) Services , University College London Hospitals NHS Foundation Trust , London , UK
| | - Farooq Rahman
- a Intestinal Failure Service, Gastrointestinal (GI) Services , University College London Hospitals NHS Foundation Trust , London , UK
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13
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Theilla M, Cohen J, Kagan I, Attal-Singer J, Lev S, Singer P. Home parenteral nutrition for advanced cancer patients: Contributes to survival? Nutrition 2017; 54:197-200. [PMID: 28571682 DOI: 10.1016/j.nut.2017.03.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 03/06/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Patients with advanced cancer often suffer from severe malnutrition and gastrointestinal obstruction. This population could benefit from home parenteral nutrition (HPN). The aim of this study was to observe the outcome of patients with advanced cancer patients who were eligible for HPN. METHODS All patients in the nutrition clinic who received HPN over the past 7 y were included in the present study. We compared patients with advanced cancer with the noncancer population in terms of hospitalization rate and mortality. RESULTS Of 221 advanced cancer patients, 153 who had no oral/enteral intake and who received HPN survived. Of these, 35% survived for 6 mo, 27% for 1 y, 18.9% survived 2 y, and 3.9% survived for the 7 y of the follow-up. Hospitalization rate was not significantly different from the noncancer population. CONCLUSION These results show that HPN is a relevant palliative therapy for patients with advanced cancer patients without oral or enteral feeding access.
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Affiliation(s)
- Miriam Theilla
- Department of General Intensive Care, Sackler School of Medicine, Tel Aviv University, Israel; Institute for Nutrition Research, Sackler School of Medicine, Tel Aviv University, Israel; Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel; Nursing Department, Steyer School of Health Professions, Sackler School of Medicine, Tel Aviv University, Israel
| | - Johnathan Cohen
- Department of General Intensive Care, Sackler School of Medicine, Tel Aviv University, Israel; Institute for Nutrition Research, Sackler School of Medicine, Tel Aviv University, Israel; Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel
| | - Ilia Kagan
- Department of General Intensive Care, Sackler School of Medicine, Tel Aviv University, Israel; Institute for Nutrition Research, Sackler School of Medicine, Tel Aviv University, Israel; Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel
| | - Joelle Attal-Singer
- Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel; Institute of Endocrinology, Diabetes Services, Sackler School of Medicine, Tel Aviv University, Israel
| | - Shaul Lev
- Department of General Intensive Care, Sackler School of Medicine, Tel Aviv University, Israel; Institute for Nutrition Research, Sackler School of Medicine, Tel Aviv University, Israel
| | - Pierre Singer
- Department of General Intensive Care, Sackler School of Medicine, Tel Aviv University, Israel; Institute for Nutrition Research, Sackler School of Medicine, Tel Aviv University, Israel; Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel.
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14
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Vidal A, Arnold N, Vartolomei MD, Kiss B, Burkhard F, Thalmann GN, Roth B. Oncological and functional outcomes of postoperative total parenteral nutrition after radical cystectomy in bladder cancer patients: A single-center randomized trial. Int J Urol 2016; 23:992-999. [PMID: 27770454 DOI: 10.1111/iju.13228] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 09/11/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To prospectively evaluate the long-term oncological and functional outcomes of postoperative total parenteral nutrition after radical cystectomy. METHODS A total of 157 consecutive patients (≤cT3, cN0, cM0) who underwent extended pelvic lymph node dissection, radical cystectomy and ileal urinary diversion from September 2008 to March 2011 at a single center were randomized to receive either postoperative total parenteral nutrition (group A; n = 74) or oral nutrition alone (group B; n = 83). All but two patients in group B (who were thus excluded from further analysis) had regular postoperative follow up at the Department of Urology, University of Bern, Switzerland. Computed tomography and bone scan were carried out to assess local recurrences and distal metastases. We used validated questionnaires to evaluate bowel function, sexual function and quality of life, and an institutional questionnaire to evaluate neobladder function. RESULTS The median follow up was 50 months (IQR 21-62). The rate of local recurrences (4/74 [5.4%] in group A; 4/81 [4.9%] in group B; P = 0.9) and the rate of distant metastases (23/74 [31%] in group A; 23/81 [28%] in group B; P = 0.72) did not differ between the two groups. There was no difference in cancer-specific (P = 0.86) and overall survival (P = 0.85). Group B patients had significantly better bowel function at 3 months (P = 0.03) and 12 months (P = 0.01). There was no difference in terms of quality of life, and sexual and neobladder function. CONCLUSIONS The administration of total parenteral nutrition after radical cystectomy does not impair long-term oncological outcomes. It does, however, negatively influence long-term bowel function.
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Affiliation(s)
- Alvaro Vidal
- Department of Urology, University of Bern, Bern, Switzerland.,Faculty of Medicine, University of Chile, Santiago, Chile
| | - Nicolas Arnold
- Department of Urology, University of Bern, Bern, Switzerland
| | - Mihai Dorin Vartolomei
- Department of Urology, University of Bern, Bern, Switzerland.,Department of Cell and Molecular Biology, University of Medicine and Pharmacy, Târgu-Mureş, Romania
| | - Bernhard Kiss
- Department of Urology, University of Bern, Bern, Switzerland
| | - Fiona Burkhard
- Department of Urology, University of Bern, Bern, Switzerland
| | | | - Beat Roth
- Department of Urology, University of Bern, Bern, Switzerland
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15
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Girke J, Seipt C, Markowski A, Luettig B, Schettler A, Momma M, Schneider AS. Quality of Life and Nutrition Condition of Patients Improve Under Home Parenteral Nutrition: An Exploratory Study. Nutr Clin Pract 2016; 31:659-65. [PMID: 27165116 DOI: 10.1177/0884533616637949] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Patients with end-stage cancer and advanced chronic bowel disease are often malnourished, which has a negative effect on patients' outcome, well-being, and activity. It is inconclusive whether these patients benefit from home parenteral nutrition. This prospective exploratory study investigates its influence on nutrition state, muscle strength, mobility, and quality of life. MATERIALS AND METHODS Patients ≥18 years old with an indication for home parenteral nutrition were included and followed for 2-24 months. Nutrition parameters, activity, and quality of life were assessed. RESULTS Forty-eight patients participated (mean age 11.5 years), and 85% were severely malnourished (subjective global assessment score, class C). Four weeks after parenteral nutrition, patients with tumors demonstrated a deterioration in phase angle (from 3.9 to 3.4) and extracellular mass:body cell mass ratio (from 1.6 to 2.1), while patients with bowel disease improved (from 3.4 to 4.0 and 2.1 to 1.6, respectively); grip strength remained constant in both groups (difference: 1.11 and -2.11, respectively). Activity improved in patients with bowel disease but stayed the same in the tumor group (P = .02 and P = .33, respectively). When the groups were pooled, emotional and social functioning domain scores (P < .03), dyspnea and sleeping (P < .04), and median quality of life improved (P = .02) 4 weeks after home parenteral nutrition. CONCLUSION Both groups seem to benefit from home parenteral nutrition without harmful side effects. If the indication is determined early, the patients' disease course could perhaps be improved.
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Affiliation(s)
- Jutta Girke
- Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Claudia Seipt
- Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Andrea Markowski
- Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Birgit Luettig
- Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Anika Schettler
- Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Michael Momma
- Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Andrea S Schneider
- Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany
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16
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Naghibi M, Smith T, Elia M. A systematic review with meta-analysis of survival, quality of life and cost-effectiveness of home parenteral nutrition in patients with inoperable malignant bowel obstruction. Clin Nutr 2015; 34:825-37. [DOI: 10.1016/j.clnu.2014.09.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 08/25/2014] [Accepted: 09/16/2014] [Indexed: 11/25/2022]
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17
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Mercadante S, Caruselli A, Villari P, Girelli D, Prestia G, Giarratano A. Frequency and Indications of Parenteral Nutrition in an Acute Palliative Care Unit. Nutr Cancer 2015. [DOI: 10.1080/01635581.2015.1055368] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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18
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Cachexia: a preventable comorbidity of cancer. A T.A.R.G.E.T. approach. Crit Rev Oncol Hematol 2014; 94:251-9. [PMID: 25468676 DOI: 10.1016/j.critrevonc.2014.10.014] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 09/17/2014] [Accepted: 10/28/2014] [Indexed: 12/31/2022] Open
Abstract
Although relevant achievements in the treatment of cancer have been obtained, some barriers still remain in the prevention and treatments of cancer comorbidities, including cachexia. Indeed, the enormous advances in the understanding of the pathogenesis of cancer cachexia have not been paralleled by effective strategies aimed at modifying the cultural approach to this devastating condition. Too little attention is still paid to the nutritional and metabolic changes occurring in cancer, despite their negative effects on patients' tolerance to antineoplastic treatments and outcome. We propose a T.A.R.G.E.T. approach as a novel strategy, encompassing active interventions and research development within the different domains influencing the onset and the progression of cancer cachexia. Moreover, based on the most recent clinical evidences, we suggest that cachexia should be considered a comorbidity of cancer.
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19
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Drissi M, Cwieluch O, Lechner P, Radziwill R, Vehling-Kaiser U, Hengst K, Masin M. Nutrition care in patients with cancer: A retrospective multicenter analysis of current practice - Indications for further studies? Clin Nutr 2014; 34:207-11. [PMID: 24679553 DOI: 10.1016/j.clnu.2014.03.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 02/26/2014] [Accepted: 03/01/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND & AIMS Weight loss and malnutrition are frequent problems in oncology patients. The aim of this study was to get a perspective of the current practice of parenteral nutrition (PN) care in an outpatient setting and to improve patient-centered nutritional care. METHODS Fifty-three outpatient oncology centers participated in this observational study performed between July 2010 and March 2011. All participating centers entered data online into a web-based documentation form, containing a number of oncology patients, diagnoses, and detailed data about oncology patients receiving PN. RESULTS Two cohorts were analyzed. First cohort consisted of all oncology patients in quarter 04/2010. Second cohort consisted of patients with PN during the whole studying period. In the first cohort 2.46% (n = 626) of 25,424 oncology patients received PN. Most frequent diagnoses of patients receiving PN were gastric cancer (n = 119) and colorectal cancer (n = 104), however most stated diagnosis was "other" (n = 163). In the second cohort (n = 1137), a common indication for PN was impaired gastrointestinal passage (n = 177), although here again most stated reason was "other" (n = 924). In the course of the PN treatment, patients (n = 1137) showed a stable or slowly increasing body mass index (from 21.6 ± 3.8 kg/m(2) to 21.8 ± 3.5 kg/m(2)). CONCLUSION This is the largest study outlining the characteristics of oncology patients in the context of PN in German ambulatory centers. They confirm the important role of PN in the care of gastrointestinal cancer. Further studies have to be performed to identify if other indications than those mentioned in relevant guidelines can trigger initiation of PN.
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Affiliation(s)
- M Drissi
- University Hospital of Münster, Department B/Clinical Nutrition, Westfälische Wilhelms-University, Münster D-48149, Germany.
| | - O Cwieluch
- University Hospital of Münster, Department B/Clinical Nutrition, Westfälische Wilhelms-University, Münster D-48149, Germany.
| | - P Lechner
- Klinikum Fulda, Department of Pharmacy and Patients Consulting Center, Fulda D-36043, Germany
| | - R Radziwill
- Klinikum Fulda, Department of Pharmacy and Patients Consulting Center, Fulda D-36043, Germany
| | - U Vehling-Kaiser
- Outpatient Clinic Landshut, Department of Hematology, Oncology and Palliative Care, Landshut D-84028, Germany
| | - K Hengst
- University Hospital of Münster, Department B/Clinical Nutrition, Westfälische Wilhelms-University, Münster D-48149, Germany
| | - M Masin
- University Hospital of Münster, Department B/Clinical Nutrition, Westfälische Wilhelms-University, Münster D-48149, Germany
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