The use of nutrition support near the end of life for hospitalized patients with advanced cancer at a reference center: Two realities

Wiegert, Emanuelly Varea Maria; Rosa, Karla Santos da Costa; Santos, Rhayara Thacilla Ferreira Dos; Santos, Daiane Almeida dos; Freitas, Renata de; Oliveira, Lívia Costa de

doi:10.1002/ncp.10737

Cited by 9 publications

(4 citation statements)

References 35 publications

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“…In such cases, individual patient assessment and multiprofessional discussion are recommended to ensure conduct that benefits the patient’s life and does not cause harm. Wiegert et al 67 compared the use of nutritional interventions in patients with incurable cancer in palliative care and in non-palliative care and observed that the prevalence of EN and PN was similar in both settings, but that their use decreased significantly with the approach of death in palliative care.…”

Section: Discussionmentioning

confidence: 99%

Effects of specialised nutritional interventions in patients with incurable cancer: a systematic review

Oliveira

Calixto-Lima

Cunha

et al. 2022

BMJ Support Palliat Care

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ObjectiveTo evaluate current evidence of the effect of specialised nutritional interventions on nutritional status, survival, quality of life and measures of functionality in patients with incurable cancer.MethodsSystematic literature review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using PubMed/MEDLINE, EMBASE, Scopus, LILACS and Cochrane Library databases. Clinical studies that evaluated different specialised nutritional interventions, such as nutritional counselling, oral nutritional supplementation (ONS), enteral nutrition (EN) and parenteral nutrition (PN), were eligible. Only studies classified as being of high methodological quality (ie, low or moderate risk of bias) were included.ResultsA total of 22 studies reporting on 2448 patients were deemed eligible. Five types of specialised nutrition were observed: mixed (multimodal nature, ie, dietary counseling, ONS, physical activity and/or drugs) (n=12), ONS (n=5), PN (n=3), EN (n=1) and multidisciplinary team counselling (n=1). Benefits of any kind from the interventions were reported in 14 (63.6%) studies, mainly resulting from mixed intervention. Nutritional status improved in 12 (60.0%) of 20 studies and quality of life improved in eight (50.0%) of 16 studies. Few studies have evaluated the influence of nutritional interventions on survival and measure of functionality, and have not shown improvement in these outcomes.ConclusionDespite the limited evidence, specialised nutritional interventions can yield positive effects for patients with incurable cancer, mainly in their nutritional status and quality of life.

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Section: Discussionmentioning

confidence: 99%

Effects of specialised nutritional interventions in patients with incurable cancer: a systematic review

Oliveira

Calixto-Lima

Cunha

et al. 2022

BMJ Support Palliat Care

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“…Furthermore, the primary research paper reported that when comparing the PNH group to the total 1453 patient group, those who received hydration only was 24.8% (n ¼ 360), and those parenteral nutrition 9.6% (n ¼ 139) [5]. An observational retrospective cohort study conducted in Brazil showed that the frequency of use of oral nutrition supplements, ETF, and parenteral nutrition in the last 30 days of life was lower in palliative than in non-palliative care settings [16]. These findings suggest that palliative care physicians withhold/withdraw parenteral nutrition and also that many palliative care units do not have the expertise to provide parenteral nutrition as readily as parenteral hydration.…”

Section: Discussionmentioning

confidence: 99%

The prevalence of artificially administered nutrition and hydration in different age groups among patients with advanced cancer admitted to palliative care units

Amano

Satomi²,

Oyamada

et al. 2021

Clinical Nutrition Open Science

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Background & Aims: The prevalence of artificially administered nutrition and hydration (AANH) in different age groups among patients with advanced cancer remains unknown. The present study investigated the current utilization of AANH according to age groups in palliative care units. Methods: This was a secondary analysis of a prospective cohort study. We obtained information on primary nutritional administration routes during the first week of admission and data on the averaged calorie sufficiency rate or total calorie intake on the 7th day of admission. Patients were divided into five age groups ( 18e39, 40e59, 60e74, 75e89, and 90-years). Among patients receiving AANH, the proportions of higher-calorie AANH were compared between the five age groups. Results: A total of 1453 patients were included. The proportion of patients categorized as receiving nutrition and hydration via the parenteral route was the highest in the 18e39 and 40e59 groups (52.4 and 41.1%, respectively). Among patients receiving AANH (n ¼ 534), the proportions of patients categorized into the <25% or <250 kcal/day group were 57.9% in all groups, 18.2% in the 18e39 group, and 50.0e66.4% in the other groups. The proportions of 50% or 500 kcal/day and 25% or 250 kcal/day in each age group significantly decreased with age (p ¼ 0.003 and 0.002, respectively). Conclusion:The present results revealed large variations in the use of AANH in different age groups and indicate that AANH was more frequently utilized in younger age groups in palliative care units.

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“…The findings obtained also indicated the superiority of enteral nutrition (oral intake and ETF) over PNH; however, only 7.0% of all patients had head and neck cancer or esophageal cancer [17]. An observational retrospective cohort study using data from the last 30 days of life of patients with advanced cancer in Brazil reported that the use of ANH was associated with head and neck cancer in a non-palliative care hospital and palliative care unit [18].…”

Section: Introductionmentioning

confidence: 88%

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

Yokota¹,

Hui²,

Oyamada

et al. 2022

Clinical Nutrition Open Science

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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.

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The use of nutrition support near the end of life for hospitalized patients with advanced cancer at a reference center: Two realities

Cited by 9 publications

References 35 publications

Effects of specialised nutritional interventions in patients with incurable cancer: a systematic review

Effects of specialised nutritional interventions in patients with incurable cancer: a systematic review

The prevalence of artificially administered nutrition and hydration in different age groups among patients with advanced cancer admitted to palliative care units

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

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