Use of artificial nutrition near the end of life: Results from a French national population‐based study of hospitalized cancer patients

Abstract

Background:The use of artificial nutrition, defined as a medical treatment that allows a non-oral mechanical feeding, for cancer patients with limited life expectancy is deemed nonbeneficial. High-quality evidence about the use of artificial nutrition near the end of life is lacking. This study aimed (a) to quantify the use of artificial nutrition near the end-of-life, and (b) to identify the factors associated with the use of artificial nutrition. Methods: This was a retrospective cohort study of decedents based on data from the French national hospital database. The study population included adult cancer patients who died in hospitals in France between 2013 and 2016 and defined to be in a palliative condition. Use of artificial nutrition during the last 7 days before death was the primary endpoint. Results: A total of 398 822 patients were included. The median duration of the last hospital stay was 10 (interquartile range, 4-21) days. The artificial nutrition was used for 11 723 (2.9%) during the last 7 days before death. Being a man, younger, having digestive cancers, metastasis, comorbidities, malnutrition, absence of dementia, and palliative care use were the main factors associated to the use of artificial nutrition. Conclusion: This study indicates that the use of artificial nutrition near the end of life is in keeping with current clinical guidelines. The identification of factors associated with the use of artificial nutrition, such as cancer localization, presence of comorbidities or specific symptoms, may help to better manage its use. K E Y W O R D S artificial nutrition, cancer, end-of-life, health services research, registry database 5 | CONCLUSION This study indicates that the use of artificial nutrition near the end of life is rather low, which is in keeping with current clinical guidelines. The identification of factors associated with the use of artificial nutrition, such as cancer | 539 BAUMSTARCK eT Al.localization, presence of comorbidities or specific symptoms, may help to better manage its use, and may improve communication with patients, families, professionals, and health policy makers.

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

“…The use of EN and PN in the PCU in our study was similar to that reported by Kempf et al 20 . and higher than that found by Baumstarck et al 12 . Previous studies have also noted that health professionals from care homes and centers specialized in palliative care are more concerned with the implications generated by NS in the last weeks of life, being more conservative in its prescription 22,23 …”

Effectiveness of two types of palliative home care in cancer and non-cancer patients: A retrospective population-based study using claims data

“…It is already known that younger age and male gender are associated with higher rates of artificial nutrition. 33 However, even after adjustment for these parameters, patients within specialized palliative homecare showed a higher probability for parenteral nutrition. This possible overprovision within specialized palliative homecare should be analyzed in future studies.…”

The Clinical Value of Nutritional Care before and during Active Cancer Treatment

“…A randomized prospective trial showed that home parenteral nutrition may have advantages, prolonging survival and improving quality of life in malnourished patients receiving home-based palliative care [ 80 ]. Other reports, however, indicate that the use of artificial nutrition, defined as a medical treatment that allows a non-oral mechanical feeding, in the end of life care is limited to 3% of the patients [ 81 ]. Despite this remains an unresolved issue [ 82 , 83 ], a tailored approach to optimize resources in every single patient is highly desirable.…”