Oral Nutritional Support Can Shorten the Duration of Parenteral Hydration in End-of-Life Cancer Patients: A Randomized Controlled Trial

Abstract

Tube feeding or hydration is often considered for end-of-life cancer patients despite the negative effects on quality of life. The efficacy of oral nutritional support in this setting is unknown. We conducted a randomized trial to compare the efficacies of an amino acid jelly, Inner Power® (IP), and a liquid enteral product, Ensure Liquid® (EL), in terminally ill cancer patients. We randomly assigned patients to 3 arms: EL, IP, and EL+IP. The primary endpoint was drip infusion in vein (DIV)-free survival, which was defined as the duration from nutritional support initiation to administration of parenteral hydration. Twenty-seven patients were enrolled in the study, of whom 21 were included in the intention-to-treat analysis. The median age of the subjects was 69 yr. There were significant differences between the arms with regard to the median DIV-free survival (0.5, 6.0, and 4.5 days in the EL, IP, and EL + IP arms, respectively; P = 0.05). The median overall survival was 7, 9, and 8 days in the EL, IP, and EL + IP arms, respectively. IP may shorten the duration of parenteral hydration in terminally ill cancer patients and does not affect their survival.

Efficacy and safety of an amino acid jelly containing coenzyme Q10 and l-carnitine in controlling fatigue in breast cancer patients receiving chemotherapy: a multi-institutional, randomized, exploratory trial (JORTC-CAM01)

“…However, no significant changes in anxiety or depression were observed. In our previous study, oral nutritional support with IP seemed to have a positive effect on QOL and survival in terminally ill cancer patients [38]. Cancer patients receiving chemotherapy experience physical exhaustion similar to terminally ill patients.…”

Atuação do nutricionista para melhora da qualidade de vida de pacientes oncológicos em cuidados paliativos

“…Aspectos psicossociais da alimentação não são abordados em ferramentas de triagens e, portanto, questões como experiências sobre a ingestão de alimentos, bem como as barreiras enfrentadas ao alimentar-se, além do papel da família, dos cuidadores e dos alimentos para o paciente devem ser incluídas na rotina 16 , a fim de ampliar a visão quanto aos cuidados do paciente. Dessa forma, o apoio nutricional e orientações dietéticas relacionadas à quantidade, consistência e frequência de ingestão devem ser realizadas para o paciente e sua família, de modo que os auxiliem a lidar com questões que tangem à alimentação e seus obstáculos neste período 25 , visando manter ou recuperar o bem-estar do indivíduo 28 . Assim, o nutricionista é um dos profissionais responsáveis por oferecer recursos e esclarecimentos sobre o tratamento ao paciente e seus familiares 9 .…”

“…quanto ao volume, nutrientes e calorias conforme sobrevida e sintomatologia do doente 28 . Para determinar os objetivos e a efetividade da TN, é imprescindível considerar aspectos clínicos e psicológicos, funcionalidade, expectativa de vida, estado nutricional, aceitação e ingestão alimentar, além da integridade do trato gastrointestinal (TGI) 13 .…”

The last days of life

“…A small randomized controlled trial found that some patients could ingest nutritional supplements even in the final days of life. [40]Active measures may be undertaken to treat any potential nutritional impact symptoms and/or complications (Figure 1), providing that they are consistent with the patients’ goals of care. For example, pain control should be optimized and oral care should be provided regularly.…”

“…A small randomized controlled trial found that some patients could ingest nutritional supplements even in the final days of life. [40]…”