Department of Palliative Medicine, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1 Yazakokarimata, Nagakute City, Aichi 480-1195, Japan.
Department of Palliative Care, Senri-chuo Hospital, 1-4-3 Shinsenrihigashi-machi, Toyonaka City, Osaka 560-0082, Japan.
Clin Nutr. 2021 Mar;40(3):1168-1175. doi: 10.1016/j.clnu.2020.07.027. Epub 2020 Jul 31.
BACKGROUND & AIMS: The benefits of artificial nutrition and hydration in patients with advanced cancer remain unknown. Therefore, we conducted a prospective study to evaluate effects of enteral nutrition (EN) and parenteral nutrition and hydration (PNH) on survival in palliative care units.
This study involved a secondary analysis of a multicenter cohort study. Data of primary nutritional administration routes during the first week after admission (oral intake, enteral tube feeding, parenteral nutrition, parenteral hydration, poor oral intake) were obtained. Data of averaged calorie sufficiency rate/total calorie intake [high (75% ≤ or 750 kcal/day ≤), moderate (50-75% or 500-750 kcal/day), low (25-50% or 250-500 kcal/day), very low (<25% or <250 kcal/day)] were also obtained. After investigating the implementation of artificial nutrition and hydration, participants were divided into three groups according to the nutritional administration route and calorie sufficiency rate/total calorie intake: EN, PNH, and control. We conducted time-to-event analyses using the Kaplan-Meier method, log-rank test, and univariate and multivariate Cox regression analyses.
Patients were divided into the EN group (n = 730), PNH group (n = 190), and control group (n = 533). Differences in survival rates among the three groups were significant (Log-rank P < 0.001). Median survival times were 43.0 (95% CI 40-46), 33.0 (95% CI 29-37), and 15.0 (95% CI 14-16) days, respectively (P < 0.001). In the multivariate-adjusted model, a significantly lower risk of mortality was observed in Cox's proportional hazard model in the EN group and PNH groups (HR 0.43 [95% CI 0.37-0.49], P < 0.001; and HR 0.52 [95% CI 0.44-0.62], P < 0.001, respectively) than in the control group.
This study indicated the clinical benefits of EN and PNH for patients with advanced cancer. Nevertheless, managing symptoms to improve oral intake is essential before initiation of PNH, because EN was superior to PNH.
晚期癌症患者接受人工营养和水合作用的益处仍不清楚。因此，我们进行了一项前瞻性研究，以评估姑息治疗病房中肠内营养（EN）和肠外营养和水合作用（PNH）对生存的影响。
本研究涉及一项多中心队列研究的二次分析。在入院后第一周内获得了主要营养管理途径的数据（口服摄入、肠内管饲、肠外营养、肠外水合、口服摄入不佳）。还获得了平均热量充足率/总热量摄入的数据[高（75%≤或 750 千卡/天≤）、中（50-75%或 500-750 千卡/天）、低（25-50%或 250-500 千卡/天）、极低（<25%或<250 千卡/天）]。在调查人工营养和水合作用的实施情况后，根据营养管理途径和热量充足率/总热量摄入，将参与者分为三组：EN 组、PNH 组和对照组。我们使用 Kaplan-Meier 方法、对数秩检验以及单变量和多变量 Cox 回归分析进行了事件时间分析。
患者分为 EN 组（n=730）、PNH 组（n=190）和对照组（n=533）。三组之间的生存率差异有统计学意义（对数秩 P<0.001）。中位生存时间分别为 43.0（95%CI 40-46）、33.0（95%CI 29-37）和 15.0（95%CI 14-16）天（P<0.001）。在多变量调整模型中，Cox 比例风险模型中 EN 组和 PNH 组的死亡率风险显著降低（HR 0.43[95%CI 0.37-0.49]，P<0.001；和 HR 0.52[95%CI 0.44-0.62]，P<0.001），而对照组则没有。
本研究表明，晚期癌症患者接受 EN 和 PNH 治疗具有临床益处。然而，在开始 PNH 之前，管理症状以改善口服摄入至关重要，因为 EN 优于 PNH。
