Evaluation of Parenteral Nutrition Utilization in Oncology Patients

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Evaluation of Parenteral Nutrition Utilization in
Oncology Patients
CPA-MPS Conference Malaysia 2007

• Sivakami Janahiraman, SM Yew, Che Ton Saari
  Pharmacy Division, Hospital Kuala Lumpur (HKL)
  

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INTRODUCTION

• Parenteral Nutrition (PN) -therapeutic
  intravenous administration of nutrients
• Indicated in cases where oral or enteral feeding
  is-
• Insufficient
• Impossible
• Undesirable
• (Messing B, 2000 Giovanni F et al, 1999)

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INTRODUCTION

• Malnutrition is a common manifestation of cancer
  which is often present with loss of appetite and
  ineffective utilization of nutrients.
• Impact of malnutrition
• Higher risk of infection
• Poorer tolerance and response to treatment
• Lower quality of life
• Shorter survival
• (Grant et al, 1994 Ottery, 1996 Nitenberg
  Raynard, 2000)

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INTRODUCTION

• The use of nutritional therapy in cancer
• patients is tailored to complement the
• primary treatment
• PN support in surgery
• PN support during chemotherapy
• PN in radiation therapy

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GENERAL OBJECTIVE
To elucidate the appropriateness of PN support
in cancer patients using the criteria of
nutritional status and ultimate outcome
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SPECIFIC OBJECTIVES

• To identify the demographic characteristics of
  cancer patients
• To obtain the diagnosis or related medical
  problem of patients
• To identify the method of PN delivery
• To analyze the quantity of PN preparations and
  duration of nutritional support provided
• To evaluate type of regimen administered to
  patients

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METHODOLOGY

• Setting Hospital Kuala Lumpur
• Design Retrospective study
• Subjects Cancer patients
• Study location
• Record Units - Wisma Kayu (K2)
• Surgical Out-Patient Dept
• Oncology and Radiotherapy Dept
• Urology and Nephrology Dept
• Study period January 2005 December 2005

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SELECTION CRITERIA
INCLUSION CRITERIA EXCLUSION CRITERIA
Adult (gt18 years) patients Paediatric (lt18years) patients
Received Total Parenteral Nutrition Preterm neonates
Patients with complete medical record
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STUDY FLOW CHART
SCREENING OF PATIENTS RECORD IN TPN PHARMACY
(n159)
PATIENTS FIT INCLUSION / EXCLUSION CRITERIA
SELECTED AS SUBJECTS (n69)
DATA COLLECTION
RECORD UNIT
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STUDY FLOW CHART
K 2, SOPD, RT UN
DATA COMPLETION (filling up incomplete details)
INSUFFICIENT DATA
COMPLETE DATA (n56)
DATA ANALYSIS
REJECTED (n13)
CONCLUSION
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METHODOLOGY

• Nutritional status was determined by
• Serum albumin level lt 35 g/L
• (Jeliffe 1966 Bishop et al 1981, Ireton J
  Hasse J 1992)
• Total protein lt 60g/L
• (Jeliffe 1966, Bishop et al 1981, Kotler DP 2000
  )
• Total lymphocyte count lt 1.5 x 10-9/L
• (Jeliffe 1966 Bishop et al 1981)
• Ultimate outcome were one of the following
• Improved
• Declined
• Death

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RESULTS DISCUSSION
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DEMOGRAPHIC
Distribution of patients by age and gender

• Mean age female (23.2) - 59.5 16.7years
• male (76.8) - 55.5 15.4 years
• There was no significant association between age
  and gender (p 0.424).
• Majority of subjects were Malays(28) followed by
  Chinese(17) and Indians(11).

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Route of PN administration

• Peripheral 1 to 15 days (mean 5 7days)
• Central 1 to 25 days (mean 10 9days)

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Total PN preparations provided to patients
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• 23 of the patients received compounded PN upon
  initiation (n13).

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93 malnourished
70 malnourished
73 malnourished
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55 malnourished
48 malnourished
37 malnourished
Nutritional status correlated positively with
albumin, total protein and total lymphocyte count
(r0.312, plt0.01).
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No significant difference in nutritional status
among cancer patients with regard to duration of
PN provided F(1,54) 0.238, pgt0.05.
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No significant difference in outcome and
duration of PN supplementation F(1,54)
0.238, pgt0.05.
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DISCUSSION

• Prevalence of malnutrition in this study as
  identified by using serum albumin, total protein
  and TLC as indicator was comparable to that found
  in other studies
• Bauer et al 2002 prevalence of malnutrition in
  oncology inpatients 76
• Results of nutritional status and outcomes differ
  from other similar studies
• Neither adjunctive therapy nor supportive PN
  improved quality of life and ultimate outcome in
  terminally ill cancer patients
• (Giovanni et al 1999)

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CONCLUSION

• Most oncology patients are malnourished before
  nutritional intervention
• Early identification of patients at risk of
  malnutrition is necessary
• Carefully targeted parenteral nutrition may
  benefit patients and improve outcome

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• Thank You.