title: Improvement of feeding independence in end-stage cancer patients under palliative care--a prospective, uncontrolled study.
abstract: OBJECTIVE
  Feeding independence is important to improve the quality of life (QOL) of patients receiving palliative care. Studies on feeding independence among cancer patients under palliative care are unavailable. This study aimed to evaluate the effectiveness of occupational therapy in promoting feeding independence in end-stage cancer patients in palliative care.
  
  
  METHODS
  Thirty-six end-stage cancer inpatients with feeding difficulties attributable to improper positioning (58.3%), one-handedness (22.2%), and upper limb impairment (11.1%) were enrolled from two hospitals in Hong Kong. The feeding independence level (level 1> or =25% assistance; level 2<25% assistance) of patients was assessed weekly for 3 weeks. Major treatment modalities included positioning (58%), feeding aid support (25%), and upper limb support (11%). Multilevel models were used for comparing feeding independence levels at baseline and weekly intervals.
  
  
  RESULTS
  There was a significant improvement in feeding independence from baseline to week 1 (P<0.0001). Multilevel models showed that there were no significant differences in the level of feeding independence between weeks 1 and 2 (P=0.246) and between weeks 1 and 3 (P=0.165) among the subjects after controlling for age and sex, indicating that the improved feeding independence in week 1 was sustainable through weeks 2 and 3.
  
  
  CONCLUSIONS
  The prospective study showed for the first time that the provision of appropriate feeding supports could markedly enhance feeding independence in end-stage cancer patients receiving palliative care, which might improve activities of daily living and QOL, and minimize excessive disability. Furthermore, it merits cooperation among occupational therapists, caregivers, and ward staff to promote feeding independence in this group of patients.
authors.affiliation: Postgraduate Program of Epidemiology and Biostatistics, School of Public Health, The Chinese University of Hong Kong, Shatin, Hong Kong, China. w.t.lee@surrey.ac.uk
authors.forename: Warren Tak Keung
authors.initials: WT
authors.lastname: Lee
authors.forename: Hung Fai
authors.initials: HF
authors.lastname: Chan
authors.forename: Eric
authors.initials: E
authors.lastname: Wong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002681:China; D004435:Eating / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms; D009788:Occupational Therapy / Q000379:methods; D010166:Palliative Care; D011446:Prospective Studies; D016896:Treatment Outcome