Feasibility and efficacy of enteral tube feeding on weight stability, lean body mass, and patient‐reported outcomes in pancreatic cancer cachexia

Autor: Sejal Mehta, Arsen Osipov, Marie Lauzon, Laith H. Jamil, Tyra Nguyen, Stephen J. Pandol, Jun Gong, Nicholas N. Nissen, Haesoo Kim, Andrew Eugene Hendifar, Gillian Gresham, Veronica Placencio-Hickok, Shirley C Paski, Simon K. Lo
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Male
Cachexia
Physiology
Diseases of the musculoskeletal system
Enteral administration
law.invention
Randomized controlled trial
law
Orthopedics and Sports Medicine
Functional ability
Prospective Studies
Cancer
Patient‐reported outcomes
Cancer cachexia
Middle Aged
Weight stability
Lean body mass
Original Article
Female
Enteral nutrition
medicine.medical_specialty
Clinical Trials and Supportive Activities
Clinical Sciences
Pancreatic Cancer
Enteral Nutrition
Rare Diseases
Clinical Research
Physiology (medical)
Internal medicine
medicine
Humans
Patient Reported Outcome Measures
Feeding tube
Aged
Nutrition
Patient-reported outcomes
business.industry
Prevention
Weight change
QM1-695
Original Articles
Human Movement and Sports Sciences
medicine.disease
Pancreatic Neoplasms
Parenteral nutrition
Good Health and Well Being
RC925-935
Human anatomy
Quality of Life
Feasibility Studies
business
Digestive Diseases
Advanced pancreatic ductal adenocarcinoma
Zdroj: Journal of Cachexia, Sarcopenia and Muscle, Vol 12, Iss 6, Pp 1959-1968 (2021)
Journal of cachexia, sarcopenia and muscle, vol 12, iss 6
Journal of Cachexia, Sarcopenia and Muscle
ISSN: 2190-5991
2190-6009
Popis: BackgroundAdvanced pancreatic ductal adenocarcinoma (PDAC) is characterized by progressive weight loss and nutritional deterioration. This wasting has been linked to poor survival outcomes, alterations in host defenses, decreased functional ability, and diminished health-related quality of life (HRQOL) in pancreatic cancer patients. There are currently no standardized approaches to the management of pancreatic cancer cachexia. This study explores the feasibility and efficacy of enteral tube feeding of a peptide-based formula to improve weight stability and patient-reported outcomes (PROs) in advanced PDAC patients with cachexia.MethodsThis was a single-institution, single-arm prospective trial conducted between April 2015 and March 2019. Eligible patients were adults (>18years) diagnosed with advanced or locally advanced PDAC and cachexia, defined as greater than 5% unexplained weight loss within 6months from screening. The study intervention included three 28day cycles of a semi-elemental peptide-based formula, administered through a jejunal or gastrojejunal feeding tube. The primary outcome was weight stability at 3months (Cycle 3), defined as weight change less than 0.1kg/baseline BMI unit from baseline. Secondary outcomes included changes in lean body mass, appendicular lean mass, bone mineral density, fat mass, and percent body fat, as measured with a DEXA scan, HRQOL (EORTC QLQC30) and NIH PROMIS PROs assessed at each cycle. Daily activity (steps, distance, active minutes, heart rate, and sleep) were remotely monitored using a wearable activity monitor (Fitbit) over the 3month study period.ResultsThirty-six patients were screened for eligibility, 31 patients consented onto study and underwent jejunal tube placement, and 16 patients completed treatment: mean age 67years (SD 9.3), 43.8% male. Among evaluable patients (n=16), weight stability was achieved in 10 patients (62.5%), thus completing the trial early. Increases in lean body mass (1273.1, SD: 4078, P=0.01) and appendicular lean mass (0.45, SD: 0.6, P=0.02) were observed. Statistically significant improvements at Cycle 3 from baseline were also observed for QLQC30 role function [mean difference (MD): 20.1, P=0.03], appetite (MD: 27.4, P=0.02), and global health scores (MD: 13.3, P=0.05) as well as for NIH PROMIS t-scores for depression (MD: -10.4, P=0.006) and pain interference (MD: -7.5, P=0.05). Objectively monitored (Fitbit) activity levels increased, although statistical significance was not reached.ConclusionsOur findings suggest that enteral nutrition support may improve weight stability, lean body mass, appendicular lean mass and PROs in PDAC patients with cachexia who completed treatment, representing a subsample of the study population. The feasibility and role of enteral feeding in routine care remain unclear, and larger and randomized controlled trials are warranted.
Databáze: OpenAIRE
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