Sayaka Arakawa1,2, Koji Amano3,4, Shunsuke Oyamada5, Isseki Maeda6, Hiroto Ishiki1, Tomofumi Miura7, Yutaka Hatano8, Akemi Shirado Naito9, Mamiko Sato10, Tetsuya Ito11, Kazuhiro Kosugi7, Satoshi Miyake12, Tatsuya Morita13, Masanori Mori13. 1. Department of Palliative Medicine, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan. 2. Department of Thoracic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan. 3. Department of Palliative Medicine, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan. kojiamano4813@gmail.com. 4. Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1 Yazakokarimata, Nagakute City, Aich, 480-1195, Japan. kojiamano4813@gmail.com. 5. Department of Biostatistics, JORTC Data Center, 2-54-6-302 Nishi-Nippori, Arakawa-ku, Tokyo, 116-0013, Japan. 6. Department of Palliative Care, Senri-Chuo Hospital, 1-4-3 Shinsenrihigashi-machi, Toyonaka City, Osaka, 560-0082, Japan. 7. Department of Palliative Medicine, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa City, Chiba, 277-8577, Japan. 8. Department of Palliative Care, Daini Kyoritsu Hospital, 5-28 Sakaemachi, Kawanishi City, Hyogo, 666-0033, Japan. 9. Department of Palliative Care, Miyazaki Medical Association Hospital, 1173 Arita, Miyazaki City, Miyazaki, 880-2102, Japan. 10. Department of Palliative Care, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai City, Miyagi, 980-8575, Japan. 11. Department of Palliative Care, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan. 12. Department of Internal Medicine, Palliative Care, Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan. 13. Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Kita-ku, Hamamatsu City, Shizuoka, 433-8558, Japan.
Abstract
PURPOSE: The benefits of parenteral nutrition and hydration (PNH) in patients with advanced cancer remain unknown. Therefore, we conducted a prospective multicenter cohort study to assess the effects of PNH on survival in patients with malignant bowel obstruction (MBO). METHODS: The present study was a secondary analysis. Data on primary nutritional administration routes during the first week of admission to palliative care units, i.e., parenteral nutrition and parenteral hydration, were obtained. Data on the averaged calorie sufficiency rate/total calorie intake (75% ≤ or 750 kcal/day ≤ , 50-75% or 500-750 kcal/day, 25-50% or 250-500 kcal/day, and < 25% or < 250 kcal/day) were also obtained. Participants with MBO were included and divided into two groups: PNH-high (25% ≤ or 250 kcal/day ≤) and PNH-low (< 25% or < 250 kcal/day). We performed time-to-event analyses using the Kaplan-Meier method, log-rank test, and univariate and multivariate Cox regression analyses. RESULTS: Patients were divided into the PNH-high (n = 68) and PNH-low (n = 76) groups. A significant difference was observed in survival rates between the two groups (log-rank P < 0.001). Median survival times were 35.5 (95% CI 27-44) and 17.5 (95% CI 13-21) days, respectively. In the multivariate-adjusted model, a significantly lower risk of mortality was observed in Cox's proportional hazard model in the PNH-high group (HR 0.55 (95% CI 0.36-0.83), P = 0.005) than in the PNH-low group. CONCLUSION: The present results indicated the beneficial effects of PNH for prolonging survival in advanced cancer patients with MBO in palliative care units.
PURPOSE: The benefits of parenteral nutrition and hydration (PNH) in patients with advanced cancer remain unknown. Therefore, we conducted a prospective multicenter cohort study to assess the effects of PNH on survival in patients with malignant bowel obstruction (MBO). METHODS: The present study was a secondary analysis. Data on primary nutritional administration routes during the first week of admission to palliative care units, i.e., parenteral nutrition and parenteral hydration, were obtained. Data on the averaged calorie sufficiency rate/total calorie intake (75% ≤ or 750 kcal/day ≤ , 50-75% or 500-750 kcal/day, 25-50% or 250-500 kcal/day, and < 25% or < 250 kcal/day) were also obtained. Participants with MBO were included and divided into two groups: PNH-high (25% ≤ or 250 kcal/day ≤) and PNH-low (< 25% or < 250 kcal/day). We performed time-to-event analyses using the Kaplan-Meier method, log-rank test, and univariate and multivariate Cox regression analyses. RESULTS:Patients were divided into the PNH-high (n = 68) and PNH-low (n = 76) groups. A significant difference was observed in survival rates between the two groups (log-rank P < 0.001). Median survival times were 35.5 (95% CI 27-44) and 17.5 (95% CI 13-21) days, respectively. In the multivariate-adjusted model, a significantly lower risk of mortality was observed in Cox's proportional hazard model in the PNH-high group (HR 0.55 (95% CI 0.36-0.83), P = 0.005) than in the PNH-low group. CONCLUSION: The present results indicated the beneficial effects of PNH for prolonging survival in advanced cancerpatients with MBO in palliative care units.
Authors: Anne Marie Sowerbutts; Simon Lal; Jana Sremanakova; Andrew Clamp; Chris Todd; Gordon C Jayson; Antje Teubner; Anne-Marie Raftery; Eileen J Sutton; Lisa Hardy; Sorrel Burden Journal: Cochrane Database Syst Rev Date: 2018-08-10