title: Impact of home enteral nutrition in malnourished patients with upper gastrointestinal cancer: A multicentre randomised clinical trial.
abstract: Weight loss is frequent in patients with gastrointestinal (GI) cancer. Nutritional status deteriorates throughout anti-cancer treatment, mostly after major surgery, increasing complications, reducing tolerance and worsening the final prognosis. Enteral nutrition is safe and effective in malnourished patients undergoing major GI surgery. Randomised trials aimed at investigating the effects of home enteral nutrition (HEN) in post-surgical patients with GI cancer are lacking. This study compares HEN and counselling in limiting weight loss during oncologic treatment.
  
  
  
  Patients with upper GI cancer and candidate to major surgery were included in the protocol when the nutritional risk screening (NRS 2002) score was ≥3. All patients were supported with enteral nutrition through a jejunostomy after surgery and randomly assigned to continue enteral nutrition or receiving nutritional counselling after discharge. Nutritional and performance status, quality of life (QoL) and tolerance to cancer treatment have been evaluated at 2 and 6 months after discharge.
  
  
  
  Seventy-nine patients were randomised; 38 continued enteral nutrition at home and 41 patients received nutritional counselling only. After 2 months, patients on HEN maintained their mean body weight, while patients in the nutritional counselling group showed a weight loss of 3.6 kg. Patients supported on HEN had a higher chance to complete chemotherapy as planned (48% versus 34%). QoL was not worsened by HEN. No complications were reported.
  
  
  
  HEN is a simple and feasible treatment to support malnourished patients with upper GI cancer after major surgery and during chemotherapy in order to limit further weight loss.
authors.affiliation: Unit of Nutrition Therapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. Electronic address: cecilia.gavazzi@istitutotumori.mi.it.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Gavazzi
authors.affiliation: Unit of Nutrition Therapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Colatruglio
authors.affiliation: Division of Abdominal-Pelvic Surgery, European Institute of Oncology, Milan, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Valoriani
authors.affiliation: Department of Surgery, Liver Transplantation and Gastroenterology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Mazzaferro
authors.affiliation: Division of Abdominal-Pelvic Surgery, European Institute of Oncology, Milan, Italy.
authors.forename: Annarita
authors.initials: A
authors.lastname: Sabbatini
authors.affiliation: Division of Abdominal-Pelvic Surgery, European Institute of Oncology, Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Biffi
authors.affiliation: Unit of Medical Statistics, Biometry, Bioinformatics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Mariani
authors.affiliation: Unit of Medical Statistics, Biometry, Bioinformatics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Rosalba
authors.initials: R
authors.lastname: Miceli
mesh_terms: D000368:Aged; D001835:Body Weight; D003376:Counseling / Q000379:methods; D013505:Digestive System Surgical Procedures; D004750:Enteral Nutrition / Q000379:methods; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000150:complications* / Q000601:surgery; D006699:Home Care Services; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000209:etiology / Q000628:therapy*; D008875:Middle Aged; D009752:Nutritional Status; D011788:Quality of Life
keywords: Gastrointestinal cancer; Home enteral nutrition; Malnutrition; Nutritional counselling