Use of oral nutrition supplements and enteral nutrition in head and neck and esophageal cancers: Findings from the International Nutrition Audit in Foregut Tumors (INFORM)
Nutrition, Food Science and Packaging
Journal of Parenteral and Enteral Nutrition
Purpose: Despite their risk for developing cancer-associated malnutrition, little is known about how well oral nutrition supplements (ONS) and enteral nutrition (EN) is being delivered to head and neck (HN) and esophageal (E) cancer patients. The purpose of this abstract is to describe the use of ONS and EN in HN and E cancers across several international care settings.
Methods: In a multicenter prospective audit, adult patients with curative HN or E cancer were enrolled from 11 international cancer care settings in North America, Europe and Australia. Baseline patient data on patient characteristics and nutrition support (NS) were obtained by a dietitian or nutritionist over 6 months, including start of EN, duration, reasons for initiating EN, percent of target energy and protein goals received. Descriptive analyses using medians, interquartile ranges [Q1-Q3] and percentages are reported overall or separately by HN and E cancer patients.
Results: Between 2016 and 2018, 170 pts (121 HN and 49 E cancer) were enrolled. A total of 137 patients, 88/121 (73%) HN patients and all 49 E patients had their nutrition needs assessed over the 6-month period and are included in this analysis. See Table 1 for patient characteristics, prescribed energy and protein gaols and route of nutrition received over 6-months. There were no significant differences in the route of nutrition between HN and E patients. A significantly higher % HN patients (45%) received >75% prescribed volume of ONS compared to E patients (27%), p=0.022. Overall, 63% patients received EN (no differences between HN and E) for median [Q1-Q3] of 140 [66-255] days. HN patients tended to 2020 ASPEN Nutrition Science & Practice Conference 61 start EN significantly sooner after admission (20 [4-39] days) than E patients (86 [0-105] days), p =0.001. Forty-nine % of patients received EN for proactive reasons and this was similar in both groups. The percentage of HN and E patients who received EN for reactive reasons was 59% and 77% (p=0.102). Gastric route was used in all 56/56 (100%) HN patients vs. 11/31 (35%) in E patients, p<0.001; while jejunal route was predominant in E patients (25/31, 81%) but never used in HN patients p<0.001. EN via the gastric route tended to start earlier in E patients vs. HN patients (0 [0-57] vs. 20 [4-39] days, p=0.105) whereas jejunal feeds in E patents started 90 days [19-105] from admission. Energy and protein in patients receiving EN via gastric route were not statistically different from those receiving jejunal. Overall median % target energy received from any route in HN vs. E patients was 79% vs. 77% (p=0.3) while the % target rate for protein was statistically higher in HN patients than E (79% vs. 74%, p=0.041; Table 1).
Conclusion: Route of nutrition (oral, EN or combination), start of enteral nutrition and % target energy and protein received from any route of nutrition are similar in HN and E patients. However, E patients compared to HN patients tended to receive significantly lower % prescribed ONS; started EN reactively and later (unless gastric route) with jejunal route being more predominant. Percent target protein received from any route tended to be higher in HN vs E patients.
Financial Support: The INFORM Study is partially supported from Royal Alexandra Hospital Foundation, Fresenius Kabi Deutschland GmbH and Baxter. Travel support has been provided by Baxter and Nestle.
Leah Gramlich, Rupinder Dhaliwal, Lisa Martin, Marian De Van Der Schueren, Alessandro Laviano, Merran Findlay, Judy Bauer, Merrilyn Banks, and Adrianne Widaman. "Use of oral nutrition supplements and enteral nutrition in head and neck and esophageal cancers: Findings from the International Nutrition Audit in Foregut Tumors (INFORM)" Journal of Parenteral and Enteral Nutrition (2020). https://doi.org/10.1002/jpen.1813