Enteral Access Potentially Endangers Esophageal Carcinoma Patients Under Multi-modality Therapy: A Population-based Study

Abstract

Background/Aim: This study aimed to evaluate the clinical outcome of esophageal cancer (EC) patients with enteral access (EA) undergoing multimodality therapy. Patients and Methods: This retrospective study analyzed data between 1997 and 2012 in Taiwan using the National Health Insurance Research Database. Patients with newly-diagnosed EC undergoing multimodality therapy were identified and classified as either EA group or no-EA group. Results: The mortality incidence of EC patients with EA was significantly higher than in no-EA patients. The Cox model revealed the EA group had a higher risk of mortality than the no-EA group. Patients with chronic obstructive pulmonary disease (COPD) were at significantly higher risk of mortality compared to patients without COPD. Conclusion: EA in EC patients undergoing multimodality therapy was associated with an increased risk of mortality.Esophageal cancer (EC) is one of the deadliest diseases and is associated with high rates of recurrence and metastasis (1). In Taiwan, it ranked as the ninth most common type of cancer, where squamous cell carcinoma (SCC) accounts for more than 90% of cases (2). After aggressive treatment in EC patients, the 5-year survival rate is rarely higher than 30% (3) and also has the highest risk of malnutrition among different cancer types due to dysphagia (4). Adverse effects and complications of multi-modality therapy can cause or worsen malnutrition in EC patients. As such, many patients are referred for surgically placed feeding tubes or routine enteral access (EA) placement to prevent weight loss and thus reduce the disruption of treatment (5-7).Research investigating the efficacy of EA in patients with EC has produced inconsistent results (8-13). Despite studies suggesting neoadjuvant therapy has the potential to reduce dysphagia symptoms; the treatment-related adverse events of esophagectomy outcomes were similar for EC patients regardless of . Presently, there is no clinical evidence to infer an association between the use of EA prior to multi-modality therapy and mortality. This populationbased retrospective cohort study was conducted to evaluate the efficacy of EA in EC patients treated with multi-modality treatment and its association with mortality. Materials and MethodsData sources. Patient data were accessed from The Registry for Catastrophic Illness Patient Database, a subsection of the Taiwanese National Health Insurance Research Database (NHIRD). The NHIRD contains all medical information from the NHI program including (i) outpatient data, (ii) inpatient data, (iii) disease profiles, (iv) drugs prescribed, and (v) intervention procedures. The diagnosis codes are based on the 9th revision of the International Classification of Diseases (ICD-9-CM). To ensure privacy, the individuals' identification is encrypted within the NHI database. This study received approval from the Hualien Tzu Chi Hospital Review Board .Study cohort and patient selection. Inclusion criteria consisted of patients who were newly diagnosed with EC (ICD-9 150.1-15...

Enteral Vs Oral Nutrition in non-interrupted compliance with chemoradiotherapy in subjects with esophageal cancer

“…A retrospective cohort study in patients with EC, under multimodal therapy in conjunction with EN, concluded that there is a potential increase in the risk of mortality with this type of nutrition 9 . Regarding the quality of life of patients undergoing chemoradiotherapy in relation to EN, Yu et al, 10 compared NGT, esophageal stent and ostomies with feeding tubes, concluding that there is slightly worse quality of life in patients with esophageal squamous cell carcinoma using NGT, compared with the percutaneous route during chemoradiotherapy.…”