Effects of artificial nutrition and hydration on survival in patients with head and neck cancer and esophageal cancer admitted to palliative care units

Abstract

Background: The benefits of artificial nutrition and hydration in patients with head and neck cancer and esophageal cancer in the late stage remain unknown. We performed a secondary analysis of a cohort study to investigate the effects of enteral tube feeding (ETF) and parenteral nutrition and hydration (PNH) on survival in this population. Methods: Patients with head and neck cancer and esophageal cancer admitted to palliative care units were included. Information on primary nutritional administration routes during the first week of admission and data on the averaged calorie sufficiency rate/total calorie intake, e.g., 75%/750 kcal/day and <25%/<250 kcal/day, were obtained. Patients were divided into oral intake-, ETF-, and PNH-groups. We performed time-to-event analyses using the Kaplan-Meier method, Log-rank test, and univariate and multivariate Cox regression analyses. Results: There were 33 patients in the oral intake-group, 25 in the ETF-group, and 44 in the PNH-group. A significant difference was observed in survival rates between these groups (Log-rank P ¼ 0.002), and median survival times were 54.0 (95% CI 33e75), 26.0 (95% CI 13e39), and 18.0 (95% CI 14e22) days, respectively. In the multivariate-adjusted model, the oral intake-group had a significantly lower risk of mortality than the PNH-group [HR 0.46 (95% CI 0.28e0.76), P ¼ 0.002], while the ETF-group had a markedly lower risk of mortality than the PNH-group [HR 0.60 (95% CI 0.34e1.06), P ¼ 0.077]. Conclusions: These results indicate the potentially beneficial effects of ETF for patients with head and neck cancer and esophageal cancer in palliative care.