A longitudinal study investigating quality of life and nutritional outcomes in advanced cancer patients receiving home parenteral nutrition
Tóm tắt
In cancer patients where gastrointestinal function is marginal and malnutrition significant enough to result in the requirement for intensive nutrition support, parenteral nutrition (PN) is indicated. This longitudinal study examined the quality of life (QoL) and nutritional outcomes in advanced cancer patients receiving home PN (HPN). Fifty-two adult cancer patients (21 males, 31 females, average age 53 years) treated at a specialized cancer facility between April 2009 and November 2011 met criteria. QoL and nutritional status were measured at baseline and every month while on HPN using EORTC-QLQ-C30, Karnofsky Performance Status (KPS), and Subjective Global Assessment (SGA). Repeated measures ANOVA and Generalized Estimating Equations (GEE) were used to evaluate longitudinal changes in QoL and SGA. Cancer diagnoses included pancreatic (n = 14), colorectal (n = 11), ovarian (n = 6), appendix (n = 5), stomach (n = 4) and others (n = 12). Average weight loss 6-months prior to HPN was 13.2 kg (16.9%). Average weight at initiation of HPN was 62.2 kg. In patients with available follow-up data after 1 month (n = 39), there was a significant improvement in SGA, weight (61.5 to 63.1 kg; p = 0.03) and KPS (61.6 to 67.3; p = 0.01) from baseline. Similarly, after 2 months (n = 22), there was an improvement in global QoL (37.1 to 49.2; p = 0.02), SGA, weight (57.6 to 60 kg; p = 0.04) and KPS (63.2 to 73.2; p = 0.01) from baseline. Finally, after 3 months (n = 15), there was an improvement in global QoL (30.6 to 54.4; p = 0.02), SGA, weight (61.1 to 65.9 kg; p = 0.04) and KPS (64.0 to 78.7; p = 0.002) from baseline. Upon GEE analysis, every 1 month of HPN was associated with an increase of 6.3 points in global QoL (p<0.001), 1.3 kg in weight (p = 0.009) and 5.8 points in KPS (p<0.001). HPN is associated with an improvement in QoL, KPS and nutritional status in advanced cancer patients, irrespective of their tumor type, who have compromised enteral intake and malnutrition. The greatest benefit was seen in patients with 3 months of HPN, although patients receiving HPN for 1 or 2 months also demonstrated significant improvements.
Tài liệu tham khảo
Gupta D, Lis CG, Granick J, Grutsch JF, Vashi PG, Lammersfeld CA: Malnutrition was associated with poor quality of life in colorectal cancer: a retrospective analysis. J Clin Epidemiol. 2006, 59: 704-709. 10.1016/j.jclinepi.2005.08.020.
Isenring E, Bauer J, Capra S: The scored Patient-generated Subjective Global Assessment (PG-SGA) and its association with quality of life in ambulatory patients receiving radiotherapy. Eur J Clin Nutr. 2003, 57: 305-309. 10.1038/sj.ejcn.1601552.
Ovesen L, Hannibal J, Mortensen EL: The interrelationship of weight loss, dietary intake, and quality of life in ambulatory patients with cancer of the lung, breast, and ovary. Nutr Cancer. 1993, 19: 159-167. 10.1080/01635589309514246.
Ravasco P, Monteiro-Grillo I, Camilo ME: Does nutrition influence quality of life in cancer patients undergoing radiotherapy?. Radiother Oncol. 2003, 67: 213-220. 10.1016/S0167-8140(03)00040-9.
Ravasco P, Monteiro-Grillo I, Vidal PM, Camilo ME: Cancer: disease and nutrition are key determinants of patients’ quality of life. Support Care Cancer. 2004, 12: 246-252.
Tong H, Isenring E, Yates P: The prevalence of nutrition impact symptoms and their relationship to quality of life and clinical outcomes in medical oncology patients. Support Care Cancer. 2009, 17: 83-90.
Shahmoradi N, Kandiah M, Peng LS: Impact of nutritional status on the quality of life of advanced cancer patients in hospice home care. Asian Pac J Cancer Prev. 2009, 10: 1003-1009.
Van Cutsem E, Arends J: The causes and consequences of cancer-associated malnutrition. Eur J Oncol Nurs. 2005, 9 (Suppl 2): S51-63-S51-S63.
Richter E, Denecke A, Klapdor S, Klapdor R: Parenteral nutrition support for patients with pancreatic cancer–improvement of the nutritional status and the therapeutic outcome. Anticancer Res. 2012, 32: 2111-2118.
Soo I, Gramlich L: Use of parenteral nutrition in patients with advanced cancer. Appl Physiol Nutr Metab. 2008, 33: 102-106. 10.1139/H07-152.
Brard L, Weitzen S, Strubel-Lagan SL, Swamy N, Gordinier ME, Moore RG, Granai CO: The effect of total parenteral nutrition on the survival of terminally ill ovarian cancer patients. Gynecol Oncol. 2006, 103: 176-180. 10.1016/j.ygyno.2006.02.013.
Fan BG: Parenteral nutrition prolongs the survival of patients associated with malignant gastrointestinal obstruction. JPEN J Parenter Enteral Nutr. 2007, 31: 508-510. 10.1177/0148607107031006508.
Wang MY, Wu MH, Hsieh DY, Lin LJ, Lee PH, Chen WJ, Lin MT: Home parenteral nutrition support in adults: experience of a medical center in Asia. JPEN J Parenter Enteral Nutr. 2007, 31: 306-310. 10.1177/0148607107031004306.
Orrevall Y, Tishelman C, Permert J: Home parenteral nutrition: a qualitative interview study of the experiences of advanced cancer patients and their families. Clin Nutr. 2005, 24: 961-970. 10.1016/j.clnu.2005.06.008.
King LA, Carson LF, Konstantinides N, House MS, Adcock LL, Prem KA, Twiggs LB, Cerra FB: Outcome assessment of home parenteral nutrition in patients with gynecologic malignancies: what have we learned in a decade of experience?. Gynecol Oncol. 1993, 51: 377-382. 10.1006/gyno.1993.1307.
Bozzetti F, Cozzaglio L, Biganzoli E, Chiavenna G, De CM, Donati D, Gilli G, Percolla S, Pironi L: Quality of life and length of survival in advanced cancer patients on home parenteral nutrition. Clin Nutr. 2002, 21: 281-288. 10.1054/clnu.2002.0560.
Huhmann MB, August DA: Review of American Society for Parenteral and Enteral Nutrition (ASPEN) Clinical Guidelines for Nutrition Support in Cancer Patients: nutrition screening and assessment. Nutr Clin Pract. 2008, 23: 182-188. 10.1177/0884533608314530.
Osoba D, Rodrigues G, Myles J, Zee B, Pater J: Interpreting the significance of changes in health-related quality-of-life scores. J Clin Oncol. 1998, 16: 139-144.
Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JC, et al: The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993, 85: 365-376. 10.1093/jnci/85.5.365.
Groenvold M, Klee MC, Sprangers MA, Aaronson NK: Validation of the EORTC QLQ-C30 quality of life questionnaire through combined qualitative and quantitative assessment of patient-observer agreement. J Clin Epidemiol. 1997, 50: 441-450. 10.1016/S0895-4356(96)00428-3.
Hjermstad MJ, Fossa SD, Bjordal K, Kaasa S: Test/retest study of the European Organization for Research and Treatment of Cancer Core Quality-of-Life Questionnaire. J Clin Oncol. 1995, 13: 1249-1254.
Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelson RA, Jeejeebhoy KN: What is subjective global assessment of nutritional status?. JPEN J Parenter Enteral Nutr. 1987, 11: 8-13. 10.1177/014860718701100108.
Duerksen DR, Yeo TA, Siemens JL, O’Connor MP: The validity and reproducibility of clinical assessment of nutritional status in the elderly. Nutrition. 2000, 16: 740-744. 10.1016/S0899-9007(00)00398-1.
Ek AC, Unosson M, Larsson J, Ganowiak W, Bjurulf P: Interrater variability and validity in subjective nutritional assessment of elderly patients. Scand J Caring Sci. 1996, 10: 163-168.
Enia G, Sicuso C, Alati G, Zoccali C: Subjective global assessment of nutrition in dialysis patients. Nephrol Dial Transplant. 1993, 8: 1094-1098.
Sacks GS, Dearman K, Replogle WH, Cora VL, Meeks M, Canada T: Use of subjective global assessment to identify nutrition-associated complications and death in geriatric long-term care facility residents. J Am Coll Nutr. 2000, 19: 570-577. 10.1080/07315724.2000.10718954.
Thoresen L, Fjeldstad I, Krogstad K, Kaasa S, Falkmer UG: Nutritional status of patients with advanced cancer: the value of using the subjective global assessment of nutritional status as a screening tool. Palliat Med. 2002, 16: 33-42. 10.1191/0269216302pm486oa.
Ferguson ML, Bauer J, Gallagher B, Capra S, Christie DR, Mason BR: Validation of a malnutrition screening tool for patients receiving radiotherapy. Australas Radiol. 1999, 43: 325-327. 10.1046/j.1440-1673.1999.433665.x.
Hasse J, Strong S, Gorman MA, Liepa G: Subjective global assessment: alternative nutrition-assessment technique for liver-transplant candidates. Nutrition. 1993, 9: 339-343.
Hirsch S, de Obaldia N, Petermann M, Rojo P, Barrientos C, Iturriaga H, Bunout D: Subjective global assessment of nutritional status: further validation. Nutrition. 1991, 7: 35-37.
Persson C, Sjoden PO, Glimelius B: The Swedish version of the patient-generated subjective global assessment of nutritional status: gastrointestinal vs urological cancers. Clin Nutr. 1999, 18: 71-77. 10.1016/S0261-5614(99)80054-5.
Gupta D, Lammersfeld CA, Vashi PG, Burrows J, Lis CG, Grutsch JF: Prognostic significance of Subjective Global Assessment (SGA) in advanced colorectal cancer. Eur J Clin Nutr. 2005, 59: 35-40. 10.1038/sj.ejcn.1602029.
Gupta D, Lis CG, Vashi PG, Lammersfeld CA: Impact of improved nutritional status on survival in ovarian cancer. Support Care Cancer. 2010, 18: 373-381.
Twisk JWR: Applied Longitudinal Data Analysis for Epidemiology: A Practical Guide. 2013, Cambridge University Press
Fitzmaurice GM, Laird NM, Ware JH: Applied Longitudinal Analysis. 2011, Wiley
Culine S, Chambrier C, Tadmouri A, Senesse P, Seys P, Radji A, Rotarski M, Balian A, Dufour P: Home parenteral nutrition improves quality of life and nutritional status in patients with cancer: a French observational multicentre study. Support Care Cancer. 2014, 22 (7): 1867-1874.
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