Proactive enteral tube feeding in pediatric patients undergoing chemotherapy

Abstract

Background To determine feasibility and safety of proactive enteral tube feeding (ETF) in pediatric oncology patients. Methods Pediatric patients with newly diagnosed brain tumors, myeloid leukemia or high‐risk solid tumors were eligible. Subjects agreeing to start ETF before cycle 2 chemotherapy were considered proactive participants (PPs). Those who declined could enroll as chart collection receiving nutritional standard of care. Nutritional status was assessed using standard anthropometric measurements. Episodes of infection and toxicity related to ETF were documented from diagnosis to end of therapy. A descriptive comparison between PPs and controls was conducted. Results One hundred four eligible patients were identified; 69 enrolled (20 PPs and 49 controls). At diagnosis, 17% of all subjects were underweight and 26% overweight. Barriers to enrollment included physician, subject and/or family refusal, and inability to initiate ETF prior to cycle 2 of chemotherapy. Toxicity of ETF was minimal, but higher percentage of subjects in the proactive group had episodes of infection than controls. Thirty‐nine percent of controls eventually started ETF and were twice as likely to receive parenteral nutrition. PPs experienced less weight loss at ETF initiation than controls receiving ETF and were the only group to demonstrate improved nutritional status at end of study. Conclusions Proactive ETF is feasible in children with cancer and results in improved nutritional status at end of therapy. Episodes of infection in this study are concerning; therefore, a larger randomized trial is required to further delineate infectious risks and toxicities that may be mitigated by improved nutritional status. Pediatr Blood Cancer 2014;61:281–285. © 2013 Wiley Periodicals, Inc.

Surgical Feeding Tubes in Pediatric and Adolescent Cancer Patients: A Single-institution Retrospective Review

“…Similar to prior studies evaluating enteral nutrition in pediatric cancer patients, cancer type was categorized as leukemia, primary central nervous system (CNS) tumors, and non-CNS solid tumors. 11,14,18 Patient records were also reviewed for the type of surgical technique performed. Procedures were categorized as open gastrostomy tube (Stamm gastrostomy), laparoscopic gastrostomy tube, percutaneous endoscopic gastrostomy (PEG) tube, interventional radiology placed gastrostomy tube, open jejunostomy tube, laparoscopic jejunostomy tube, separate open gastrostomy and jejunostomy tubes, and open gastro-jejunal feeding tube.…”

“…10 Because of the harmful effects of undernourishment among pediatric cancer patients, including increased mortality and higher risk of recurrence, additional nutritional support is often needed. 5,6,11 …”

“…14,15 Infections and toxicity from enteral feeding are also of concern. 11,16 Although major postoperative complications are uncommon, the combined rate of major and minor complications has been shown to exceed 70%. 16,17 …”

Parent, patient and health professional perspectives regarding enteral nutrition in paediatric oncology

“…This method uses a tube inserted directly into the stomach, or jejunum, either surgically or endoscopically. Evidence shows that ETF promotes weight gain in paediatric oncology patients, especially when used prophylactically …”

Nutrition in Pediatric Oncology Patients: A Systematic Review

“…Çalışma kapsamına alınan sekiz çalışmanın sonuçları açık bir şekilde belirtilmiş, bir çalışmanın sonucu ise belirtilmemiştir (32) (Tablo II). Ayrıca, çalışma kapsamına alınan çalışmalarda yüksek protein ve enerji içeren ürünlerin kilo kaybında azalma sağladığı, proaktif beslenme tüpü ve gastrostomi tüpünün kanserli çocuklarda kullanımının uygun olduğu, beslenme ürünü olarak glutaminin ve megestrol asetatın kanserli çocuklarda kullanımın uygun olduğu ve parenteral beslenmenin enteral beslenmeden daha etkili olduğu belirlenmiştir (20)(21)(22)(24)(25)(26).…”