title: Quality of life after early enteral feeding versus standard care for proven or suspected advanced epithelial ovarian cancer: Results from a randomised trial.
abstract: BACKGROUND
  Malnutrition is common in patients with advanced epithelial ovarian cancer (EOC), and is associated with impaired quality of life (QoL), longer hospital stay and higher risk of treatment-related adverse events. This phase III multi-centre randomised clinical trial tested early enteral feeding versus standard care on postoperative QoL.
  
  
  METHODS
  From 2009 to 2013, 109 patients requiring surgery for suspected advanced EOC, moderately to severely malnourished were enrolled at five sites across Queensland and randomised to intervention (n=53) or control (n=56) groups. Intervention involved intraoperative nasojejunal tube placement and enteral feeding until adequate oral intake could be maintained. Despite being randomised to intervention, 20 patients did not receive feeds (13 did not receive the feeding tube; 7 had it removed early). Control involved postoperative diet as tolerated. QoL was measured at baseline, 6weeks postoperatively and 30days after the third cycle of chemotherapy. The primary outcome measure was the difference in QoL between the intervention and the control group. Secondary endpoints included treatment-related adverse event occurrence, length of stay, postoperative services use, and nutritional status.
  
  
  RESULTS
  Baseline characteristics were comparable between treatment groups. No significant difference in QoL was found between the groups at any time point. There was a trend towards better nutritional status in patients who received the intervention but the differences did not reach statistical significance except for the intention-to-treat analysis at 7days postoperatively (11.8 intervention vs. 13.8 control, p 0.04).
  
  
  CONCLUSIONS
  Early enteral feeding did not significantly improve patients' QoL compared to standard of care but may improve nutritional status.
authors.affiliation: Institute for Health and Biomedical Innovation, School of Public Health, Queensland University of Technology, Australia.
authors.forename: Jannah
authors.initials: J
authors.lastname: Baker
authors.affiliation: Institute for Health and Biomedical Innovation, School of Public Health, Queensland University of Technology, Australia.
authors.forename: Monika
authors.initials: M
authors.lastname: Janda
authors.affiliation: Institute for Health and Biomedical Innovation, School of Public Health, Queensland University of Technology, Australia.
authors.forename: Nick
authors.initials: N
authors.lastname: Graves
authors.affiliation: Centre for Dietetics Research (C-DIET-R), School of Human Movement Studies, University of Queensland, Australia.
authors.forename: Judy
authors.initials: J
authors.lastname: Bauer
authors.affiliation: Royal Brisbane and Women's Hospital, Department of Nutrition and Dietetics, Queensland, Australia.
authors.forename: Merrilyn
authors.initials: M
authors.lastname: Banks
authors.affiliation: Queensland Centre for Gynaecologic Cancer, Royal Brisbane and Women's Hospital, The University of Queensland, School of Medicine, Queensland, Australia.
authors.forename: Andrea
authors.initials: A
authors.lastname: Garrett
authors.affiliation: Mater Public and Private Hospital, Queensland, Australia.
authors.forename: Naven
authors.initials: N
authors.lastname: Chetty
authors.affiliation: Mater Public and Private Hospital, Queensland, Australia.
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Crandon
authors.affiliation: Queensland Centre for Gynaecologic Cancer, Royal Brisbane and Women's Hospital, The University of Queensland, School of Medicine, Queensland, Australia.
authors.forename: Russell
authors.initials: R
authors.lastname: Land
authors.affiliation: Gold Coast Hospital, Queensland, Australia.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Nascimento
authors.affiliation: Queensland Centre for Gynaecologic Cancer, Royal Brisbane and Women's Hospital, The University of Queensland, School of Medicine, Queensland, Australia.
authors.forename: James L
authors.initials: JL
authors.lastname: Nicklin
authors.affiliation: Mater Public and Private Hospital, Queensland, Australia.
authors.forename: Lewis C
authors.initials: LC
authors.lastname: Perrin
authors.affiliation: Queensland Centre for Gynaecologic Cancer, Royal Brisbane and Women's Hospital, The University of Queensland, School of Medicine, Queensland, Australia. Electronic address: ao@surgicalperformance.com.
authors.forename: Andreas
authors.initials: A
authors.lastname: Obermair
mesh_terms: D000077216:Carcinoma, Ovarian Epithelial; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000379:methods; D044342:Malnutrition / Q000209:etiology / Q000628:therapy; D008875:Middle Aged; D009375:Neoplasms, Glandular and Epithelial / Q000150:complications / Q000601:surgery / Q000628:therapy*; D010051:Ovarian Neoplasms / Q000150:complications / Q000601:surgery / Q000628:therapy*; D011788:Quality of Life; D011795:Surveys and Questionnaires
keywords: Gynaecological cancer; Malnutrition; Ovarian cancer; Quality of life