Ruggeri Enrico, Agostini Federica, Fettucciari Luana, Giannantonio Marilena, Pironi Loris, Pannuti Franco
ANT (Associazione Nazionale Tumori) Foundation, Bologna, Italy.
Tumori. 2013 Mar-Apr;99(2):218-24. doi: 10.1177/030089161309900216.
Malnutrition is over 50% in advanced cancer patients and is related to a decreased survival. Cachexia is the first reason for death in 4-23% of cases. The aim of the study was to estimate the appropriateness of the criteria to select patients for home artificial nutrition and its effectiveness to avoid death from cachexia and to improve quality of life in patients with advanced cancer assisted at home by the National Tumor Association (ANT) Foundation.
The criteria for patient selection are: inadequate caloric intake ± malnutrition; life expectancy ≥6 weeks; suitable psycho-physical conditions; informed consent. The measured parameters were sex, age, tumor site, food intake, nutritional status, Karnofsky performance status, indication for home artificial nutrition, type of home artificial nutrition (enteral or parenteral), and survival after starting home artificial nutrition.
The ANT Foundation assisted 29,348 patients in Bologna and its province from July 1990 to July 2012. Home artificial nutrition had been submitted to 618 patients (2.1%): enteral to 285/618 (46.1%) and parenteral to 333/618 (53.9%). Access routes for home artificial nutrition were: 39% nasogastric tube, 26% percutaneous endoscopic gastrostomy, 33% digiunostomy, and 2% gastrostomy. The central venous catheters used for home artificial nutrition were: 61% non-tunneled, 13 peripherally inserted, 8% partially tunneled, and 18% totally implanted. By July 2012, all the patients had died. Duration of life ≥6 weeks was 78% (484/618). Karnofsky performance status was related to survival ( P <0.0001): one month after starting home artificial nutrition, it decreased in 73 patients (12%), was unchanged in 414 (67%), and increased in 131 (21%).
The low incidence of home artificial nutrition over all the patients assisted by the ANT Foundation and the achievement to avoid death from cachexia in 78% prove the efficacy of the criteria of patient selection in order to prevent its excessive and indiscriminate use. It was effective in maintaining and improving the performance status in 88% of patients. Karnofsky performance status is a reliable prognostic index to start home artificial nutrition.
晚期癌症患者中营养不良发生率超过50%，且与生存率降低相关。恶病质是4%-23%病例的首要死亡原因。本研究旨在评估为居家人工营养选择患者的标准是否恰当，以及其在避免因恶病质导致死亡和改善由国家肿瘤协会（ANT）基金会提供居家护理的晚期癌症患者生活质量方面的有效性。
患者选择标准为：热量摄入不足±营养不良；预期寿命≥6周；合适的身心状况；知情同意。测量参数包括性别、年龄、肿瘤部位、食物摄入量、营养状况、卡氏功能状态、居家人工营养指征、居家人工营养类型（肠内或肠外）以及开始居家人工营养后的生存率。
1990年7月至2012年7月，ANT基金会在博洛尼亚及其省份为29348名患者提供了护理。618名患者（2.1%）接受了居家人工营养：肠内营养285/618例（46.1%），肠外营养333/618例（53.9%）。居家人工营养的接入途径为：鼻胃管39%，经皮内镜下胃造口术26%，十二指肠造口术33%，胃造口术2%。用于居家人工营养的中心静脉导管为：非隧道式61%，外周插入式13%，部分隧道式8%，完全植入式18%。截至2012年7月，所有患者均已死亡。生存期≥6周的患者占78%（484/618）。卡氏功能状态与生存率相关（P<0.0001）：开始居家人工营养1个月后，73名患者（12%）的状态下降，414名患者（67%）不变，131名患者（21%）改善。
在ANT基金会护理的所有患者中，居家人工营养发生率较低，且78%的患者避免了因恶病质导致死亡，这证明了患者选择标准在防止其过度和滥用方面的有效性。它在88%的患者中有效维持和改善了功能状态。卡氏功能状态是开始居家人工营养的可靠预后指标。
