Survival of patients with advanced cancer in Enteral Nutritional Therapy: a comparison between caloric estimates

WANDERLEY, Brenda Domingues; SANTOS, Rosane de Souza; COSTA, Mariana Fernandes

doi:10.1590/1678-9865202235e210054

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Sumário

ORIGINAL • Rev Nutr 35 • 2022 • https://doi.org/10.1590/1678-9865202235e210054 copy

Survival of patients with advanced cancer in Enteral Nutritional Therapy: a comparison between caloric estimates

Sobrevida de pacientes com câncer avançado em Terapia Nutricional Enteral: um comparativo entre estimativas calóricas

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To assess factors related to the achievement of the caloric estimates of enteral nutritional therapy and the survival of patients with advanced cancer in exclusively palliative care.

Methods

Retrospective study, where patients using enteral nutrition admitted from March 2019 to February 2020 were divided into two groups: Group 1 included patients who reached 75% of the estimated caloric goals, and Group 2 included those who did not. The data were extracted from the patients’ electronic medical records. Logistic regression analyzes were performed to assess associations between the studied sociodemographic, clinical, and nutritional variables, and the Kaplan-Meier curve and Cox regression were used to assess the survival of the groups.

Results

A total of 158 patients participated in the study, with a median age of 63 (IIQ: 55-70) years. 57% reached the caloric goal (Group 1). In the logistic regression, the functional capacity (OR: 5.82; CI: 2.28-14.84; p<0.001) and symptoms of nausea or vomiting (OR: 0.050; CI: 0.005-0.455; p=0.008) were independent variables for achieving the caloric goal. Cox regression showed Karnofsky Performance Status as an independent predictor for survival (HR: 1.85; CI: 1.13-3.04).

Conclusion

Patients with better functionality have longer survival and are potential candidates for reaching the caloric goals proposed by national and international guidelines for cancer patients.

Keywords
Enteral nutrition; Neoplasms; Palliative care; Quality indicators; health care. Survival

Indicators	Formula	Goal	Results
Frequency of measurement or estimation of energy expenditure and protein need	Number of patients in ENT who had their energetic and protein expenditure evaluated X 100/Total patients in ENT	80%	58%
Frequency (in days) of adequate administration of the prescribed X infused volumes^* * Adapted formula. ENT: Enteral Nutrition Therapy.	Number of days with adequate ENT volume X 100/Total number of days in ENT	≥80%	89%
Frequency (in days) of inadequate administration of protein	Number of days with protein intake <100% of the prescription X 100/Total number of days in ENT	≤10%	84%
Frequency (in days) of inadequate administration of energy	Number of days with caloric intake below 25% of 25Kcal/kg or above 25% of 30Kcal/kg x 100/ Total number of days in ENT	<20%	45%
Frequency of episodes of abdominal distension	Number of patients in ENT who presented abdominal distension X 100/Total patients in ENT	<15%	8%

Variables		N	%	Median	IQR
Sex
	Male	116	73.4
	Female	42	26.6
Age				63	55-70
	<60 years	60	38
	≥60 years	98	62
Caloric goals
	Yes	90	57
	No	68	43
mGPS (n=101)
	0	46	45.5
	1 e 2	55	54.5
KPS				40	30-50
	≤30%	69	43.7
	40-50%	72	45.6
	≥60%	17	10.7
Tumoral location
	Head and neck	109	69
	Gastro-intestinal tract	20	12.7
	Neurologic	10	06.3
	Breasts	4	02.5
	Other	15	09.5
Reason for ENT
	Total dysphagia	92	58.2
	Partial dysphagia	50	31.6
	Gastric or bowel Obstruction	7	04.4
	Lowering of the level of consciousness	9	05.7
Administration
	Naso-entheric catheter	100	63.3
	Gastrostomy	57	36.1
	Jejunostomy	1	00.6
ENT Complications (n=96)
	Abdominal distension	13	13.5
	Tube obstruction	7	07.3
	Tube exit	8	08.3
	Nausea or vomit	13	13.5
	End-life care	55	57.3
ENT Characteristics
	Duration of ENT (days)			7	4-14
	Administered volume (mL/day)			833	667-959
	Administered protein (g/day)			45	38-59
	Administered Calories /weight (Kcal/kg/day)			20	15-24
	Survival (days)			19	8-45

Variables	Univariate (n=90)			Multivariate (n=90)
Variables	OR	95%CI	p-value	OR	95%CI	p-value
Age ≥60 years	0.91	0.48-1.75	0.785	–		–
Female	0.77	0.38-1.57	0.776	–		–
KPS ≥40%	2.69	1.40-5.15	0.003	5.82	2.28-14.84	<0.001
mGPS ≥1	0.61	0.28-1.29	0.200	–		–
Survival ≤20 days	0.46	0.24-0.88	0.020	–		–
Abdominal distension	0.30	0.90-1.04	0.057	–		–
Catheter obstruction	0.55	0.12-2.55	0.447	–		–
Unintended cateter exit	0.23	0.05-1.20	0.082	–		–
Nausea or vomit	0.20	0.05-0.76	0.018	0.05	0.01-0.45	<0.008

Variables	Univariate (n=90)			Multivariate (n=90)
Variables	HR	95%CI	p-value	HR	95%CI	p-value
Age ≥ 60	1.11	0.74-1.67	0.600	–		–
Female	1.16	0.76-1.78	0.485	–		–
KPS ≥ 40	1.68	1.13-2.49	0.010	1.85	1.13-3.04	0.015
mGPS ≥ 1	1.45	0.90-2.35	0.125	–		–
Abdominal distension	0.87	0.44-1.75	0.710	–		–
Catheter obstruction	0.57	0.21-1.56	0.274	–		–
Unintended catheter exit	1.23	0.57-2.69	0.600	–		–
Nausea or vomits	1.19	0.62-2.28	0.590	–		–

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[1] Correspondence to: RS SANTOS. E-mail: rosanerssoli@gmail.com.