Palliative Considerations Regarding Enteral Access in Surgical Patients

Abstract

With a focus on advanced-stage cancer patients, this review will highlight applications of nutrition support both as an adjunct therapy for a subset of conditions and as a key standard of practice in palliative care. Recent studies indicate the importance of early integration of palliative care into the treatment of patients with advanced cancer. Advances in the field of cancer-directed therapies have led to historically incurable cancers being treated more like chronic diseases. The type, method, and role of nutrition in the management of these patients are critical components of the treatment of advanced cancer patients. Nutrition support for surgical, critically or terminally ill patients has undergone significant advances in the last decades. These patients are at an increased risk of malnutrition. Acute and chronic illness, trauma, inflammation stress-related catabolism, and drug-induced adverse effects may reduce appetite or increase nausea and vomiting in such patients. Proper surgical palliation for an incurable disease aims to incorporate the ethos of palliative care into an acute setting and this requires a multidisciplinary approach, primarily concentrating on improving patients’ quality of life. An important element of providing palliation to patients with late-stage cancer is to understand the role of nutrition. Methods to deliver nutrition include provision of either enteral nutrition, parenteral nutrition, or a combination of both. Enteral access is considered in patients who cannot ingest food normally but whose gastrointenstinal (GI) tract is adequate for digestion and absorbtion of required nutrients. Regardless of the type of advanced cancer, the overall objectives of palliative interventions must be clearly defined before proceeding and re-evaluated often, for all patients in whom enteral access is being considered.