Impact of supplemental home enteral feeding postesophagectomy on nutrition, body composition, quality of life, and patient satisfaction

Abstract

The aim of this prospective cohort study is to analyze the impact of supplemental home enteral nutrition (HEN) post-esophageal cancer surgery on nutritional parameters, quality of life (QL), and patient satisfaction. A systematic review reported that over 60% of patients lose >10% of both body weight and BMI by 6 months after esophagectomy. Enteral feeding (EF) is increasingly a modern standard postoperatively; however, the impact of extended HEN postdischarge has not been systematically studied. One hundred forty-nine consecutive patients [mean age 62 ± 9, 80% male,76% adenocarcinoma, 66% on multimodal protocols, and 69% with BMI ≥ 25 kg/m2] were studied. Jejunal EF commenced day 1 postoperatively, and supplemental overnight HEN (764 kcal; 32g protein) continued on discharge for a planned further 4 weeks. Weight, BMI, and body composition analysis (bioimpedance analysis) were measured at baseline, preoperatively and at 1, 3, and 6 months, along with the EORTC QLQ-C30/OES18 QL measures. A patient satisfaction questionnaire addressed eight key items in relation to HEN (max score 100/item). Median (range) total duration of EF was 49 days (28-96). Overall compliance was 96%. At 6 months, compared with preoperatively, 58 (39%) patients lost >10% weight, with median (IQR) loss of 6.8 (4-9) kg, and 62 (41%) patients lost >10% BMI. Lean body mass and body fat were significantly (p < 0.001) decreased. Mean global QL decreased (p < 0.01) from 82 to 72. A high mean satisfaction score (>70 ± 11/100) was reported, >80 for practical training, activities of daily living, pain, anxiety, recovery and impact on caregivers, with lower scores for appetite (33 ± 24) and sleep (63 ± 30). Supplemental HEN for a minimum of one month postdischarge is associated with high compliance and patient satisfaction. Weight and BMI loss may still be substantial, however this may be less than published literature, in addition the impact on HR-QL may be attenuated. HEN has both subjective and objective rationale and merits further validation toward optimizing nutritional recovery and overall wellbeing.

The Effect of Enteral Tube Feeding on Patients’ Health-Related Quality of Life: A Systematic Review

“…Gastrostomies resulted in improved QoL compared to standard care in the majority of studies across a variety of patient conditions over a 6–12 month post gastrostomy timeframe [27,30,33], although in the other studies [31,32], there was either no significant change or a decrease in QoL over 3–34 months post gastrostomy tube placement. Similarly, in the majority of studies, enteral tube feeding /HEN showed a positive effect on QoL in a range of patient conditions, over a 3 week–25 month timeframe [35,37,38,39,40], while in the other studies [34,36], enteral tube feeding /HEN showed a reduction in QoL over a 4 to 6 month period.…”

“…Furthermore, Ireland, Australia, Iran, Germany and New Zealand each had one study (Table 2). These studies were a mix of randomized controlled trials [26,33], prospective cohort studies [27,31,34,37], non-randomized studies [39,40], cross-sectional studies [30,32,38], retrospective review [29], cross-sectional and longitudinal studies [36] and uncontrolled clinical pilot study [35].…”

“…Seven studies [34,35,36,37,38,39,40] assessed the effect of enteral tube feeding on QoL. Based on the QLQ-C30 and QLQ-OES19 tools, Donohue et al [34] found that weight loss and negative consequences on QoL occurred in most post-esophageal cancer surgery patients, despite supplemental HEN for further 4 weeks. These findings were similar to that of Loeser et al [36] who noted that QoL is reduced in patients on home enteral tube feeding (HETF), although HETF can prevent further weight loss and improve some aspects of QoL within 4 months.…”

“…Evaluation of the selected studies on the impact of enteral tube feeding on QoL resulted in the emergence of 3 distinct areas (the effect of early versus late enteral tube feeding; the QoL of patients on gastrostomy versus standard care, and the effect of enteral tube feeding on QoL) with different outcomes observed in each area. Overall, nine [27,29,30,33,35,37,38,39,40] of the 14 studies included showed improvement in the QoL of patients on enteral tube feeding, while the remaining five studies [26,31,32,34,36] demonstrated either no significant difference or reductions in QoL (Table 2). Gastrostomies resulted in improved QoL compared to standard care in the majority of studies across a variety of patient conditions over a 6–12 month post gastrostomy timeframe [27,30,33], although in the other studies [31,32], there was either no significant change or a decrease in QoL over 3–34 months post gastrostomy tube placement.…”

Feasibility of Home Jejunal Feeding Following Discharge after Major Gastrointestinal Surgery—A Randomised Controlled Trial

“…Currently there is limited literature looking at the feasibility of home JF in upper gastrointestinal surgical patients. Some studies have found improvements in nutrient status, quality of life and reduced weight loss with the use of home JF compared to oral diet [15] [16] [17], while others have not [18] [19]. Although complications of JF have been reported in previous research [11] [20] [21], qualitative studies have reported positive feelings towards home JF [22] although there are consequences, such as disturbed sleeping pattern and stoma site-related problems.…”