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Impact of home artificial nutrition on quality of life and survival in advanced cancer patients
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Selected Abstracts / Nutrition 32 (2016) 399–408
16 Institute for Biomedicine of Aging, Friedrich-Alexander-Uni€t Erlangen-Nu € rnberg, Nu € rnberg, Germany versita 17 The Gilad Geriatric Center, Ramat-Gan, Israel 18 Nutrition and Dietetics, Flinders University, Adelaide, Australia 19 Rehabilitation Studies Unit, University of Sydney, Australia 20 Unit of Primary Health Care, Helsinki University Central Hospital, Department of General Practice, Helsinki, Finland 21 The S. H. Ho Center for Gerontology and Geriatrics, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China 22 Division of Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan 23 Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA 24 Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, Endocrinology and Nutrition Unit, University of Pavia, Pavia, Italy 25 €ping, Linko €ping, Faculty of Health Sciences, University of Linko Sweden 26 Section of Dietetics, Department of Agriculture and Food Sciences, University of Applied Sciences, Neubrandenburg, Germany 27 Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University Vienna, Vienna, Austria 28 Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala Science Park, Uppsala, Sweden 29 Department of Medical Sciences, University of Ferrara, Ferrara, Italy 30 Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong
Introduction: Body mass index (BMI) and mortality in old adults from general population have been related in a U-shaped or J-shaped curve. However, limited information is available for elderly nursing-home populations, particularly about specific cause death. Materials and Methods: A collaborative international meta-analysis. A systematic PubMed/EMBASE/CINAHL/SCOPUS search until 05/31/2014 without language restrictions was made. As no published study reported mortality in standard BMI groups (<18.5, 18.5-24.9, 25-29.9, >30), the most adjusted hazard ratios (HRs) according to a pre-defined list of covariates were obtained from authors and pooled by random-effect model across each BMI category. Results: Out of 342 hits, 20 studies including 19,538 older residents with 5,223 deaths and during a median of 2 years of follow-up were meta-analyzed. Compared to normal weight, allcause mortality HRs were 1.41 (95%CI¼1.26-1.58) for underweight, 0.85 (95%CI¼0.73-0.99) for overweight and 0.74 (95% CI¼0.57-0.96) for obesity. Underweight was a risk factor for higher mortality due to infections [HR¼1.65 (95%CI¼1.13-2.40)]. RR results corroborated primary HR results, with additionally lower infection-related mortality in overweight and obese than normal weight individuals. Conclusions: Like in the general population, underweight is a risk factor for mortality in old nursing-home residents. However, uniquely, not only overweight but also obesity is protective, which has relevant nutritional goal implications in this population/setting. 03. IMPACT OF HOME ARTIFICIAL NUTRITION ON QUALITY OF LIFE AND SURVIVAL IN ADVANCED CANCER PATIENTS F. Agostini 1, 2, E. Ruggeri 1, M. Giannantonio 1, L. Fettucciari 1, L. Pironi 2, F. Pannuti 1 1 ANT Foundation, Bologna, Italy 2 Chronic Intestinal Failure Center, St Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
Introduction: Cachexia is up to 50% in advanced cancer patients, resulting in weight loss, reduced quality of life (QoL), and shortened survival. Aim of the study: evaluating the impact of Home Artificial Nutrition (HAN) on QoL and survival in cancer patients assisted at home by ANT Foundation. Materials and Methods: Criteria of patients’ selection: inadequate caloric intake malnutrition; life expectancy 6 weeks; suitable psycho-physical conditions; informed consent. Clinical parameters: tumor site, QoL evaluated using Karnofsky Performance Status (KPS) and nutritional status at the start and after one month of HAN, survival. HAN features: indications, access routes (enteral: HEN; parenteral: HPN) and daily caloric-protein regimen. Results: From July 1990 to July 2015 HAN had been administered to790 patients (2.3% of total cancer patients), 465 M, 325 F (age: 65.812.7 yrs). Tumor site: 80.5% head-neck and gastrointestinal tract. Mean BMI: 19.33.0, caloric intake: <50% of total energy expenditure in all patients. HEN: 315/790 pts (39.9%); main indication: dysphagia (68.7%). HPN: 475/790 pts (60.1%); main indication: gastro-intestinal obstruction (83.9%). At the end of the study 744 pts had died, 575 (77%) had survived 6 weeks. Mean duration of HAN was 17.620.4 weeks, strongly correlated (p<0.0001) with KPS at the start. KPS was unchanged or increased in 89% of patients after one month of HAN, correlated with longer survival (p<0.0001). HAN allowed a significant weight gain, more in patients with high KPS. Conclusions: HAN can prevent death from cachexia. The survival increases proportionally to improvement of the quality of life due to HAN. 04. RENAL FUNCTION IN PATIENTS ON LONG-TERM HOME PARENTERAL NUTRITION FOR CHRONIC INTESTINAL FAILURE: A PROSPECTIVE STUDY F. Agostini 1, 2, M. Guidetti 1, C. Pazzeschi 1, R. Petitto 1, L. Pironi 1 Chronic Intestinal Failure Center, St Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy 2 PhD in Specialistic Medical Sciences, University of Bologna, Bologna, Italy
1
Introduction: The incidence and the causes of chronic renal failure (CRF) in patients on home parenteral nutrition (HPN) remain to be clarified. We investigated the renal function outcome in patients on long term HPN for chronic intestinal failure (CIF) due to benign disease. Materials and Methods: A 30 month prospective study was performed on adult patients (age > 18 yrs) who were on HPN at 31/10/2011 (baseline). Renal function was evaluated by: estimated glomerular filtration rate (eGFR) according to MDRD(Modification of Diet in Renal Disease) and by serum Cystatin C. An eGFR< 60 ml was considered indicative of CRF. The following parameters evaluated: characteristics of CIF and of HPN program; catheter related bloodstream infection (CRBSI) episodes. Statistic: only those patients who completed the follow up period were included in the final analysis; non parametric tests. Results: Fifty-three patients were analyzed: 39 short bowel syndrome (17 with jejunostomy and 22 with colon in continuity), 12 chronic intestinal pseudo obstruction, 2 mucosal disease. According to the eGFR at baseline and to its outcome during the follow up, patients were categorized in 3 groups: A) presence of CRF at baseline (n. 12) ; B) development of CRF during the follow up (n. 6); C) normal eGFR at both baseline and follow up (n. 35). During the follow up, the variation of eGFR was -5.87%/year in
Selected Abstracts / Nutrition 32 (2016) 399–408
16 Institute for Biomedicine of Aging, Friedrich-Alexander-Uni€t Erlangen-Nu € rnberg, Nu € rnberg, Germany versita 17 The Gilad Geriatric Center, Ramat-Gan, Israel 18 Nutrition and Dietetics, Flinders University, Adelaide, Australia 19 Rehabilitation Studies Unit, University of Sydney, Australia 20 Unit of Primary Health Care, Helsinki University Central Hospital, Department of General Practice, Helsinki, Finland 21 The S. H. Ho Center for Gerontology and Geriatrics, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China 22 Division of Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan 23 Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA 24 Department of Public Health, Experimental and Forensic Medicine, Section of Human Nutrition, Endocrinology and Nutrition Unit, University of Pavia, Pavia, Italy 25 €ping, Linko €ping, Faculty of Health Sciences, University of Linko Sweden 26 Section of Dietetics, Department of Agriculture and Food Sciences, University of Applied Sciences, Neubrandenburg, Germany 27 Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University Vienna, Vienna, Austria 28 Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala Science Park, Uppsala, Sweden 29 Department of Medical Sciences, University of Ferrara, Ferrara, Italy 30 Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong
Introduction: Body mass index (BMI) and mortality in old adults from general population have been related in a U-shaped or J-shaped curve. However, limited information is available for elderly nursing-home populations, particularly about specific cause death. Materials and Methods: A collaborative international meta-analysis. A systematic PubMed/EMBASE/CINAHL/SCOPUS search until 05/31/2014 without language restrictions was made. As no published study reported mortality in standard BMI groups (<18.5, 18.5-24.9, 25-29.9, >30), the most adjusted hazard ratios (HRs) according to a pre-defined list of covariates were obtained from authors and pooled by random-effect model across each BMI category. Results: Out of 342 hits, 20 studies including 19,538 older residents with 5,223 deaths and during a median of 2 years of follow-up were meta-analyzed. Compared to normal weight, allcause mortality HRs were 1.41 (95%CI¼1.26-1.58) for underweight, 0.85 (95%CI¼0.73-0.99) for overweight and 0.74 (95% CI¼0.57-0.96) for obesity. Underweight was a risk factor for higher mortality due to infections [HR¼1.65 (95%CI¼1.13-2.40)]. RR results corroborated primary HR results, with additionally lower infection-related mortality in overweight and obese than normal weight individuals. Conclusions: Like in the general population, underweight is a risk factor for mortality in old nursing-home residents. However, uniquely, not only overweight but also obesity is protective, which has relevant nutritional goal implications in this population/setting. 03. IMPACT OF HOME ARTIFICIAL NUTRITION ON QUALITY OF LIFE AND SURVIVAL IN ADVANCED CANCER PATIENTS F. Agostini 1, 2, E. Ruggeri 1, M. Giannantonio 1, L. Fettucciari 1, L. Pironi 2, F. Pannuti 1 1 ANT Foundation, Bologna, Italy 2 Chronic Intestinal Failure Center, St Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
Introduction: Cachexia is up to 50% in advanced cancer patients, resulting in weight loss, reduced quality of life (QoL), and shortened survival. Aim of the study: evaluating the impact of Home Artificial Nutrition (HAN) on QoL and survival in cancer patients assisted at home by ANT Foundation. Materials and Methods: Criteria of patients’ selection: inadequate caloric intake malnutrition; life expectancy 6 weeks; suitable psycho-physical conditions; informed consent. Clinical parameters: tumor site, QoL evaluated using Karnofsky Performance Status (KPS) and nutritional status at the start and after one month of HAN, survival. HAN features: indications, access routes (enteral: HEN; parenteral: HPN) and daily caloric-protein regimen. Results: From July 1990 to July 2015 HAN had been administered to790 patients (2.3% of total cancer patients), 465 M, 325 F (age: 65.812.7 yrs). Tumor site: 80.5% head-neck and gastrointestinal tract. Mean BMI: 19.33.0, caloric intake: <50% of total energy expenditure in all patients. HEN: 315/790 pts (39.9%); main indication: dysphagia (68.7%). HPN: 475/790 pts (60.1%); main indication: gastro-intestinal obstruction (83.9%). At the end of the study 744 pts had died, 575 (77%) had survived 6 weeks. Mean duration of HAN was 17.620.4 weeks, strongly correlated (p<0.0001) with KPS at the start. KPS was unchanged or increased in 89% of patients after one month of HAN, correlated with longer survival (p<0.0001). HAN allowed a significant weight gain, more in patients with high KPS. Conclusions: HAN can prevent death from cachexia. The survival increases proportionally to improvement of the quality of life due to HAN. 04. RENAL FUNCTION IN PATIENTS ON LONG-TERM HOME PARENTERAL NUTRITION FOR CHRONIC INTESTINAL FAILURE: A PROSPECTIVE STUDY F. Agostini 1, 2, M. Guidetti 1, C. Pazzeschi 1, R. Petitto 1, L. Pironi 1 Chronic Intestinal Failure Center, St Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy 2 PhD in Specialistic Medical Sciences, University of Bologna, Bologna, Italy
1
Introduction: The incidence and the causes of chronic renal failure (CRF) in patients on home parenteral nutrition (HPN) remain to be clarified. We investigated the renal function outcome in patients on long term HPN for chronic intestinal failure (CIF) due to benign disease. Materials and Methods: A 30 month prospective study was performed on adult patients (age > 18 yrs) who were on HPN at 31/10/2011 (baseline). Renal function was evaluated by: estimated glomerular filtration rate (eGFR) according to MDRD(Modification of Diet in Renal Disease) and by serum Cystatin C. An eGFR< 60 ml was considered indicative of CRF. The following parameters evaluated: characteristics of CIF and of HPN program; catheter related bloodstream infection (CRBSI) episodes. Statistic: only those patients who completed the follow up period were included in the final analysis; non parametric tests. Results: Fifty-three patients were analyzed: 39 short bowel syndrome (17 with jejunostomy and 22 with colon in continuity), 12 chronic intestinal pseudo obstruction, 2 mucosal disease. According to the eGFR at baseline and to its outcome during the follow up, patients were categorized in 3 groups: A) presence of CRF at baseline (n. 12) ; B) development of CRF during the follow up (n. 6); C) normal eGFR at both baseline and follow up (n. 35). During the follow up, the variation of eGFR was -5.87%/year in