QoL of Cancer Patients Receiving Enteral Nutrition: Comparison
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Please note this is a comparison between Version 2 by Lindsay Dong and Version 1 by Dominika Głąbska.

Most studies supported the positive influence of enteral nutrition on the quality of life, either assessed based on the psychological measures of the quality of life or by considering the other potential determinants (e.g., malnutrition, complications, etc.). Taking this into account, enteral nutrition should be applied whenever possible, both to prevent and treat malnutrition in cancer patients. However, considering the limited number of studies conducted so far, further research conducted in homogenic populations of patients is necessary.

  • cancer
  • diet
  • nutrition
  • enteral nutrition
  • oncology
  • quality of life
  • QoL

1. Introduction

Cancer is a growing global problem, being the first or second leading cause of death of individuals aged under 70 years in 112 of 183 countries, according to the World Health Organization (WHO) [1]. The Global Cancer Observatory (GCO) by the International Agency for Research on Cancer (IARC) and the WHO, within their GLOBOCAN 2020 estimates of incidence and mortality, indicated nearly 19.3 million new cancer cases and almost 10 million cancer deaths registered worldwide in 2020 [2]. Taking this into account, the WHO emphasizes that cancer is one of the main challenges for public health within both areas of prevention and treatment [3].
The cancer treatment methods are classified by the National Cancer Institute (NCI) as biomarker testing, chemotherapy, hormone therapy, immunotherapy, radiation therapy, stem cell transplant, surgery, and targeted therapy [4]. As indicated in the systematic review by Shrestha et al. [5], while choosing the therapeutic option, the length of life and quality of life are taken into consideration—patients with better health value rather than length of life over quality of life, and those with poorer physical status value rather than the quality of life over the length of life. The quality of life is defined as a sense of well-being and includes physical, psychological, social, and spiritual aspects, which may be changed in cancer patients [6]. The quality of life of cancer patients is significantly reduced [7[7][8][9],8,9], which results from the disease process itself— its course, symptoms and complications, the applied treatment, and the disease duration [10].
Among cancer symptoms and complications, malnutrition is one of the most common, as it results from anorexia and metabolic dysregulation combined, both caused by the tumor itself or by its treatment and contributing to cachexia [11]. It may affect up to 80% of cancer patients, while its prevalence depends on the cancer type, disease setting, comorbidities, and type of treatment performed [12]. Although the problem of malnutrition and cancer-related cachexia have been known for a long time, effective prevention and treatment remain a challenge [13]. Prevention and treatment are especially important as malnutrition not only affects the effectiveness of cancer treatment, as well as the prognosis and hospital stay length [14], but also influences the quality of life [15,16,17][15][16][17].
Taking this into consideration, the European Society for Clinical Nutrition and Metabolism (ESPEN), within its guidelines, indicated that the most important action against cancer-related malnutrition is to provide early screening and to assure individualized nutritional interventions [18]. An effective, personalized nutrition plan should include not only an appropriate diet or oral nutrition support but also enteral or parenteral nutrition if needed [19]. However, the recommendations by ESPEN indicate the superiority of feeding by the gastrointestinal tract over parenteral nutrition, and enteral nutrition is recommended if possible [20]. Similarly, the systematic review by Chow et al. [21] indicated that, for cancer patients, parenteral nutrition may result in an increased risk of complications compared with enteral nutrition but would not prolong survival.

2. QoL of Cancer Patients Receiving Enteral Nutrition

Due to an increase in the effectiveness of anti-cancer treatment [44][22] and an increase in life expectancy in cancer patients [45][23], the long-term complications will probably be observed more often, resulting in increasing role of the quality of life [46][24]. Taking this into account, it must be emphasized that the systematic review by Lis et al. [47][25], assessing the role of nutritional status in predicting quality of life in cancer individuals, indicated that correcting malnutrition may improve quality of life in cancer patients.

In agreement with the indicated association between nutritional status and quality of life, the ESPEN, within its recent practical guidelines [48][26] recommended applying nutritional support, including dietary advice, oral nutrition supplements, and enteral and parenteral nutrition as an effective way of improving nutritional status and malnutrition prevention. However, while choosing the method of nutritional support, it is indicated that, despite nutritional interventions, enteral nutrition should be recommended if oral nutrition remains inadequate, and parenteral nutrition should be recommended if enteral nutrition is not sufficient or feasible [48][26].

There are beneficial effects of enteral nutrition for cancer patients in the area of quality of life. While comparing patients treated with and without enteral nutrition, it was stated that enteral nutrition has a beneficial effect on the quality of life in a majority of studies, confirmed in groups of head and neck cancer patients [28[27][28][29],32,34], upper gastrointestinal tract cancer patients [38[30][31][32],39,43], and ovarian cancer patients [36][33]. At the same time, the results were not so consistent while comparing patients treated with enteral and parenteral nutrition; depending on the study, the various results were observed [29[34][35][36],37,40], but generally combined enteral and parenteral nutrition was stated to be superior to both enteral [40][36] and parenteral nutrition alone [37][35]. The indicated observations are in agreement with the recommendations by ESPEN [48][26], indicating the need to meet the energy requirements of patients, which must be considered the overall objective.

In spite of the fact that the majority of studies concluded the beneficial role of enteral nutrition (especially while compared with no nutritional support), some disadvantages or contradictory results are also indicated. Such observations were formulated mainly within studies assessing the effect of prophylactic enteral nutrition, applied, not when necessary, but earlier, in order to limit the risk of malnutrition [33,35,41][37][38][39]. This may result from the fact that the enteral nutrition procedure itself can generate complications [49][40]. As such complications may indirectly affect the quality of life, each of them needs to be considered while choosing the best option for nutritional support.

While the quality of life is linked to the stage of cancer [51][41], the prognosis [52][42], malnutrition [53][43], and applied therapy [54][44], enteral nutrition must also be taken into account as a factor indirectly affecting it by improving the effectiveness of cancer therapy [55][45] and reducing the risk of malnutrition [56][46].

3. Conclusions

Most of the studies support the positive influence of enteral nutrition on the quality of life, either assessed based on the psychological measures of the quality of life or by considering the other potential determinants (e.g., malnutrition, complications, etc.). Taking this into account, enteral nutrition should be applied whenever possible, both to prevent and treat malnutrition in cancer patients. However, considering the limited number of studies conducted so far, further research conducted in homogenic populations of patients is necessary.

References

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