Oral Nutrition or Parenteral Nutrition: what is best for patients with advanced cancer?

Malnutrition worsens health-related quality of life and prognosis in patients with advanced cancer. Thus, Bouleuc et al. conducted a study that evaluated the clinical benefits of parenteral nutrition compared to oral feeding in patients with cachexia for advanced cancer without gastrointestinal impairment. For this, a randomized, controlled, prospective, multicenter study was carried out in malnourished patients, with a life expectancy between 2 and 12 months, with functioning GIT without symptoms of peritoneal carcinomatosis or intestinal obstruction and with a central catheter. Patients were randomized into an oral diet group, in which they ate an oral diet as desired or a parenteral diet group, who would receive parenteral nutrition depending on their oral intake, with a minimum of 1000 kcal and 6g of nitrogen or until reaching 30-35kcal / kg and 1.2-1.5g ptn / kg.

The study included 111 cancer patients, 48 in the Parenteral Nutrition (PN) group, and 60 in the Oral Nutrition (ON) group. Their average age was 67 years old, 55% women and digestive cancer was the most common type (28.8%). The average weight loss was 8.2 kg in the last 6 months, 73% had low albumin and the average caloric intake was 40% of the needs. There was no difference between the PN or ON groups in the results of the quality of life questionnaire (HR 1.31; p = 0.18), physical functionality (HR 1.58; p = 0.024), and fatigue (HR 1.19; p = 0.393). The post hoc analysis, excluding data beyond 6 months of follow-up, showed a statistically significant increase in worsening-free survival for physical functioning, with a median of 2.23 months in the ON group versus 1.05 months for the PN group (HR, 2.03; p = 0.0008). There was also a statistically significant increase in worsening-free survival for pain dimension (HR, 1.79; p = 0.004) in the ON group versus the PN group and a trend in favor of ON. There was no statistical difference in group survival, with an average of 3 months for the ON group and 2 months for the PN group (p = 0.14). The adverse events were greater in the PN group than in the ON group (7 versus 1 patient) and the main adverse events were catheter infection (5), infection (1), and acute lung edema (1).

Thus, the authors concluded that parenteral nutrition did not improve the quality of life and survival of patients with advanced cancer and cancer-related cachexia, in addition to causing more adverse effects compared to the oral route. This study supports the recommendation of not prescribing parenteral nutrition for patients with advanced cancer with a life expectancy of fewer than 3 months and a functioning gastrointestinal tract.

Reference:

Bouleuc C et al. Impact on Health-Related Quality of Life of Parenteral Nutrition for Patients with Advanced Cancer Cachexia: Results from a Randomized Controlled Trial. Oncologist. 2020 May; 25 (5): e843 – e851.