1. Effects of enteral nutrition and parenteral nutrition on survival in patients with advanced cancer cachexia: Analysis of a multicenter prospective cohort study
- Author
-
Koji Amano, Isseki Maeda, Hiroto Ishiki, Tomofumi Miura, Yutaka Hatano, Hiroaki Tsukuura, Tomohiko Taniyama, Yoshihisa Matsumoto, Yosuke Matsuda, Hiroyuki Kohara, Tatsuya Morita, Masanori Mori, Satoshi Inoue, Naosuke Yokomichi, Kengo Imai, Toshihiro Yamauchi, Akemi Shirado Naito, Yu Uneno, Akira Yoshioka, Shuji Hiramoto, Ayako Kikuchi, Tetsuo Hori, Hiromi Funaki, Keiko Tanaka, Kozue Suzuki, Tina Kamei, Yukari Azuma, Teruaki Uno, Jiro Miyamoto, Hirofumi Katayama, Hideyuki Kashiwagi, Eri Matsumoto, Kiyofumi Oya, Takeya Yamaguchi, Tomonao Okamura, Hoshu Hashimoto, Shunsuke Kosugi, Nao Ikuta, Yaichiro Matsumoto, Takashi Ohmori, Takehiro Nakai, Takashi Ikee, Yuto Unoki, Kazuki Kitade, Shu Koito, Nanao Ishibashi, Masaya Ehara, Kosuke Kuwahara, Shohei Ueno, Shunsuke Nakashima, Yuta Ishiyama, Akihiro Sakashita, Ryo Matsunuma, Hana Takatsu, Takashi Yamaguchi, Satoko Ito, Toru Terabayashi, Jun Nakagawa, Tetsuya Yamagiwa, Akira Inoue, Takuhiro Yamaguchi, Mitsunori Miyashita, Saran Yoshida, Yusuke Hiratsuka, Keita Tagami, Hiroaki Watanabe, Takuya Odagiri, Tetsuya Ito, Masayuki Ikenaga, Keiji Shimizu, Akira Hayakawa, Rena Kamura, Takeru Okoshi, Tomohiro Nishi, Kazuhiro Kosugi, Yasuhiro Shibata, Takayuki Hisanaga, Takahiro Higashibata, Ritsuko Yabuki, Shingo Hagiwara, Miho Shimokawa, Satoshi Miyake, Junko Nozato, Tetsuji Iriyama, Keisuke Kaneishi, Mika Baba, Ayumi Okizaki, Yuki Sumazaki Watanabe, Yuko Uehara, Eriko Satomi, Kaoru Nishijima, Junichi Shimoinaba, Ryoichi Nakahori, Takeshi Hirohashi, Jun Hamano, Natsuki Kawashima, Takashi Kawaguchi, Megumi Uchida, Ko Sato, Yoichi Matsuda, Satoru Tsuneto, Sayaka Maeda, Yoshiyuki Kizawa, and Hiroyuki Otani
- Subjects
0301 basic medicine ,Male ,medicine.medical_specialty ,Parenteral Nutrition ,Palliative care ,Calorie ,Cachexia ,Nutritional Status ,030209 endocrinology & metabolism ,Critical Care and Intensive Care Medicine ,03 medical and health sciences ,0302 clinical medicine ,Enteral Nutrition ,Internal medicine ,Neoplasms ,medicine ,Humans ,In patient ,Prospective Studies ,Prospective cohort study ,Enteral Tube Feeding ,Aged ,Proportional Hazards Models ,Aged, 80 and over ,030109 nutrition & dietetics ,Nutrition and Dietetics ,business.industry ,Palliative Care ,Middle Aged ,medicine.disease ,Survival Rate ,Parenteral nutrition ,Treatment Outcome ,Female ,business ,Energy Intake ,Cohort study - Abstract
The benefits of artificial nutrition and hydration in patients with advanced cancer remain unknown. Therefore, we conducted a prospective study to evaluate effects of enteral nutrition (EN) and parenteral nutrition and hydration (PNH) on survival in palliative care units.This study involved a secondary analysis of a multicenter cohort study. Data of primary nutritional administration routes during the first week after admission (oral intake, enteral tube feeding, parenteral nutrition, parenteral hydration, poor oral intake) were obtained. Data of averaged calorie sufficiency rate/total calorie intake [high (75% ≤ or 750 kcal/day ≤), moderate (50-75% or 500-750 kcal/day), low (25-50% or 250-500 kcal/day), very low (25% or250 kcal/day)] were also obtained. After investigating the implementation of artificial nutrition and hydration, participants were divided into three groups according to the nutritional administration route and calorie sufficiency rate/total calorie intake: EN, PNH, and control. We conducted time-to-event analyses using the Kaplan-Meier method, log-rank test, and univariate and multivariate Cox regression analyses.Patients were divided into the EN group (n = 730), PNH group (n = 190), and control group (n = 533). Differences in survival rates among the three groups were significant (Log-rank P 0.001). Median survival times were 43.0 (95% CI 40-46), 33.0 (95% CI 29-37), and 15.0 (95% CI 14-16) days, respectively (P 0.001). In the multivariate-adjusted model, a significantly lower risk of mortality was observed in Cox's proportional hazard model in the EN group and PNH groups (HR 0.43 [95% CI 0.37-0.49], P 0.001; and HR 0.52 [95% CI 0.44-0.62], P 0.001, respectively) than in the control group.This study indicated the clinical benefits of EN and PNH for patients with advanced cancer. Nevertheless, managing symptoms to improve oral intake is essential before initiation of PNH, because EN was superior to PNH.
- Published
- 2020