EOLP-05. SUPPLEMENTAL ENTERAL NUTRITION DOES NOT IMPROVE SURVIVAL IN OLDER PATIENTS WITH PRIMARY MALIGNANT BRAIN TUMORS

Abstract

Abstract BACKGROUND The risk of dysphagia increases with age and is prevalent among older adults with primary malignant brain tumors (PMBTs). As a result, patients with PMBTs may receive supplemental enteral nutrition (EN) but its impact on outcomes is uncertain. Therefore, we compared survival among Medicare beneficiaries with PMBTs and dysphagia by use of EN. METHODS We analyzed a Medicare 5% limited data set from 2013-2018. We included beneficiaries ≥65 years with PMBTs and solid tumors (lung, breast, melanoma, renal, and colorectal) identified by ICD9/10 codes. Predisposing conditions for dysphagia were excluded. To assess differences in survival of dysphagic patients by EN access (i.e., gastrostomy tube), hazard ratios and 95% confidence intervals (CI) from a Cox proportional-hazards model were calculated after adjusting for age, sex, race, and Elixhauser Comorbidity Index (ECI). RESULTS The rate of dysphagia among 79,926 beneficiaries was 4.7% (n=3,777), and significantly higher among those with PMBTs (11%, p< 0.01) compared to solid organ tumors with (8.0%) and without brain metastases (4.4%). Among patients with PBMTs, the presence of dysphagia was associated with lower survival compared to those without dysphagia (p< 0.001). For patients with PMBT and dysphagia, adjusted models showed no significant difference (p=0.08) in survival among those who received EN (N=78) compared to those that did not (N=271); however, those with EN had a 33% higher hazard of death compared to those without EN [HR= 1.34, 95% CI: (0.99, 1.81)]. CONCLUSION Dysphagia is common among older patients with brain cancer and disproportionally affects those with PMBTs. The use of EN in this population-based study of Medicare beneficiaries did not significantly improve survival and there was a trend toward harm. Given the frequency of EN use and observed worse outcomes, further validation in a larger clinical dataset is warranted.