Enteral and parenteral nutrition in patients with cancer: complication rates compared-updated systematic review and meta-analysis.

IF 2 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES BMJ Supportive & Palliative Care Pub Date : 2025-01-31 DOI:10.1136/spcare-2024-005244

Ronald Chow, James H B Im, Jann Arends, Egidio Del Fabbro, Lukas Mortensen-Truscott, Denis Qeska, Shilpa Balaji, Chris Walsh, Geoffrey Watson, Michael Lock, Elizabeth Prsic, Lawson Eng, Camilla Zimmermann, Eduardo Bruera

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引用次数: 0

Abstract

Background: The aim of this systematic review and meta-analysis is to compare the complication rates of enteral nutrition (EN) (oral or tube feeding (TF)) and parenteral nutrition (PN) in patients with any cancer.

Methods: A systematic review of the literature until 2024 was conducted, including randomised controlled trials comparing EN and PN with respect to one or more of four endpoints: (1) infection, (2) nutrition support complications, (3) major complications and (4) mortality. A meta-analysis was conducted to generate summary effect estimates. Analysis was stratified by paediatric (≤21 years old) versus adults (>21 years old) patients. Subgroup analyses were conducted, based on including patients with (vs without) protein-energy malnutrition (PEM) and type of EN. Cumulative meta-analysis and leave-one-out analysis was conducted. Type I error was set at 0.05.

Results: 49 studies reporting on 6361 patients were included: 41 reported on adults and 8 on children. Among adults, the infection rate was higher for PN compared with EN (risk ratio=1.07, 95% CI: 1.00 to 1.14), with no differences in rates of nutrition support complications, major complications or mortality. Among children, there were no differences in all four endpoints. On cumulative meta-analysis, EN was overall marginally superior to PN for infection, although results fluctuated over time between superiority and no difference. Subgroup analysis found no differences in effects among patients with (vs without) PEM and patients provided with EN options of standard care versus TF.

Discussion: From the perspective of complications, EN and PN are equivalent, with EN demonstrating marginal superiority for infection among adults.

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来源期刊

BMJ Supportive & Palliative Care Medicine-Medicine (miscellaneous)

CiteScore

4.60

自引率

7.40%

发文量

170

期刊介绍： Published quarterly in print and continuously online, BMJ Supportive & Palliative Care aims to connect many disciplines and specialties throughout the world by providing high quality, clinically relevant research, reviews, comment, information and news of international importance. We hold an inclusive view of supportive and palliative care research and we are able to call on expertise to critique the whole range of methodologies within the subject, including those working in transitional research, clinical trials, epidemiology, behavioural sciences, ethics and health service research. Articles with relevance to clinical practice and clinical service development will be considered for publication. In an international context, many different categories of clinician and healthcare workers do clinical work associated with palliative medicine, specialist or generalist palliative care, supportive care, psychosocial-oncology and end of life care. We wish to engage many specialties, not only those traditionally associated with supportive and palliative care. We hope to extend the readership to doctors, nurses, other healthcare workers and researchers in medical and surgical specialties, including but not limited to cardiology, gastroenterology, geriatrics, neurology, oncology, paediatrics, primary care, psychiatry, psychology, renal medicine, respiratory medicine.