ESPEN 2013 - Late breaking abstract submission
Late Breaking Abstract
ESPEN13-1820
WHAT IMPACT DO THE NEEDS-BASED COMPOSITION OF THE NUTRITION SOLUTION AND THE STARTING TIME OF AN HPN THERAPY HAVE ON THE OUTCOME IN PATIENTS WITH GASTROINTESTINAL TUMORS? – FIRST RESULTS FROM A NON-INTERVENTIONAL STUDY IN GERMAN OUTPATIENTS
M. Stauch 1J. Germeroth 2K. Blumenstenegel 3C. Hering-Schubert 4A. Glandt 5S. Karsten 6N. Nagel 7,*A. Crispin 8
1Ambulantes Zentrum für Hämatologie und Onkologie, Kronach, 2Onkologische Praxis, Reichenbach/Sa., 3Gemeinschaftspraxis für Hämatologie und Onkologie, 4Klinikum St. Georg Eisenach, Eisenach, 5Institut für Ernährungsphysiologie, Jena, 6B. Braun TravaCare, Halbergmoos, 7Medical Scientific Affairs OPM, B. Braun Melsungen AG, Melsungen, 8Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Ludwig-Maximilians-Universität München, München, Germany
Rationale: Unintended weight loss is common in advanced cancer patients. Home parenteral nutrition (HPN) is a therapy to maintain or improve the nutritional status. The aim of this study was to investigate
(1) the impact of the nutritional status -pre-cachectic or cachectic1)- at the start of HPN and
(2) the impact of the applied energy -< 15 kcal/kg/d: supplemental HPN (SHPN) or ≥ 15 kcal/kg/d: total HPN (THPN)-
on the development of patient body weight (BW) and body cell mass (BCM).
Methods: From a longitudinal, observational study from 2008 to 2011 (n=288), 54 patients with gastrointestinal tumors receiving HPN for at least 12 weeks were included in this analysis. The respective physicians decided the onset of HPN and the amount of calories prescribed. A linear mixed model was used to analyze the impact of the cofactors nutritional status and parenteral energy on BW and BCM under HPN over time.
Results: The average cachectic THPN patient gained 0.99 kg BW/month(mo) (p=0.013), and 0,55 kg BCM/mo (not significant; n.s.). Pre-cachectic in comparison to cachectic patients gained additional 0.33 kg BW/mo (n.s.) and 0.77 kg BCM/mo (p=0.022). In contrast to THPN, patients receiving SHPN on average lost 1.51 kg BW/mo (p=0,001) and 0.87 kg BCM/mo (p=0.014). Pre-cachectic and cachectic patients benefited from THPN providing sufficient energy. SHPN seemed to stabilize BCM in pre-cachectic patients but was insufficient to maintain their BW as well as the nutritional status of patients who were cachectic.
Conclusion: Sufficient energy supply seems to be more important than the nutritional status at the start of HPN for the maintenance of the nutritional status in patients with gastrointestinal tumors.
References: 1) Fearon K et al. Lancet Oncol 2011;12:489–95
Disclosure of Interest: M. Stauch Grant / Research Support from: B.BraunJ. Germeroth Grant / Research Support from: B.BraunK. Blumenstenegel Grant / Research Support from: B.BraunC. Hering-Schubert Grant / Research Support from: B.BraunA. Glandt Grant / Research Support from: B.BraunS. Karsten Other: Employee of B. Braun Melsungen AGN. Nagel Other: Employee of B. Braun Melsungen AGA. Crispin: None Declared
Keywords: cancer cachexiahome parenteral nutrition