The Role of Nutritional Support for Cancer Patients in Palliative Care

Cotogni, Paolo; Stragliotto, Silvia; Ossola, Marta; Collo, Alessandro; Riso, Sergio

doi:10.3390/nu13020306

Cited by 44 publications

(37 citation statements)

References 88 publications

(36 reference statements)

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“…In patients undergoing palliative treatment, covering and determining their nutritional needs should be of greater importance [ 58 ]. The provided nutritional support has to be tailored to the patients’ needs, enhancing patients comfort and QoL [ 59 , 60 ]. Palliative treatment should be initiated alongside standard medical care for cancer patients with dismal prognosis [ 61 ].…”

Section: Resultsmentioning

confidence: 99%

Clinical nutrition as part of the treatment pathway of pancreatic cancer patients: an expert consensus

et al. 2021

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Purpose Malnutrition is a common problem among pancreatic cancer (PC) patients that negatively impacts on their quality of life (QoL) and clinical outcomes. The main objective of this consensus is to address the role of Medical Nutrition Therapy (MNT) into the comprehensive therapeutic management of PC patients. Methods A Spanish multidisciplinary group of specialists from the areas of Medical Oncology; Radiation Oncology; Endocrinology and Nutrition; and General Surgery agreed to assess the role of MNT as part of the best therapeutic management of PC patients. Results The panel established different recommendations focused on nutritional screening and nutritional screening tools, MNT strategies according to PC status, and MNT in palliative treatment. Conclusions There is an unmet need to integrate nutritional therapy as a crucial part of the multimodal care process in PC patients. Health authorities, health care professionals, cancer patients, and their families should be aware of the relevance of nutritional status and MNT on clinical outcomes and QoL of PC patients.

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Section: Resultsmentioning

confidence: 99%

Clinical nutrition as part of the treatment pathway of pancreatic cancer patients: an expert consensus

et al. 2021

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“…Malnutrition leads to increased comorbidities and decreased performance status and quality of life [ 10 ]. Therefore, nutritional support should be integrated into palliative care, and its implications with respect to quality of life and life expectancy should be assessed [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…If the patient takes less than 50% of their nutritional requirements and there are no contraindications or bronchoaspiration risks, and their life expectancy is less than 6 weeks [ 10 ], Enteral Nutrition (EN) must be prescribed through a nasogastric (NG) tube [ 11 ]. This is a widely used and easily accessible technique, although in the case of patients with advanced dementia who receive PC, evidence supporting the use of NG tube is limited, and this technique may have a negative impact on the quality of life of these patients [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Enteral Nutrition by Nasogastric Tube in Adult Patients under Palliative Care: A Systematic Review

Sánchez-Sánchez

Ruano-Álvarez²,

Díaz-Jiménez

et al. 2021

Nutrients

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Nutritional management of patients under palliative care can lead to ethical issues, especially when Enteral Nutrition (EN) is prescribed by nasogastric tube (NGT). The aim of this review is to know the current status in the management of EN by NG tube in patients under palliative care, and its effect in their wellbeing and quality of life. The following databases were used: PubMed, Web of Science (WOS), Scopus, Scielo, Embase and Medline. After inclusion and exclusion criteria were applied, as well as different qualities screening, a total of three entries were used, published between 2015 and 2020. In total, 403 articles were identified initially, from which three were selected for this review. The use of NGT caused fewer diarrhea episodes and more restrictions than the group that did not use NG tubes. Furthermore, the use of tubes increased attendances to the emergency department, although there was no contrast between NGT and PEG devices. No statistical difference was found between use of tubes (NGT and PEG) or no use, with respect to the treatment of symptoms, level of comfort, and satisfaction at the end of life. Nevertheless, it improved hospital survival compared with other procedures, and differences were found in hospital stays in relation to the use of other probes or devices. Finally, there are not enough quality studies to provide evidence on improving the health status and quality of life of the use of EN through NGT in patients receiving palliative care. For this reason, decision making in this field must be carried out individually, weighing the benefits and damages that they can cause in the quality of life of the patients.

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“…Proximal and bulky tumors also do not allow gastrojejunostomy to be performed to restore gastrointestinal continuity. Thus, in these cases, jejunostomy or nasoenteric tube are often indicated as a palliative measure to allow maintenance of nutritional enteral support[ 16 ]. Once the nutritional emergency is solved, patients may receive palliative CMT and resume oral intake in cases with good response.…”

Section: Discussionmentioning

confidence: 99%

Jejunostomy in the palliative treatment of gastric cancer: A clinical prognostic score

Ramos¹,

Pereira²,

Dias³

et al. 2021

WJCO

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BACKGROUND Clinical stage IV gastric cancer (GC) may need palliative procedures in the presence of symptoms such as obstruction. When palliative resection is not possible, jejunostomy is one of the options. However, the limited survival of these patients raises doubts about who benefits from this procedure. AIM To create a prognostic score based on clinical variables for 90-d mortality for GC patients after palliative jejunostomy. METHODS We performed a retrospective analysis of Stage IV GC who underwent jejunostomy. Eleven preoperative clinical variables were selected to define the score categories, with 90-d mortality as the main outcome. After randomization, patients were divided equally into two groups: Development (J1) and validation (J2). The following variables were used: Age, sex, body mass index (BMI), American Society of Anesthesiologists classification (ASA), Charlson Comorbidity index (CCI), hemoglobin levels, albumin levels, neutrophil-lymphocyte ratio (NLR), tumor size, presence of ascites by computed tomography (CT), and the number of disease sites. The score performance metric was determined by the area under the receiver operating characteristic (ROC) curve (AUC) to define low and high-risk groups. RESULTS Of the 363 patients with clinical stage IVCG, 80 (22%) patients underwent jejunostomy. Patients were predominantly male (62.5%) with a mean age of 62.4 years old. After randomization, the binary logistic regression analysis was performed and points were assigned to the clinical variables to build the score. The high NLR had the highest value. The ROC curve derived from these pooled parameters had an AUC of 0.712 (95%CI: 0.537–0.887, P = 0.022) to define risk groups. In the validation cohort, the diagnostic accuracy for 90-d mortality based on the score had an AUC of 0.756, (95%CI: 0.598–0.915, P = 0.006). According to the cutoff, in the validation cohort BMI less than 18.5 kg/m 2 ( P < 0.001), CCI ≥ 1 ( P = 0.001), ASA III/IV ( P = 0.002), high NLR ( P = 0.012), and the presence of ascites on CT exam ( P = 0.004) were significantly associated with the high-risk group. The risk groups showed a significant association with first-line ( P = 0.012), second-line chemotherapy ( P = 0.009), 30-d ( P = 0.013), and 90-d mortality ( P < 0.001). CONCLUSION The scoring system developed with 11 variables related to patient’s performance status and medical condition was able to distinguish patients undergoing jejunostomy with high risk of 90 d mortality.

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The Role of Nutritional Support for Cancer Patients in Palliative Care

Cited by 44 publications

References 88 publications

Clinical nutrition as part of the treatment pathway of pancreatic cancer patients: an expert consensus

Clinical nutrition as part of the treatment pathway of pancreatic cancer patients: an expert consensus

Enteral Nutrition by Nasogastric Tube in Adult Patients under Palliative Care: A Systematic Review

Jejunostomy in the palliative treatment of gastric cancer: A clinical prognostic score

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