Evaluation on the Time to Start Parenteral Nutrition in Hospitalized Cancer Patients

PURPOSE: Malnutrition is quite prevalent in hospitalized cancer patients, with a 40%~80% rate. Malnutrition in cancer patients can result in an increase in the number of complications, length of stay, mortality, and morbidity. Therefore, cancer patients with malnutrition must have the appropriate nutritional support to improve the prognosis of cancer. This study evaluated the appropriate time point to start parenteral nutrition (PN) after admission according to the nutrition support guidance in Samsung Medical Center. METHODS: This study enrolled patients diagnosed with the Korean standard classification of disease 6 (KCD6) code C00-C97 and discharged from March 1st to 31st, 2016. The following data were collected: patients'age, gender, diagnosis, length of stay, body mass index, nutritional status, and whether to consult nutrition support team (NST). RESULTS: Among a total of 2,944 patients, 381 patients (12.9%) were in a malnourished status upon admission. In the malnourished patients, 139 patients were prescribed PN for a median of 6 days (range, 1∼49) and moderate to severe malnourished patients were started on PN within 2 days after admission. The proportion of patients with a poor nutritional status was lower in the NST group than in the non-NST group (50.0% vs. 66.7%) on the 28th day after admission. Among the nourished patients, 229 patients were prescribed PN. Of them, 183 patients (79.9%) were started on PN within 7 days after admission. CONCLUSION: In moderate to severe malnourished cancer patients, the initiation of PN on the day after admission is appropriate.

Evaluation of Postoperative Nutrition Support with Commercial Peripheral Parenteral Nutrition after an Ivor-Lewis Esophagectomy in Patients with Esophageal Cancer

PURPOSE: Deteriorated nutritional status is common during a hospital stay for esophagectomy in patients with esophageal cancer. Malnutrition in those patients is often marked compared with other gastrointestinal cancer. The purpose of this study is to evaluate the appropriateness of commercial peripheral parenteral nutrition (CPPN) use in patients who underwent Ivor-Lewis esophagectomy (I-L op). METHODS: Patients who were provided with CPPN after I-L op were enrolled in this study from January to May 2015. Body weight, height, nutritional status, length of hospital stay, duration of CPPN therapy, and parenteral nutrition (PN) induced complications were assessed, respectively, using electronic medical records. RESULTS: Thirty-nine patients were enrolled. Average age was 65.9 years and 36 patients were male. All patients were provided with the same CPPN. The duration of fasting and CPPN use was 5.8+/-1.4 days and 7.5+/-1.8 days, respectively. Calorie supported by CPPN was 22.6+/-3.5 kcal/kg/day and only 20.5% of patients (n=8) reached the daily target calories. Most frequent PN induced complication was phlebitis which occurred in 8 patients (20.5%). Calcium, magnesium, and transthyretin levels in serum were not monitored during the PN support period. CONCLUSION: The indications for CPPN were appropriate because the fasting duration in patients with I-L op was 5 to 10 days. Although a large portion of patients could not be supplied daily target calories, their nutrition status was not significantly changed on admission and at discharge. We did not find it necessary to individualize PN support for a short period after an I-L op in patients with esophageal cancer. Further study will be needed to determine why the incidence of phlebitis was dominant.

Quality Improvement Activities for Establishment of Intestinal Rehabilitation in Intestinal Failure Patients

PURPOSE: Intestinal failure (IF) is a complex clinical condition requiring a multi-disciplinary team approach. Our objective was to set up the treatment protocols and education documents for IF patients for development of intestinal rehabilitation programs in our hospital. METHODS: We compared the number of inpatients, length of hospital stay, mode of nutrition and calorie supply at discharge, and the frequency of blood transfusions before and after quality improvement of multidisciplinary activities, in order to evaluate the indirect effects of new protocols and training materials and for development of the intestinal rehabilitation system. RESULTS: We integrated eleven protocols for treatment and monitoring and seven educational materials for patients and caregivers. We compared indirect effects before and after the quality improvement activities. The number of IF patients hospitalized was reduced from 12 to 9. The mean days of hospital stay was decreased from 322 days to 73 days, the average number of monthly blood transfusions was also reduced from 1.8 to 0.3. In addition, the percentage of patients administered enteral nutrition and calories supplied was increased at discharge. CONCLUSION: By integrating IF protocols and education materials for IF patients, we found possible indirect effects of intestinal rehabilitation using a multidisciplinary team approach.