title: Enteral and parenteral nutrition in cancer patients: a systematic review and meta-analysis.
abstract: BACKGROUND
  In cancer patients, weight loss is an ominous sign suggesting disease progression and shortened survival time. As a result, providing nutrition support for cancer patients has been proposed as a logical approach for improving clinical outcomes. Nutrition support can be given to patients through enteral nutrition (EN) or parenteral nutrition (PN). The purpose of the review was to compare the outcomes of PN and EN in cancer patients.
  
  
  METHODS
  A literature search was conducted in Ovid MEDLINE and OLDMEDLINE, Embase Classic and Embase, and Cochrane Central Register of Controlled Trials. Studies were included if over half of the patient population had cancer and reported on any of the following endpoints: the percentage of patients that experienced no infection, nutrition support complications, major complications or mortality. Risk ratios (RR) and 95% confidence intervals (CIs) using Review Manager Version 5.3 were calculated. Primary endpoints were stratified according to type of EN for subgroup analysis, grouping studies into either tube feeding (TF) or standard care (SC). Additionally, another subgroup analysis was conducted comparing studies with protein-energy malnutrition (PEM) patients and studies without PEM patients.
  
  
  RESULTS
  The literature search yielded 674 articles of which 36 were included for the meta-analysis. There were no difference in the endpoints between the two study interventions except that PN resulted in more infection when compared with EN (RR =1.09, 95% CI: 1.01-1.18; P=0.03).
  
  
  CONCLUSIONS
  Other than increased incidence of infection, PN has not resulted in prolonging the survival, increasing nutrition support complications, or major complications when compared with EN in cancer patients.
authors: Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada.
authors: Ronald
authors: R
authors: Chow
authors: The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors: Eduardo
authors: E
authors: Bruera
authors: Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada.
authors: Leonard
authors: L
authors: Chiu
authors: Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada.
authors: Selina
authors: S
authors: Chow
authors: Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada.
authors: Nicholas
authors: N
authors: Chiu
authors: Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada.
authors: Henry
authors: H
authors: Lam
authors: Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada.
authors: Rachel
authors: R
authors: McDonald
authors: Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada.
authors: Carlo
authors: C
authors: DeAngelis
authors: Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada.
authors: Sherlyn
authors: S
authors: Vuong
authors: Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada.
authors: Vithusha
authors: V
authors: Ganesh
authors: Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre,2075 Bayview Avenue, Toronto, Ontario M4N 3M5,Canada. edward.chow@sunnybrook.ca.
authors: Edward
authors: E
authors: Chow
mesh_terms: D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D017053:Infection Control; D009369:Neoplasms / Q000178:diet therapy* / Q000401:mortality; D018529:Nutritional Support / Q000401:mortality; D010288:Parenteral Nutrition / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D011502:Protein-Energy Malnutrition / Q000188:drug therapy* / Q000401:mortality; D016032:Randomized Controlled Trials as Topic
keywords: Parenteral nutrition (PN); cancer patients; enteral nutrition (EN); malnutrition; standard care (SC); tube feeding (TF)