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Perception of need for nutritional support in advanced cancer patients with cachexia: a survey in palliative care settings

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Abstract

Purpose

Few studies have investigated the need for nutritional support in advanced cancer patients in palliative care settings. Therefore, we conducted a questionnaire to examine the relationship between the perception of need for nutritional support and cancer cachexia and the prevalence of specific needs, perceptions, and beliefs in nutritional support.

Methods

We conducted a questionnaire in palliative care settings. Patients were classified into two groups: (1) non-cachexia/pre-cachexia and (2) cachexia/refractory cachexia.

Results

A total of 117 out of 121 patients responded (96.7%). A significant difference was observed in the need for nutritional support between the groups: non-cachexia/pre-cachexia (32.7%) and cachexia/refractory cachexia (53.6%) (p = 0.031). The specific needs of patients requiring nutritional support were nutritional counseling (93.8%), ideas to improve food intake (87.5%), oral nutritional supplements (83.0%), parenteral nutrition and hydration (77.1%), and tube feeding (22.9%). The top perceptions regarding the best time to receive nutritional support and the best medical staff to provide nutritional support were “when anorexia, weight loss, and muscle weakness become apparent” (48.6%) and “nutritional support team” (67.3%), respectively. The top three beliefs of nutritional treatments were “I do not wish to receive tube feeding” (78.6%), “parenteral nutrition and hydration are essential” (60.7%), and “parenteral hydration is essential” (59.6%).

Conclusions

Patients with cancer cachexia expressed a greater need for nutritional support. They wished to receive nutritional support from medical staff when they become unable to take sufficient nourishment orally and the negative impact of cachexia becomes apparent. Most patients wished to receive parenteral nutrition and hydration.

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References

  1. Fearon KC, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL, Jatoi A, Loprinzi C, MacDonald N, Mantovani G, Davis M, Muscaritoli M, Ottery F, Radbruch L, Ravasco P, Walsh D, Wilcock A, Kaasa S, Baracos VE (2011) Definition and classification of cancer cachexia: an international consensus. Lancet Oncol 12:489–495

    Article  PubMed  Google Scholar 

  2. Tisdale MJ (2009) Mechanisms of cancer cachexia. Physiol Rev 89:381–410

    Article  PubMed  CAS  Google Scholar 

  3. Radbruch L, Elsner F, Trottenberg P, Strasser F, Fearon K (2010) Clinical practice guidelines on cancer cachexia in advanced cancer patients with a focus on refractory cachexia: European clinical guidelines. Aachen, Department of Palliative Medicine/ European Palliative Care Research Collaborative

  4. Fearon K, Glass DJ, Guttridge DC (2012) Cancer cachexia: mediators, signaling, and metabolic pathways. Cell Metab 16:153–166

    Article  PubMed  CAS  Google Scholar 

  5. Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F, Fearon K, Hütterer E, Isenring E, Kaasa S, Krznaric Z, Laird B, Larsson M, Laviano A, Mühlebach S, Muscaritoli M, Oldervoll L, Ravasco P, Solheim T, Strasser F, de van der Schueren M, Preiser JC (2017) ESPEN guidelines on nutrition in cancer patients. Clin Nutr 36:11–48

    Article  PubMed  Google Scholar 

  6. Amano K, Maeda I, Morita T, Baba M, Miura T, Hama T, Mori I, Nakajima N, Nishi T, Sakurai H, Shimoyama S, Shinjo T, Shirayama H, Yamada T, Ono S, Ozawa T, Yamamoto R, Yamamoto N, Shishido H, Kinoshita H (2017) C-reactive protein, symptoms and activity of daily living in patients with advanced cancer receiving palliative care. J Cachexia Sarcopenia Muscle 8:457–465

    Article  PubMed  PubMed Central  Google Scholar 

  7. Reid J, Santin O, Porter S (2012) The psychological and social consequences of cachexia in patients with advanced cancer: a systematic review. Cachexia Conference; Boston, USA. J Cachexia Sarcopenia Muscle 3:281–301

    Article  Google Scholar 

  8. Oberholzer R, Hopkinson JB, Baumann K, Omlin A, Kaasa S, Fearon KC, Strasser F (2013) Psychosocial effects of cancer cachexia: a systematic literature search and qualitative analysis. J Pain Symptom Manag 46(1):77–95

    Article  Google Scholar 

  9. Hopkinson JB (2014) Psychosocial impact of cancer cachexia. J Cachexia Sarcopenia Muscle 5:89–94

    Article  PubMed  PubMed Central  Google Scholar 

  10. Amano K, Maeda I, Morita T, Tatara R, Katayama H, Uno T, Takagi I (2016) Need for nutritional support, eating-related distress and experience of terminally ill cancer patients: a survey in an inpatient hospice. BMJ Support Palliat Care 6(3):373–376

    Article  PubMed  Google Scholar 

  11. Amano K, Maeda I, Morita T, Okajima Y, Hama T, Aoyama M, Kizawa Y, Tsuneto S, Shima Y, Miyashita M (2016) Eating-related distress and need for nutritional support of families of advanced cancer patients: a nationwide survey of bereaved family members. J Cachexia Sarcopenia Muscle 7(5):527–534

    Article  PubMed  PubMed Central  Google Scholar 

  12. Good P, Richard R, Syrmis W et al (2014) Medically assisted nutrition for adult palliative care patients. Cochrane Database Syst Rev 23(4):CD006274

    Google Scholar 

  13. Amano K, Morita T, Baba M et al (2013) Effect of nutritional support on terminally ill patients with cancer in a palliative care unit. Am J Hosp Palliat Care 30(7):728–731

    Article  Google Scholar 

  14. Amano K, Maeda I, Ishiki H et al (2016) A feasibility study to investigate the effect of nutritional support for advanced cancer patients in an inpatient hospice in Japan. Palliat Med Hosp Care Open J 2(2):37–45

    Article  Google Scholar 

  15. Aapro-Piancentini M, Arends J, Bozzetti F et al (2014) Early recognition of malnutrition and cachexia in the cancer patient: a position paper of a European School of Oncology Task Force. Ann Oncol 25(8):1492–1499

    Article  Google Scholar 

  16. Lee JL, Leong LP, Lim SL (2016) Nutrition intervention approaches to reduce malnutrition in oncology patients: a systemic review. Support Care Cancer 24(1):469–480

    Article  PubMed  Google Scholar 

  17. Laviano A, Di Lazzaro Giraldi G, Koverech A (2016) Does nutrition support have a role in managing cancer cachexia? Curr Opin Support Palliat Care 10(4):288–292

    Article  PubMed  Google Scholar 

  18. Bruera E, Kuehn N, Miller MJ, Selmser P, Macmillan K (1991) The Edmonton Symptom Assessment System (ESAS): a simple method for the assessment of palliative care patients. J Palliat Care 7:6–9

    PubMed  CAS  Google Scholar 

  19. Yokomichi N, Morita T, Nitto A, Takahashi N, Miyamoto S, Nishie H, Matsuoka J, Sakurai H, Ishihara T, Mori M, Tarumi Y, Ogawa A (2015) Validation of the Japanese version of the Edmonton Symptom Assessment System-revised. J Pain Symptom Manag 50(5):718–723

    Article  Google Scholar 

  20. Morita T, Miyashita M, Shibagaki M, Hirai K, Ashiya T, Ishihara T, Matsubara T, Miyoshi I, Nakaho T, Nakashima N, Onishi H, Ozawa T, Suenaga K, Tajima T, Akechi T, Uchitomi Y (2006) Knowledge and beliefs about end-of-life care and the effects of specialized palliative care: a population-based survey in Japan. J Pain Symptom Manag 31(4):306–316

    Article  Google Scholar 

  21. Bükki J, Unterpaul T, Nübling G, Jox RJ, Lorenzl S (2014) Decision making at the end of life—cancer patients’ and their caregivers’ views on artificial nutrition and hydration. Support Care Cancer 22(12):3287–3299

    Article  PubMed  Google Scholar 

  22. Torres-Vigil I, Cohen MZ, de la Rosa A, Cárdenas-Turanzas M, Burbach BE, Tarleton KW, Shen WM, Bruera E (2012) Food or medicine: ethnic variations in perceptions of advanced cancer patients and their caregivers regarding artificial hydration during the last weeks of life. BMJ Support Palliat Care 2(3):276–279

    Article  PubMed  PubMed Central  Google Scholar 

  23. Druml C, Ballmer PE, Druml W, Oehmichen F, Shenkin A, Singer P, Soeters P, Weimann A, Bischoff SC (2016) ESPEN guideline on ethical aspects of artificial nutrition and hydration. Clin Nutr 35:545–556

    Article  PubMed  Google Scholar 

  24. Cohen MZ, Torres-Vigil I, Burbach BE, de la Rosa A, Bruera E (2012) The meaning of parenteral hydration to family caregivers and patients with advanced cancer receiving hospice care. J Pain Symptom Manag 43(5):855–865

    Article  Google Scholar 

  25. Epstein AS, Morrison RS (2012) Palliative oncology: identity, progress, and the path ahead. Ann Oncol 23(Suppl 3):43–48

    Article  PubMed  PubMed Central  Google Scholar 

  26. Hui D, Finlay E, Buss MK, Prommer EE, Bruera E (2015) Palliative oncologists: specialists in the science and art of patient care. J Clin Oncol 33(20):2314–2317

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors received no financial support for the research, authorship, or publication of this manuscript. We are very grateful to the nurses of the palliative care team in Osaka City General Hospital, Ms. Namiki Kitada, Ms. Hiromi Fumimoto, Ms. Emi Sato, Ms. Rie Ota, Ms. Sayuri Tojima, and Ms. Chika Shiraishi, for their collection of the questionnaires analyzed in this study.

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Authors and Affiliations

  1. Department of Palliative Medicine, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka City, Osaka, 534-0021, Japan

    Koji Amano, Jiro Miyamoto, Teruaki Uno, Hirofumi Katayama & Ryohei Tatara

  2. Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Kita-ku, Hamamatsu City, Shizuoka, 433-8558, Japan

    Tatsuya Morita

Authors
  1. Koji Amano
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  2. Tatsuya Morita
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  3. Jiro Miyamoto
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  4. Teruaki Uno
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  5. Hirofumi Katayama
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  6. Ryohei Tatara
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Corresponding author

Correspondence to Koji Amano.

Ethics declarations

The completion and return of the questionnaire was regarded as consent to participate in this study. The Institutional Review Board approved this study.

Conflict of interest

The authors declare that they have no conflict of interest.

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Amano, K., Morita, T., Miyamoto, J. et al. Perception of need for nutritional support in advanced cancer patients with cachexia: a survey in palliative care settings. Support Care Cancer 26, 2793–2799 (2018). https://doi.org/10.1007/s00520-018-4104-6

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  • DOI: https://doi.org/10.1007/s00520-018-4104-6

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