Indicadores de qualidade da terapia nutricional enteral são ferramentas úteis para o monitoramento em pacientes com câncer avançado em cuidados paliativos?

Abstract

Introduction: Enteral nutritional therapy (ENT) in patients with advanced cancer in palliative care should be directed towards a better quality of life, being important its monitoring so that the patient has access to the best that the therapy can offer. The objective of this study was to apply the quality indicators of ENT in patients with advanced cancer in palliative care. Methods: Descriptive, observational study with a quantitative approach. Seven ENT quality indicators proposed by the International Life Sciences Institute in Brazil were applied and the reasons for the suspension or interruption of the enteral diet during hospitalization were quantified. Results: 51 patients admitted from May to November 2019 participated in the study. The frequencies of inadvertent exit of enteral nutrition tube (0.02%), the days of adequate administration of the prescribed volume versus infused volume (92.6%) and diarrhea (2%) are within the goal used. The administration of protein (25.5%) and energy (57.4%), the frequency of episodes of abdominal distension (33.3%) and constipation (86.3%) were inadequate. The diet was interrupted or suspended mainly due to the occurrence of vomiting, end-of-life care or tube obstruction. Conclusion: The use of quality indicators of nutritional therapy proved to be viable in this group of patients. Some inadequacies found in this population may be associated with the change in the objective of nutritional therapy in patients with shorter life expectancy. Adaptations based on the prognosis may be necessary, in addition to the application of new indicators, or adjustments to the proposed goals.

Quality indicator in nutritional therapy in oncology and the interface with nursing: integrative review

“…For nursing, summarizing the information of the investigated IQNT becomes essential in the sense of strategically directing care to the need for the nutrition of the oncological patient to optimize treatment and ensure better quality of life. 30 The review identified that the authors' profile was composed mostly of nutritionists, [21][22][23][25][26][27][28] although nursing is responsible for monitoring the indicator under analysis. 13 In Brazil, specific legislation 31 standardizes the performance of the nursing team in the oro/nasogastric and transpyloric probing and highlights the crucial role of the nurse in the process of installing the device, choosing the route of administration together with the doctor, in addition to registration, patient evaluation and monitoring of complications.…”

“…37,38 In addition, cancer is one of the main underlying diseases of hospitalized adult patients in Brazil. 39 In analytical corpus in which the IQNT goal was not met [21][22][23][24][25][26]29 the most prevalent cancers were head and neck 21,26 , gastrointestinal tract 21,26 , gynecological 21,26 and urological. 21,29 In those who have reached the goal 23,27,28 the most identified cancers were head and neck 23 gastrointestinal tract 23,27 , breast 23,28 and lung.…”

“…39 In analytical corpus in which the IQNT goal was not met [21][22][23][24][25][26]29 the most prevalent cancers were head and neck 21,26 , gastrointestinal tract 21,26 , gynecological 21,26 and urological. 21,29 In those who have reached the goal 23,27,28 the most identified cancers were head and neck 23 gastrointestinal tract 23,27 , breast 23,28 and lung. 23,24 These findings corroborate with other Brazilian studies 40,41 which also identified the prevalence of these cancers in hospitalized patients.…”

“…21,29 In those who have reached the goal 23,27,28 the most identified cancers were head and neck 23 gastrointestinal tract 23,27 , breast 23,28 and lung. 23,24 These findings corroborate with other Brazilian studies 40,41 which also identified the prevalence of these cancers in hospitalized patients. This situation reflects the statistics and estimates of the oncological scenario in Brazil, which identifies breast and gastrointestinal cancers as the most prevalent in the Brazilian population.…”

“…42 The analysis also identified that most of the studies failed to achieve the goal of the investigated IQNT. [21][22][23][24][25][26]29 This reality allows us to reflect that, could it be the specific characteristics of the tumor and the treatment, as well as the nutritional repercussions triggered in cancer patients 37,38 that could condition the prognosis of the treatment and its repercussions? This review found that the nutritional supply for the cancer patient hospitalized by enteral route has not guaranteed the adequate/total infusion of the prescribed volume of EN, and therefore, this route is not the most appropriate for these patients, and the parenteral route may be more effective, given the clinical weakness of the cancer patient throughout his treatment.…”