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Nutritional support and risk status among cancer patients in palliative home care services

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Abstract

Goal of work

The aim of this study was to investigate the nutritional risk status and use of nutritional support among cancer patients enrolled in palliative home care services. Differences in the use of nutritional support in relation to nutritional, social and clinical factors, as well as survival were also investigated.

Patients and methods

Structured telephone interviews were conducted with cancer patients enrolled in all 21 palliative home care services in the Stockholm region. An interview guide was designed to investigate topics related to the patient’s nutritional situation.

Main results

Interviews with 621 patients were analysed. Sixty-eight percent of the patients were scored as at nutritional risk according on a modified version of NRS-2002. Nutritional support was used by 55% of the patients, with oral nutritional supplements most common and 14% using artificial nutrition. Use of nutritional support was related to low BMI and severe weight loss and was more common in patients with shorter survival times.

Conclusions

These findings demonstrate that nutritional support is used to treat already malnourished patients with shorter survival time, rather than to prevent malnutrition. A more structured approach to nutritional issues for patients in palliative phases, which considers life expectancy and psycho-social aspects of nutritional issues, could help identify potential candidates for nutritional support.

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References

  1. Arends J, Bodoky G, Bozzetti F, Fearon K, Muscaritoli M, Selga G, van Bokhorst-de van der Schueren MA, von Meyenfeldt M, Zurcher G, Fietkau R, Aulbert E, Frick B, Holm M, Kneba M, Mestrom HJ, Zander A (2006) ESPEN Guidelines on Enteral Nutrition: non-surgical oncology. Clin Nutr 25(2):245–259, Medline, DOI 10.1016/j.clnu.2006.01.020

    Article  PubMed  CAS  Google Scholar 

  2. Baldwin C, McGough C, Norman AR, Frost GS, Cunningham DC, Andreyev HJ (2006) Failure of dietetic referral in patients with gastrointestinal cancer and weight loss. Eur J Cancer 42(15):2504–2509, Medline, DOI 10.1016/j.ejca.2006.05.028

    Article  PubMed  CAS  Google Scholar 

  3. Bauer J, Capra S, Ferguson M (2002) Use of the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in patients with cancer. Eur J Clin Nutr 56(8):779–785, Medline, DOI 10.1038/sj.ejcn.1601412

    Article  PubMed  CAS  Google Scholar 

  4. Beck AM, Balknas UN, Furst P, Hasunen K, Jones L, Keller U, Melchior JC, Mikkelsen BE, Schauder P, Sivonen L, Zinck O, Oien H, Ovesen L (2001) Food and nutritional care in hospitals: how to prevent undernutrition—report and guidelines from the Council of Europe. Clin Nutr 20(5):455–460, Medline, DOI 10.1054/clnu.2001.0494

    Article  PubMed  CAS  Google Scholar 

  5. Bozzetti F (2003) Home total parenteral nutrition in incurable cancer patients: a therapy, a basic humane care or something in between? Clin Nutr 22(2):109–111, Medline, DOI 10.1054/clnu.2002.0629

    Article  PubMed  CAS  Google Scholar 

  6. Bozzetti F, Amadori D, Bruera E, Cozzaglio L, Corli O, Filiberti A, Rapin CH, Neuenschwander H, Aoun M, Ricci SB, De Conno F, Doci R, Garrone M, Gentilini M, Lery N, Mantell M, Sheldon-Collins R, Trompino G (1996) Guidelines on artificial nutrition versus hydration in terminal cancer patients. European Association for Palliative Care. Nutrition 12(3):163–167, Medline, DOI 10.1016/S0899-9007(96)91120-X

    Article  PubMed  CAS  Google Scholar 

  7. Bozzetti F, Cozzaglio L, Biganzoli E, Chiavenna G, De Cicco M, Donati D, Gilli G, Percolla S, Pironi L (2002) Quality of life and length of survival in advanced cancer patients on home parenteral nutrition. Clin Nutr 21(4):281–288, Medline, DOI 10.1054/clnu.2002.0560

    Article  PubMed  CAS  Google Scholar 

  8. Buchman AL (2002) Must every cancer patient die with a central venous catheter? Clin Nutr 21(4):269–271, Medline, DOI 10.1054/clnu.2002.0568

    Article  PubMed  Google Scholar 

  9. Dietitians Association of Australia (2006) Evidence based practical guidelines for the nutritional management of cancer cachexia. Nutrition and Dietetics 63(S2):5–32

    Google Scholar 

  10. Elia M, Zellipour L, Stratton RJ (2005) To screen or not to screen for adult malnutrition? Clin Nutr 24(6):867–884, Medline, DOI 10.1016/j.clnu.2005.03.004

    Article  PubMed  CAS  Google Scholar 

  11. Hopkinson J, Corner J (2006) Helping patients with advanced cancer live with concerns about eating: a challenge for palliative care professionals. J Pain Symptom Manage 31(4):293–305, Medline, DOI 10.1016/j.jpainsymman.2005.09.005

    Article  PubMed  Google Scholar 

  12. Hopkinson J, Wright D, Corner J (2006) Exploring the experience of weight loss in people with advanced cancer. J Adv Nurs 54(3):304–312, Medline, DOI 10.1111/j.1365-2648.2006.03818.x

    Article  PubMed  Google Scholar 

  13. Howard P, Jonkers-Schuitema C, Furniss L, Kyle U, Muehlebach S, Odlund-Olin A, Page M, Wheatley C (2006) Managing the patient journey through enteral nutritional care. Clin Nutr 25(2):187–195, Medline, DOI 10.1016/j.clnu.2006.01.013

    Article  PubMed  CAS  Google Scholar 

  14. Hughes N, Neal RD (2000) Adults with terminal illness: a literature review of their needs and wishes for food. J Adv Nurs 32(5):1101–1107, Medline, DOI 10.1046/j.1365-2648.2000.01580.x

    Article  PubMed  CAS  Google Scholar 

  15. Hutton JL, Martin L, Field CJ, Wismer WV, Bruera ED, Watanabe SM, Baracos VE (2006) Dietary patterns in patients with advanced cancer: implications for anorexia-cachexia therapy. Am J Clin Nutr 84(5):1163–1170

    PubMed  CAS  Google Scholar 

  16. Isenring EA, Bauer JD, Capra S (2007) Nutrition support using the American Dietetic Association medical nutrition therapy protocol for radiation oncology patients improves dietary intake compared with standard practice. J Am Diet Assoc 107(3):404–412, Medline, DOI 10.1016/j.jada.2006.12.007

    Article  PubMed  CAS  Google Scholar 

  17. Kondrup J, Allison SP, Elia M, Vellas B, Plauth M (2003) ESPEN guidelines for nutrition screening 2002. Clin Nutr 22(4):415–421, Medline, DOI 10.1016/S0261-5614(03)00098-0

    Article  PubMed  CAS  Google Scholar 

  18. Kondrup J, Rasmussen HH, Hamberg O, Stanga Z (2003) Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr 22(3):321–336, Medline, DOI 10.1016/S0261-5614(02)00214-5

    Article  PubMed  Google Scholar 

  19. Korner U, Bondolfi A, Buhler E, Macfie J, Meguid MM, Messing B, Oehmichen F, Valentini L, Allison SP (2006) Ethical and legal aspects of enteral nutrition. Clin Nutr 25(2):196–202, Medline, DOI 10.1016/j.clnu.2006.01.024

    Article  PubMed  CAS  Google Scholar 

  20. Lundstrom S, Strang P (2004) Establishing and testing a palliative care research network in Sweden. Palliat Med 18(2):139, Medline, DOI 10.1191/0269216304pm869xx

    Article  PubMed  Google Scholar 

  21. Marin Caro MM, Laviano A, Pichard C (2007) Nutritional intervention and quality of life in adult oncology patients. Clin Nutr 26(3):289–301, Medline, DOI 10.1016/j.clnu.2007.01.005

    Article  PubMed  Google Scholar 

  22. Mowe M, Bosaeus I, Rasmussen HH, Kondrup J, Unosson M, Irtun O (2006) Nutritional routines and attitudes among doctors and nurses in Scandinavia: a questionnaire based survey. Clin Nutr 25(3):524–532, Medline, DOI 10.1016/j.clnu.2005.11.011

    Article  PubMed  Google Scholar 

  23. National Collaborating Centre for Acute Care (2006) Nutritional Support for Adults, Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition. Methods, Evidence and Guidence. National Collaborating Centre for Acute Care, London

    Google Scholar 

  24. Orrevall Y, Tishelman C, Herrington MK, Permert J (2004) The path from oral nutrition to home parenteral nutrition: a qualitative interview study of the experiences of advanced cancer patients and their families. Clin Nutr 23(6):1280–1287, DOI 10.1016/j.clnu.2004.04.006

    PubMed  Google Scholar 

  25. Orrevall Y, Tishelman C, Permert J (2005) Home parenteral nutrition: a qualitative interview study of the experiences of advanced cancer patients and their families. Clin Nutr 24(6):961–970, Medline, DOI 10.1016/j.clnu.2005.06.008

    Article  PubMed  Google Scholar 

  26. Ravasco P, Monteiro Grillo I, Camilo M (2007) Cancer wasting and quality of life react to early individualized nutritional counselling!. Clin Nutr 26(1):7–15, Medline, DOI 10.1016/j.clnu.2006.10.005

    Article  PubMed  Google Scholar 

  27. Sarhill N, Mahmoud F, Walsh D, Nelson KA, Komurcu S, Davis M, LeGrand S, Abdullah O, Rybicki L (2003) Evaluation of nutritional status in advanced metastatic cancer. Support Care Cancer 11(10):652–659, Medline, DOI 10.1007/s00520-003-0486-0

    Article  PubMed  CAS  Google Scholar 

  28. Segura A, Pardo J, Jara C, Zugazabeitia L, Carulla J, de Las Penas R, Garcia-Cabrera E, Luz Azuara M, Casado J, Gomez-Candela C (2005) An epidemiological evaluation of the prevalence of malnutrition in Spanish patients with locally advanced or metastatic cancer. Clin Nutr 24(5):801–814, Medline, DOI 10.1016/j.clnu.2005.05.001

    Article  PubMed  Google Scholar 

  29. Shang E, Weiss C, Post S, Kaehler G (2006) The influence of early supplementation of parenteral nutrition on quality of life and body composition in patients with advanced cancer. JPEN J Parenter Enteral Nutr 30(3):222–230, DOI 10.1177/0148607106030003222

    Article  PubMed  Google Scholar 

  30. Shragge JE, Wismer WV, Olson KL, Baracos VE (2007) Shifting to conscious control: psychosocial and dietary management of anorexia by patients with advanced cancer. Palliat Med 21(3):227–233, Medline, DOI 10.1177/0269216307077172

    Article  PubMed  Google Scholar 

  31. Socialstyrelsen (2006) Vård i livets slutskede. Socialstyrelsens bedömning av utveckling i landsting och kommuner. Socialstyrelsen

  32. Strasser F, Binswanger J, Cerny T, Kesselring A (2007) Fighting a losing battle: eating-related distress of men with advanced cancer and their female partners. A mixed-methods study. Palliat Med 21(2):129–137, Medline, DOI 10.1177/0269216307076346

    Article  PubMed  CAS  Google Scholar 

  33. Stratton RJ, Green CJ, Elia M (2003) Disease-related malnutrition, an evidence-based approach to treatment. Cabi, Wallingford

    Google Scholar 

  34. Statistics Sweden (2007) Överviktiga eller feta. Personer 16–84 år. Korrigerad 2007. Avaiable from URL: http://www.scb.se/templates/tableOrChart____49531.asp (accessed December 19, 2007)

  35. Thoresen L, Fjeldstad I, Krogstad K, Kaasa S, Falkmer UG (2002) Nutritional status of patients with advanced cancer: the value of using the subjective global assessment of nutritional status as a screening tool. Palliat Med 16(1):33–42, Medline, DOI 10.1191/0269216302pm486oa

    Article  PubMed  Google Scholar 

  36. Walsh D, Donnelly S, Rybicki L (2000) The symptoms of advanced cancer: relationship to age, gender, and performance status in 1,000 patients. Support Care Cancer 8(3):175–179, Medline, DOI 10.1007/s005200050281

    Article  PubMed  CAS  Google Scholar 

  37. Winter SM (2000) Terminal nutrition: framing the debate for the withdrawal of nutritional support in terminally ill patients. Am J Med 109(9):723–726, Medline, DOI 10.1016/S0002-9343(00)00609-4

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

Economic support has been received from the King Gustaf V Jubilee Fund, Swedish Cancer Society, and the Cancer & Traffic Injury Fund. We thank statistician Sara Runesdotter and Dr Margery K Herrington for valuable advice.

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Authors and Affiliations

  1. Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, 141 86, Stockholm, Sweden

    Y. Orrevall & J. Permert

  2. R & D Unit, Stockholms Sjukhem Foundation, Mariebergsgatan 22, 112 35, Stockholm, Sweden

    Y. Orrevall & C. Tishelman

  3. Department of Medical Epidemiology and Biostatistics and Department of Learning, Informatics, Management and Ethics, Medical Management Center, Karolinska Institutet, 171 77, Stockholm, Sweden

    C. Tishelman

  4. School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK

    C. Tishelman

  5. Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala Science Park, 751 85, Uppsala, Sweden

    T. Cederholm

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  1. Y. Orrevall
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Correspondence to Y. Orrevall.

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Orrevall, Y., Tishelman, C., Permert, J. et al. Nutritional support and risk status among cancer patients in palliative home care services. Support Care Cancer 17, 153–161 (2009). https://doi.org/10.1007/s00520-008-0467-4

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  • DOI: https://doi.org/10.1007/s00520-008-0467-4

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