For patients with cancer who are experiencing unintentional weight loss and insufficient oral nutrition, enteral nutrition (EN) may be preferred over parenteral nutrition (PN), according to a report recently published in Support Care Cancer.1
The report was based on an updated literature review and meta-analysis that included 43 randomized, controlled trials on EN and PN. It consisted of analyses of 36 studies that had been evaluated for an earlier report, with the addition of 7 new studies with publication dates from 2015 through 2018. Primary endpoints involved infection rates and rates of complications related to nutritional support, while secondary endpoints related to major complications and survival.
PN showed a higher rate of infection than EN did, with a rate ratio of 1.11 (95% CI, 1.04-1.19). The rate ratio for nutrition support complications was 1.00 (95% CI, 0.96-1.05). Major complications and mortality occurred at similar rates for PN and EN, including in subgroup analyses.
In subgroup analyses of infection rates, significantly greater infection risk with PN was seen among studies of adults, but not among studies evaluating children. For patients receiving EN, tube feeding showed superiority in infection risk over PN, but standard care did not. Among patients with protein-energy malnutrition, the infection risk did not significantly differ between PN and EN.
According to the researchers, results of this analysis indicate that PN and EN are equivalent for many of the examined outcomes, apart from an enhanced risk of infection with PN. The researchers concludes that EN is preferable in the presence of a functional gastrointestinal system, which is in agreement with European Society of Clinical Nutrition and Metabolism guidelines.
Chow R, Bruera E, Arends J, et al. Enteral and parenteral nutrition in cancer patients, a comparison of complication rates: an updated systematic review and (cumulative) meta-analysis [published online December 7, 2019]. Support Care Cancer. doi:10.1007/s00520-019-05145-w