Adequate calorie and protein administration via enteral nutrition may contribute to improved 30-day survival in patients with solid tumors at nutritional risk

Abstract

Patients with cancer receiving adequate enteral nutrition (EN) have improved clinical outcomes. Unfortunately, discrepancies may exist between the amounts prescribed and received. This study aimed to investigate: (1) the receiving exclusive EN, (2) the relationship between inadequacy and unfavorable outcomes, and (3) the impact of inadequate EN administration on the survival of patients with cancer. This study included hospitalized patients with solid tumors who exclusively received EN and were evaluated using data extracted from electronic medical records. Nutritional risk was evaluated using Nutritional Risk Screening (NRS - 2002). EN adequacy was assessed from days 3-7 of hospitalization. Calorie and protein delivery by EN was classified as adequate (≥80% of EN administration) or inadequate (<80% of EN administration). Data were analyzed using dispersion and Bland-Altman plots, Pearson's chi-square and Fisher's exact tests, and Kaplan-Meier survival curves. A total of 114 patients were evaluated (63.9±13.1 years of age, 67.5% male, 32.5% with head and neck cancer, and 86.8% at nutritional risk). During the 5-day evaluation period, only 14% of the patients received the mean volume, proteins, and calories according to the EN prescription. A relationship was observed between inadequate EN (<80%) and 30-day in-hospital mortality. This result was confirmed by Kaplan-Meier survival analysis (p=0.020), which showed a survival benefit in patients at nutritional risk who received adequate calories and protein. This study demonstrated significant caloric and protein deficits related with EN. Furthermore, adequate calorie and protein administration could contribute to improved survival in patients with cancer who are at a risk of malnutrition, however, randomized controlled trials are required to confirm whether adequate calorie administration could contribute to improved survival.