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HOME ENTERAL NUTRITION IN PATIENTS WITH ESOPHAGEAL CANCER
M Johnson, L Gramlich
Division of Gastroenterology, University of Alberta, Edmonton, Alberta
OBJECTIVES: The Northern Alberta Home Enteral Nutrition Support Program (NAHENSP) is a multidisciplinary team that oversees all patients and provides product and supplies to patients receiving home enteral nutrition in Northern Alberta. Many patients with cancer are referred to the NAHENSP for nutritional support with the aim of improving quantity and quality of life and reducing morbidity and mortality. Our objective was to review characteristics of the cohort of patients with esophageal cancer and to evaluate survival post initiation of HEN.
METHODS: A retrospective analysis was performed of all patients referred to the NAHENSP during a 15 month period (Jan 2006 to March 2007). Patients with esophageal cancer who received home enteral feeding via gastrostomy tubes were identified and grouped according to type of cancer treatment. Patient characteristics including age, body mass index (BMI), Karnofsky Performance Score (KPS), subjective global assessment (SGA) score and survival were compiled though a multidisciplinary team review.
RESULTS: 23 patients with esophageal cancer were identified who received gastrostomy tube feeding. Nine patients did not receive any additional therapy (Group 1), 7 received chemotherapy and/or radiotherapy (Group 2) and 7 received surgical or endoscopic therapy (Group 3). From the initiation of feeding, patients in Group 1 survived a mean of 66.0 days, significantly less than patients in Groups 2 and 3 (173 and 134 days, chi-square=6.80, p=0.033). The average BMI and KPS scores were lower in Group 1 (21.2 kg/m2, 58) compared with Group 2 (27.2 kg/m2, 64) and Group 3 (23.8 kg/m2, 68), however these differences were not statistically significant. The mean SGA of Group 1 was greater (worse) compared with Groups 2 and 3, but this was also not statistically significant.
CONCLUSIONS: Patients with esophageal cancer who did not receive additional therapy had decreased survival despite receiving home enteral nutrition. Our numbers of patients were too small to show significance, however there was a trend towards lower BMI, KPS and SGA in this group. Although the decision to offer home enteral feeding to patients with esophageal cancer should continue on a case by case basis until there are more definitive studies, patients in whom no further treatment is planned and who have low BMI, KPS and SGA appear least likely to benefit from home enteral nutrition.