Parenteral nutrition support for patients with pancreatic cancer. Results of a phase II study

Abstract

BackgroundCachexia is a common problem in patients (pts) suffering from upper gastrointestinal cancer. In addition, most of these patients suffer from malabsorption and stenosis of the gastrointestinal tract due to their illness. Various methods of supplementary nutrition (enteral, parenteral) are practised. In patients with advanced pancreatic cancer (APC), phase angle, determined by bio-electrical impedance analysis (BIA), seems to be a survival predictor. The positive influence of BIA determinate predictors by additional nutrition is currently under discussion.MethodsTo examine the impact of additional parenteral nutrition (APN) we assessed outpatients suffering from APC and progressive cachexia. The assessment based on the BIA method. Assessment parameters were phase angle, ECM/BCM index (ratio of extracellular mass to body cell mass), and BMI (body mass index). Patients suffering from progressive weight loss in spite of additional enteral nutritional support were eligible for the study.ResultsMedian treatment duration in 32 pts was 18 [8-35] weeks. Response evaluation showed a benefit in 27 pts (84%) in at least one parameter. 14 pts (43.7%) improved or stabilised in all three parameters. The median ECM/BCM index was 1.7 [1.11-3.14] at start of APN and improved down to 1.5 [1.12-3.36] during therapy. The median BMI increased from 19.7 [14.4-25.9] to 20.5 [15.4-25.0]. The median phase angle improved by 10% from 3.6 [2.3-5.1] to 3.9 [2.2-5.1].ConclusionsWe demonstrated the positive impact of APN on the assessed parameters, first of all the phase angle, and we observed at least a temporary benefit or stabilisation of the nutritional status in the majority of the investigated patients. Based on these findings we are currently investigating the impact of APN on survival in a larger patient cohort.Trial registrationClinicalTrials.gov Identifier: NCT00919659

Extracellular–to–Body Cell Mass Ratio and Subjective Global Assessment in Head-and-Neck Cancers

“…Bioelectrical impedance analysis (bia) has been established as a valuable tool in the evaluation of body composition and nutrition status in many conditions, including cancer [5][6][7][8][9] . Parameters of nutrition status (for example, weight change, mid-arm muscle circumference, triceps skin fold thickness) or laboratory measurements are unstable in cancer patients in the clinical setting 10 . Some serum parameters (for example, serum albumin, transferrin) are likely to be influenced by many non-nutrition factors 11 .…”

Aktuelle Standards in der Behandlung des Pankreaskarzinoms

“…Symptomorientierte Therapie | Gleichrangig ne ben der tumorspezifischen Behandlung sollte von Diagnose an die symptomorientierte Therapie stehen, um Schmerz und Kachexie frühzeitig zu behandeln, einen fortschreitenden Gewichtsver lust mit Verschlechterung des Allgemeinzustan des zu verhindern und krankheitsspezifische Komplikationen bereits präventiv zu therapieren [4,5]. Geeignete Maßnahmen, wie Sicherung des Galleabflusses und der Magen-Darm-Passage oder die medikamentöse Thromboemboliepro phylaxe, lassen Komplikationen wie Verschluss ikterus, Cholangitiden, Magenausgangs bzw.…”

The management of metastatic pancreatic cancer: expert discussion and recommendations from the 14th ESMO/World Congress on Gastrointestinal Cancer, Barcelona, 2012

“…There are no data on the impact of additional parenteral nutrition on survival of patients with metastatic pancreatic cancer [8,9].…”