A Feasibility Study to Investigate the Effect of Nutritional Support for Advanced Cancer Patients in an Inpatient Hospice in Japan

Crossmark: check for updates

Authors

  • Koji Amano Department of Palliative Medicine, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka City, Osaka 534-0021, Japan
  • Isseki Maeda Gratia Hospital Hospice, 6-14-1 Aomadaninishi, Mino City, Osaka 562-8567, Japan
  • Hiroto Ishiki Department of Palliative Medicine, The Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, Japan
  • Tatsuya Morita Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Kita-ku, Hamamatsu City, Shizuoka 433-8558, Japan
  • Teruaki Uno Department of Palliative Medicine, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka City, Osaka 534-0021, Japan
  • Hirofumi Katayama Department of Palliative Medicine, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka City, Osaka 534-0021, Japan
  • Ryohei Tatara Department of Palliative Medicine, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka City, Osaka 534-0021, Japan

DOI:

https://doi.org/10.17140/PMHCOJ-2-117

Keywords:

Advanced cancer patient, Inpatient hospice, Nutritional support, Feasibility, Cancer cachexia

Abstract

Backgrounds: There has been no prospective study to investigate the effect of nutritional sup-port for advanced cancer patients in inpatient hospices. Therefore, we conducted a prospective observational study to explore the feasibility of investigating the effect of nutritional support for advanced cancer patients in an inpatient hospice.
Methods: We prospectively collected the following data: performance status, results of blood tests, calorie and protein intake, body weight, skeletal muscle mass, and Functional Assessment of Anorexia/Cachexia Therapy (FAACT) on the 1st day of admission and every 2 weeks. All patients were followed-up to their discharge or 4 weeks. Primary endpoint was percentage of patients who completed the intervention. Secondary endpoints were overall survival and improvement of Karnofsky Performance Status (KPS) in the 2nd week. Subgroup analysis was performed by dividing patients into 3 groups with change of KPS in the second week (improving, maintaining, and deteriorating KPS groups).
Results: A total of 43 patients met the inclusion criteria, and among them, 14 refused to partici-pate. Thus, 29 were analyzed in the present study. The percentage of patients who completed the intervention in the 2nd week was 93.1% and in the 4th week 44.8%. Sixteen patients, 55.2%, were alive 4 weeks. The KPS improvement rate was 41.4%. The 29 patients were divided into improving KPS (n=12), maintaining KPS (n=9), and deteriorating KPS (n=8). All patients in improving KPS and 4 patients in maintaining KPS were alive 4 weeks. Survival decreased with deterioration of KPS (p<0.001). Calorie/protein sufficiency rate and FAACT score of patients in improving KPS group temporarily improved in the 2nd week.
Conclusions: This study indicated the feasibility of conducting trials to investigate the effect of nutritional support for advanced cancer patients in an inpatient hospice.

References

Hopkinson JB. Psychosocial impact of cancer cachexia. J Cachexia Sarcopenia Muscle. 2014; 5: 89-94. doi: 10.1007/ s13539-014-0142-1

Oberholzer R, Hopkinson JB, Baumann K, et al. Psychoso-cial effects of cancer cachexia: A systematic literature search and qualitative analysis. J Pain Symptom Manage. 2013; 46(1): 77- 95. doi: 10.1016/j.jpainsymman.2012.06.020

Reid J, Santin O, Porter S. The psychological and social consequences of cachexia in patients with advanced cancer: A systematic review. [Abstract taken from the Cancer Cachexia Conference, Boston, USA, 21-23 September 2012]. J Cachexia Sarcopenia Muscle. 2012; 3: 281-301. Web site. http://www. cancercachexia.com/impact-hcp. Accessed November 10, 2016.

Fearon K, Glass DJ, Guttridge DC. Cancer cachexia: Media-tors, signaling, and metabolic pathways. Cell Metab. 2012; 153- 166. doi: 10.1016/j.cmet.2012.06.011

Fearon KC, Strasser F, Anker SD, et al. Definition and clas-sification of cancer cachexia: An international consensus. Lancet Oncol. 2011; 12: 489-495. doi: 10.1016/S1470-2045(10)70218-7

Fearon KC. Cancer cachexia and fat-muscle physiology. N Engl J Med. 2011; 365: 565-567. doi: 10.1056/NEJMci-br1106880

Laviano A, Seelaender M, Rianda S, et al. Neuroinflamma-tion: A contributing factor to the pathogenesis of cancer cachex-ia. Crit Rev Oncog. 2012; 17(3): 247-251. doi: 10.1615/CritRev-Oncog.v17.i3.20

Tisdale MJ. Mechanisms of cancer cachexia. Physiol Rev. 2009; 89: 381-410. doi: 10.1152/physrev.00016.2008

Radbruch L, Elsner F, Trottenberg P, Strasser F, Fearon K. Clinical practice guidelines on cancer cachexia in advanced can-cer patients. Aachen, Department of Palliative Medicine/Euro-pean Palliative Care Research Collaborative. 2010.

Fearon KC, Meyenfeldt MF, Moses AW, et al. Effect of a pro-tein and energy dense n-3 fatty acid enriched oral supplement on loss of weight and lean tissue in cancer cachexia: A randomised double blind trial. Gut. 2003; 52: 1479-1486. Web site. https:// www.ncbi.nlm.nih.gov/pubmed/12970142. Accessed November 10, 2016.

Lundholm K, Daneryd P, Bosaeus I, et al. Palliative nutri-tional intervention in addition to cyclooxygenase and erythro-poietin treatment for patients with malignant disease: Effects on survival, metabolism, and function. Cancer. 2004; 100(9): 1967-1977. Web site. https://www.ncbi.nlm.nih.gov/labs/arti-cles/15112279/. Accessed November 10, 2016.

Lundholm K, Korner U, Gunnebo L, et al. Insulin treatment in cancer cachexia: effects on survival, metabolism, and physi-cal functioning. Clin Cancer Res. 2007; 13(9): 2699-2706. doi: 10.1158/1078-0432.CCR-06-2720

van der Meij BS, Langius JAE, Spreeuwenberg MD, et al. Oral nutritional supplements containing n-3 polyunsaturated fatty acids affect quality of life and functional status in lung can-cer patients during multimodality treatment: An RCT. Eur J Clin Nutr. 2012; 66: 399-404. doi: 10.1038/ejcn.2011.214

Murphy RA, Yeung E, Mazurak VC, Mourtzakis M. Influ-ence of eicosapentaenoic acid supplementation on lean body mass in cancer cachexia. Br J Cancer. 2011; 105(10): 1469- 1473. doi: 10.1038/bjc.2011.391

Aapro M, Arends J, Bozzetti F, et al. Early recognition of malnutrition and cachexia in the cancer patient: A position pa-per of a European School of Oncology Task Force. Ann Oncol. 2014; 25(8): 1492-1499. doi: 10. 1093/annonc/mdu085

Good P, Richard R, Syrmis W, et al. Medically assisted nutri-tion for adult palliative care patients. Cochrane Database of Sys-tematic Review. 2014; (4): CD006274. doi: 10.1002/14651858. CD006274.pub3

Karnofsky DA, Burchenal JH. The clinical evaluation of chemotherapeutic agents in cancer. In: MacLeod CM, ed. Evalu-ation of Chemotherapeutic Agents in Cancer. New York, NY, USA: Columbia University Press; 1949: 191-205.

Morita T, Tsunoda J, Inoue S, Chihara S. The palliative prog-nostic index: A scoring system for survival prediction of termi-nally ill cancer patients. Support Care Cancer. 1999; 7(3): 128- 133. doi: 10.1007/s005200050242

Ribaudo JM, Cella D, Hahn EA, et al. Re-validation and shortening of the functional assessment of anorexia/cachexia therapy (FAACT) questionnaire. Qual Life Res. 2000; 9: 1137- 1146. doi: 10.1023/A:1016670403148

Recommended Daily Allowances 1989. National Food Agency of Denmark, Saborg, Denmark, Publication No. 182, 1989.

Harris JA, Benedict FG. A Biometric Study of Basal Me-tabolism in Man. Washington, DC, USA: Carnegie Institute of Washington; 1919: 279.

Anderson LJ, Erceg DN, Schroeder ET. Unity of multifre-quency bioelectrical impedance compared with dual-energy X-ray absorptiometry for assessment of total and regional body composition varies between men and women. Nutr Res. 2012; 32: 479-485. doi: 10.1016/j.nutres.2012.05.009

Hoyle GE, Chua M, Soiza RL. Volaemic assessment of the elderly hyponatraemic patient: Reliability of clinical assessment and validation of bioelectrical impedance analysis. QJM. 2011; 104: 35-39. doi: 10.1093/qjmed/hcq157

Jensky-Squires NE, Dieli-Conwright CM, Rossuello A, Er-ceg DN, McCauley S, Schroeder ET. Validity and reliability of body composition analysers in children and adults. Br J Nutr. 2008; 100: 859-865. doi: 10.1017/S0007114508925460

Hui D, Glitza I, Chisholm G, Yennu S, Bruera E. Attrition rates, reasons, and predictive factors in supportive care and palliative oncology clinical trials. Cancer. 2013; 119(5): 1098- 1105. doi: 10.1002/cncr.27854

Prado CM, Lieffers JR, McCargar LJ, et al. Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: A popula-tion-based study. Lancet Oncol. 2008; 9: 629-635. doi: 10.1016/ S1470-2045(08)70153-0

Martin L, Birdsell L, Macdonald N, et al. Cancer cachexia in the age of obesity: Skeletal muscle depletion is a powerful prog-nostic factor, independent of body mass index. J Clin Oncol. 2013; 31: 1539-1547. doi: 10.1200/JCO.2012.45.2722

Kazemi-Bajestani SM, Mazurak VC, Baracos V. Computed tomography-defined muscle and fat wasting are associated with cancer clinical outcomes. Semin Cell Dev Biol. 2016; 54: 2-10. doi: 10.1016/j.semcdb.2015.09.001

Muscaritoli M, Anker SD, Argilés J, et al. Consensus defini-tion of sarcopenia, cachexia and pre-cachexia: Joint document elaborated by Special Interest Groups (SIG) “cachexia-anorexia in chronic wasting diseases” and “nutrition in geriatrics”. Clin Nutr. 2010; 29(2): 154-159. doi: 10.1016/j.clnu.2009.12.004

Prado CM, Sawyer MB, Ghosh S, et al. Central tenet of can-cer cachexia therapy: Do patients with advanced cancer have exploitable anabolic potential? Am J Clin Nutr. 2013; 98(4): 1012-1019. doi: 10.3945/ajcn.113.060228

Di Sebastiano KM, Yang L, Zbuk K, et al. Accelerated mus-cle and adipose tissue loss may predict survival in pancreatic cancer patients: The relationship with diabetes and anaemia. Br J Nutr. 2013; 109: 302-312. doi: 10.1017/S0007114512001067

Downloads

Published

2016-11-23

How to Cite

Koji Amano, Isseki Maeda, Hiroto Ishiki, Tatsuya Morita, Teruaki Uno, Hirofumi Katayama, & Ryohei Tatara. (2016). A Feasibility Study to Investigate the Effect of Nutritional Support for Advanced Cancer Patients in an Inpatient Hospice in Japan. Palliative Medicine and Hospice Care, 2(2), 37–45. https://doi.org/10.17140/PMHCOJ-2-117

Issue

Vol. 2 No. 2 (2016): Volume 2 Issue 2 2016

Section

Articles

License

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

All content published in Palliative Medicine and Hospice Care (PMHC) is licensed under the Creative Commons Attribution 4.0 International License (CC BY 4.0). This license allows anyone to copy, distribute, transmit, and adapt the work — including for commercial purposes — provided appropriate credit is given to the original author(s) and source.