Introduction Nutritional problems in upper gastrointestinal (UGI) cancer are common and artificial nutrition support (ANS) is sometimes needed to meet requirements. Whilst ANS could have a positive impact on nutritional status, this may not always improve quality of life (QoL) due to problems with tube placement and function potentially causing psychological distress.1We aim to investigate the incidence of tube related complications in this patient group.
Method All UGI cancer patients treated by the oncology team who received ANS in 2014 were included. We looked at the number of episodes of feeding rather than number of patients as some switched between feeding routes. Patients receiving ANS in the immediate post operative period who remained under the care of the surgical team only were excluded. Data was analysed descriptively.
Results There were 86 feeding episodes of amongst 67 patients. 76% of these episodes were in oesophageal cancer patients. 43%, 17% and 11% were in patients receiving high dose radiotherapy, palliative chemotherapy and best supportive care respectively. 26%, 22% and 17% of the feeding episodes used nasojejunal tube (NJT), jejunostomy tube or radiologically inserted gastrostomy respectively. Common reasons for ANS were dysphagia (37%), eating problems relating to UGI surgery (14%) and side effects of high dose radiotherapy (13%). The most common complications were tube displacement (21%), infected stoma site (12%) and blocked tube (10%).
60% of these episodes had feeding tubes in situfor >30 days and 60% also continued ANS at home. Median time on ANS was 40 days (Range: 1–365+ days). 38% of patients were admitted to hospital due to a feeding tube complication. Reasons for admission were hydration and treatment of a stoma infection.
Conclusion Tube related complications are particularly common amongst NJT and jejunostomy tubes. Further guidance on tube care and dietetic support to patients and their carers needs to be in place to reduce the frequency of these complications and reduce admissions resulting from this. Consideration may be needed as to whether other feeding tubes may be more appropriate in some patients which carry less complications. Further research on the clinical outcomes of ANS in UGI cancers and the effect of ANS on QoL would help to better support clinical practice.
Disclosure of interest None Declared.
Bozetti F. Quality of life and enteral nutrition. Curr Opin Clin Nutr Metab Care. 2008;11(5):661–5