Introduction A significant amount of head and neck (H&N) and upper gastrointestinal (UGI) cancer patients require enteral nutrition (EN) at home. At our centre in 2014 alone we established 156 H&N patients and 52 UGI patients on home EN. However, a significant proportion of cancer patients with other tumours may also require EN. ESPEN guidelines recommend EN should be considered if under-nutrition exists, oral intake is < 60% of requirements and prognosis exceeds 2–3 months.1Our aim was to determine the extent of EN use in non-surgical oncology patients (excluding H&N and UGI patients) and to compare its use against ESPEN guidelines.
Method We undertook a retrospective review of dietetic records between January 2013 and December 2014 for all patients who required home EN. Data was analysed descriptively.
Results 17 patients were initiated on EN during the data collection period. 16 patients were fed via naso-gastric tube (NGT) and 1 via percutaneous endoscopic gastrostomy (PEG), with 2 of the NGT’s later converted to gastrostomies. Table 1shows the number of patients with EN by tumour site and stage of cancer pathway. The main indication for EN was dysphagia secondary to disease (76%), oesophagitis secondary to radiotherapy (12%), inadequate oral intake (6%) and tracheal-oesophageal fistula (6%). 12 patients were nil by mouth due to aspiration risk and 5 were managing < 60% of estimated nutritional requirements. Only 3 (18%) patients were given a predicted prognosis of <3 months but all were fed following MDT discussion with the aim of improving quality of life (QOL).
Conclusion A small but significant proportion of oncology patients require home EN outside of H&N and UGI cancers. In particular lung cancer patients may have a need for EN due to swallowing difficulties where the cause can be multifactorial.2Our practice appears compliant with ESPEN guidelines with all patients managing less than 60% of requirements on initiation of feeding and prognosis was > 3 months in all but 3 patients. However, the effectiveness of EN is rarely recorded and greater consideration should be given to validated outcome measures both in terms of anthropometry and QOL.
Disclosure of interest None Declared.
Arends J, et al. ESPEN Guidelines on Enteral Nutrition: Non surgical oncology. Clin Nutr. 2006;25:245–259.
Camidge D. The causes of dysphagia in carcinoma of the lung. J Roy Soc Med. 2001;94:567–572.