Ronald Chow1,2,3, Eduardo Bruera4, Jann Arends5, Declan Walsh6, Florian Strasser7, Elisabeth Isenring8, Egidio G Del Fabbro9, Alex Molassiotis10, Monica Krishnan11, Leonard Chiu12, Nicholas Chiu12, Stephanie Chan12, Tian Yi Tang13, Henry Lam12, Michael Lock13, Carlo DeAngelis12,14. 1. Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada. rchow48@uwo.ca. 2. Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada. rchow48@uwo.ca. 3. London Health Sciences Centre, University of Western Ontario, 800 Commissioners Road East, London, ON, Canada, N6A 5W9. rchow48@uwo.ca. 4. University of Texas MD Anderson Cancer Center, Houston, TX, USA. 5. University of Freiburg, Freiburg, Germany. 6. Levine Cancer Institute, Charlotte, NC, USA. 7. Cantonal Hospital, St. Gallen, Switzerland. 8. Bond University, QLD, Robina, 4226, Australia. 9. Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA. 10. Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR. 11. Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA. 12. Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada. 13. London Health Sciences Centre, University of Western Ontario, 800 Commissioners Road East, London, ON, Canada, N6A 5W9. 14. Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.
Abstract
INTRODUCTION: Weight loss in cancer patients is a worrisome constitutional change predicting disease progression and shortened survival time. A logical approach to counter some of the weight loss is to provide nutritional support, administered through enteral nutrition (EN) or parenteral nutrition (PN). The aim of this paper was to update the original systematic review and meta-analysis previously published by Chow et al., while also assessing publication quality and effect of randomized controlled trials (RCTs) on the meta-conclusion over time. METHODS: A literature search was carried out; screening was conducted for RCTs published in January 2015 up until December 2018. The primary endpoints were the percentage of patients achieving no infection and no nutrition support complications. Secondary endpoints included proportion of patients achieving no major complications and no mortality. Review Manager (RevMan 5.3) by Cochrane IMS and Comprehensive Meta-Analysis (version 3) by Biostat were used for meta-analyses of endpoints and assessment of publication quality. RESULTS: An additional seven studies were identified since our prior publication, leading to 43 papers included in our review. The results echo those previously published; EN and PN are equivalent in all endpoints except for infection. Subgroup analyses of studies only containing adults indicate identical risks across all endpoints. Cumulative meta-analysis suggests that meta-conclusions have remained the same since the beginning of publication time for all endpoints except for the endpoint of infection, which changed from not favoring to favoring EN after studies published in 1997. There was low risk of bias, as determined by assessment tool and visual inspection of funnel plots. CONCLUSIONS: The results support the current European Society of Clinical Nutrition and Metabolism guidelines recommending enteral over parenteral nutrition, when oral nutrition is inadequate, in adult patients. Further studies comparing EN and PN for these critical endpoints appear unnecessary, given the lack of change in meta-conclusion and low publication bias over the past decades.
INTRODUCTION:Weight loss in cancerpatients is a worrisome constitutional change predicting disease progression and shortened survival time. A logical approach to counter some of the weight loss is to provide nutritional support, administered through enteral nutrition (EN) or parenteral nutrition (PN). The aim of this paper was to update the original systematic review and meta-analysis previously published by Chow et al., while also assessing publication quality and effect of randomized controlled trials (RCTs) on the meta-conclusion over time. METHODS: A literature search was carried out; screening was conducted for RCTs published in January 2015 up until December 2018. The primary endpoints were the percentage of patients achieving no infection and no nutrition support complications. Secondary endpoints included proportion of patients achieving no major complications and no mortality. Review Manager (RevMan 5.3) by Cochrane IMS and Comprehensive Meta-Analysis (version 3) by Biostat were used for meta-analyses of endpoints and assessment of publication quality. RESULTS: An additional seven studies were identified since our prior publication, leading to 43 papers included in our review. The results echo those previously published; EN and PN are equivalent in all endpoints except for infection. Subgroup analyses of studies only containing adults indicate identical risks across all endpoints. Cumulative meta-analysis suggests that meta-conclusions have remained the same since the beginning of publication time for all endpoints except for the endpoint of infection, which changed from not favoring to favoring EN after studies published in 1997. There was low risk of bias, as determined by assessment tool and visual inspection of funnel plots. CONCLUSIONS: The results support the current European Society of Clinical Nutrition and Metabolism guidelines recommending enteral over parenteral nutrition, when oral nutrition is inadequate, in adult patients. Further studies comparing EN and PN for these critical endpoints appear unnecessary, given the lack of change in meta-conclusion and low publication bias over the past decades.
Entities:
Keywords:
Cancer patients; Enteral nutrition (EN); Malnutrition; Parenteral nutrition (PN); Standard care (SC); Tube feeding (TF)
Authors: Petra G Boelens; Fanny F B M Heesakkers; Misha D P Luyer; Kevin W Y van Barneveld; Ignace H J T de Hingh; Grard A P Nieuwenhuijzen; Arnout N Roos; Harm J T Rutten Journal: Ann Surg Date: 2014-04 Impact factor: 12.969
Authors: A Carrato; L Cerezo; J Feliu; T Macarulla; E Martín-Pérez; R Vera; J Álvarez; J I Botella-Carretero Journal: Clin Transl Oncol Date: 2021-08-07 Impact factor: 3.405