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Supplemental home parenteral nutrition improved nutrition status with comparable quality of life in malnourished unresectable/metastatic gastric cancer receiving salvage chemotherapy

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Abstract

Background

Even with significant advances in surgical techniques and treatment, salvage chemotherapy remains the major treatment strategy for patients with unresectable or metastatic gastric cancer (GC). Practical and technical advances have simplified safe and convenient use of supplemental home parenteral nutrition (HPN). We aimed to clarify the role of HPN in patients with incurable GC undergoing salvage chemotherapy.

Methods

We enrolled 25 patients with GC with a nutritional risk index (NRI) of ≦ 97.5 undergoing HPN. Their nutritional status, laboratory data, and quality of life (QoL) were analyzed using the Research and Treatment of Cancer quality of life questionnaire-C30 before and after HPN administration at 0.5, 1, 2, and 3 months. We enrolled 25 patients with an NRI of > 97.5 not undergoing HPN as the control group.

Results

Total protein (P = 0.008), prealbumin (P < 0.001), and total cholesterol (P = 0.023) levels improved significantly after 0.5 months of HPN administration. The study group also demonstrated a marked improvement in nitrogen balance (P = 0.004) and prealbumin levels (P < 0.012) after 1 month. Gains in body weight after 1 month and body mass index after 2 months of HPN administration remained comparable with those of the control group. Global QoL scores were maintained and comparable with those of the control group.

Conclusions

Supplemental HPN therapy for malnourished patients with unresectable or metastatic GC undergoing salvage chemotherapy is feasible and revealed marked improvement in nutritional status. Early HPN intervention should be considered an important part of palliative treatment for advanced GC.

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Availability of data and materials

The data and materials analyzed in the current study are available from the corresponding author on reasonable requests.

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Funding

This work was supported by grants from the Ministry of Science and Technology (MOST108-2321-B-037-001, MOST107-2321-B-037-003, MOST107-2314-B-037-116, MOST107-2314-B-037-022-MY2, and MOST107-2314-B-037-023-MY2) and the Ministry of Health and Welfare (MOHW107-TDU-B-212-123006, MOHW107-TDU-B-212-114026B, MOHW108-TDU-B-212-133006, and MOHW109-TDU-B-212-134026), which were funded by the health and welfare surcharge of tobacco products. Further funding was obtained from Kaohsiung Medical University Hospital (KMUH108-8R34, KMUH108-8R35, KMUH108-8M33, KMUH108-8M35, KMUH108-8M36, KMUHS10801, KMUHSA10804, KMUHS10807, and KMUH-DK109005~3), the Center for Cancer Research (KMU-TC108A04), and the Cohort Research Center Grant (KMU-TC108B07). In addition, this study was supported by the Grant of Taiwan Precision Medicine Initiative, Academia Sinica, Taiwan, ROC.

Author information

Authors and Affiliations

  1. Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung, 807, Taiwan

    Cheng-Jen Ma, Ching-Wen Huang, Yung-Sung Yeh, Hsiang-Lin Tsai, Wei-Chih Su, Tsung-Kun Chang & Jaw-Yuan Wang

  2. Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

    Cheng-Jen Ma

  3. Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    Ching-Wen Huang, Hsiang-Lin Tsai & Jaw-Yuan Wang

  4. Division of Trauma and Surgical Critical Care, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

    Yung-Sung Yeh

  5. Division of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

    Li-Chu Sun & Ying-Ling Shih

  6. Nutrition Therapy Team, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

    Li-Chu Sun & Ying-Ling Shih

  7. Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

    Fang-Jung Yu & Deng-Chyang Wu

  8. Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    Fang-Jung Yu & Deng-Chyang Wu

  9. Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    Jaw-Yuan Wang

  10. Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    Jaw-Yuan Wang

  11. Clinical Pharmacogenomics and Pharmacoproteinomics, College of Pharmacy, Taipei Medical University, Taipei, Taiwan

    Jaw-Yuan Wang

  12. Cohort Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan

    Jaw-Yuan Wang

  13. Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan

    Jaw-Yuan Wang

Authors
  1. Cheng-Jen Ma
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  2. Ching-Wen Huang
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  3. Yung-Sung Yeh
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Contributions

C.J. Ma conducted the treatment, interpreted the final results, and drafted the manuscript. C.W. Huang and Y.S. Yeh collected data. H.L. Tsai, W.C. Su, and T.K. Chang participated in data analysis. L.C. Sun and Y.L. Shih assisted in treatment. F.J. Yu and D.C. Wu assisted in data interpretation. J.Y. Wang was responsible for study design and coordination. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jaw-Yuan Wang.

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Conflict of interests

The authors declare that they have no conflict of interest.

Ethical approval

The protocol was approved by the local ethics committees (KMUHIRB-2013-02-71) and was performed in accordance with Declaration of Helsinki of 1975, as revised in 1996.

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Written informed consent was obtained from patients before any study activities were performed.

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Ma, CJ., Huang, CW., Yeh, YS. et al. Supplemental home parenteral nutrition improved nutrition status with comparable quality of life in malnourished unresectable/metastatic gastric cancer receiving salvage chemotherapy. Support Care Cancer 29, 1977–1988 (2021). https://doi.org/10.1007/s00520-020-05687-4

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