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The Influence of Early Supplementation of Parenteral Nutrition on Quality of Life and Body Composition in Patients With Advanced Cancer

Edward Shang, MD^*, Christel Weiss, PhD, Stefan Post, MD^* and Georg Kaehler, MD^*

From the ^* Department of Surgery; and the Department of Biostatistics, University Hospital Mannheim, Mannheim, Germany

Correspondence: Edward Shang, MD, University Hospital Manheim, Department of Surgery, Theodor-Kutzer-Ufer 1–3, 68135 Mannheim, Germany. Electronic mail may be sent to edward.shang{at}urz.uni-heidelberg.de.

Background: According to current evidence, most organizations, including the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.), do not recommend the routine use of artificial nutrition for patients with cancer. Despite the recommendation for parenteral nutrition (PN), data for early PN supplementation (PNS) in patients with an advanced malignancy are extremely limited, especially in terms of the affects on nutrition outcomes, body composition, and quality of life (QOL), as well as effects on oncologic outcomes. The aim of the study was to evaluate the effect of PNS on body composition and the quality of life in patients with advanced malignancies. Methods: One hundred fifty-two consecutive patients with advanced cancer were prospectively randomized to either use of oral enteral nutrition supplement (PN–) or use of oral enteral nutrition supplement plus supplemental PN (PN+). Body weight, body mass index (BMI), and caloric intake were assessed, and hemoglobin (g/dL) and serum albumin (g/L) were measured. Body composition was assessed by body impedance analysis (BIA), and QOL was evaluated by European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire every 6 weeks. Results: No significant differences were evident at baseline between the 2 groups for age, gender, medical diagnosis, weight, BMI, or QOL. A statistically significant difference in mean BMI was observed by week 48 for the PN+ group (PN+ = 21.9, PN–= 20.5, p = .0149), by week 6 in mean body cell mass (PN+ = 55%, PN–= 50,1%, p < .001), mean albumin (PN+ = 40.2 g/L, PN–= 36.2 g/L, p = .015), mean QOL (PN+ = 55.7, PN–= 50.9, p = .035). The cumulative survival rate was significantly greater in the PN+ group (p < .0001). Conclusions: According to the positive effect of supplemental PN on survival, body composition, and QOL, additional controlled studies must be conducted to confirm these findings.

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