Nutritional support and quality of life in cancer patients undergoing palliative care

Abstract

In palliative care, the nutrition provided has to be tailored to the patient's needs, enhancing patient comfort and quality of life (QoL). We conducted a literature search to review methods of measuring QoL, and modalities of nutritional intervention and their influence on QoL of cancer patients in palliative care. Original papers published in English were selected from PubMed database by using the search terms, palliative medicine, cancer, nutrition and quality of life. Specific tools that are particularly recommended to assess QoL in a palliative care setting are reviewed. The main goal in palliative care is to maintain oral nutrition by providing nutritional counselling. Enteral nutritional support showed inconsistent effects on survival and QoL. An evidence-base for parenteral nutrition is still lacking. Ethical considerations concerning provision of food and hydration in end-of-life care are discussed. Nutritional status should be assessed early and regularly during treatment using appropriate tools. In the particularly acute context of palliative care, optimal patient management requires adequate education and counselling to patients and families. Meaningful interactions between the patient, caregivers and medical team would also increase the chance of resolving nutrition-related issues and help to fulfil each patient's specific nutritional needs and thus improve the QoL.

Oral health conditions affect functional and social activities of terminally ill cancer patients

“…The dry oral environment caused by salivary hypofunction may increase the risk for developing oral conditions including candidiasis and dental caries and may contribute to oral functional complaints, such as dysphagia and chewing difficulty. Moreover, hyposalivation may be related to nutrition intake and hydration status in patients at their end of life [11, 27]. Orofacial pain assessment included self-report of facial pain, intraoral pain, mouth sores, and shooting or sharp extraoral/intraoral pains.…”

When Is Parenteral Nutrition Appropriate?

“…‐ 6 PN administration in patients with advanced cancer does not improve nutrition status, reverse cachexia, or improve survival 3 , 4 , 6 , 7 . Within the context of palliative care, the aim of nutrition care shifts away from maintaining or restoring nutrition status to maintaining or increasing comfort, by alleviating gastrointestinal symptoms, for example 6 , 8 . In addition to concerns regarding the lack of benefit, PN may also contribute to complications and other adverse events, such as central venous access device infection and hepatic dysfunction 7 , 9 …”

Decision making at the end of life—cancer patients’ and their caregivers’ views on artificial nutrition and hydration

“…The questionnaire for patients contained 10 items (patient questionnaire [PQ] 1-10). The 12 items of the version for relatives/friends (relative questionnaire [RQ] [1][2][3][4][5][6][7][8][9][10][11][12] include additional questions about the preference of relatives speaking on behalf of the patient (RQ 2) and about the relatives' satisfaction with previous ANH decisions they had been involved in (RQ 10). Both versions cover core domains of ANH decision making (questionnaires see Appendix).…”

“…Generally, there are inconsistent data about the benefit/ burden ratio of ANH at the end of life (EoL) [2,3]. While a recent randomized, placebo-controlled trial in the USA did not find any effect of artificial hydration (AH) on symptom control [4], a qualitative sub-study of this trial showed that AH was nevertheless valued by family caregivers and patients as improving comfort and "nourishing the body, mind, and spirit" [5].…”