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  • Enteral and parenteral nutrition in patients with cancer: complication rates compared—updated systematic review and meta-analysis

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Systematic review
Enteral and parenteral nutrition in patients with cancer: complication rates compared—updated systematic review and meta-analysis
  1. Ronald Chow1,2,
  2. James H B Im3,
  3. Jann Arends4,
  4. Egidio Del Fabbro5,
  5. Lukas Mortensen-Truscott1,
  6. Denis Qeska1,
  7. Shilpa Balaji1,
  8. Chris Walsh1,
  9. Geoffrey Watson1,
  10. Michael Lock6,
  11. Elizabeth Prsic7,
  12. Lawson Eng1,
  13. Camilla Zimmermann1 and
  14. Eduardo Bruera8
  1. 1 Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
  2. 2 Centre for Evidence-Based Medicine, University of Oxford, Oxford, UK
  3. 3 Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
  4. 4 Department of Medicine I, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Fahnenbergplatz, Germany
  5. 5 Medical College of Georgia, Augusta University, Augusta, GA, USA
  6. 6 Schulich School of Medicine & Dentistry, Universiy of Western Ontario, London, ON, Canada
  7. 7 Yale School of Medicine, Yale University, New Haven, CT, USA
  8. 8 The University of Texas MD Anderson Cancer Center, Houston, TX, USA
  1. Correspondence to Ronald Chow; ronald.chow{at}uhn.ca

Abstract

Background The aim of this systematic review and meta-analysis is to compare the complication rates of enteral nutrition (EN) (oral or tube feeding (TF)) and parenteral nutrition (PN) in patients with any cancer.

Methods A systematic review of the literature until 2024 was conducted, including randomised controlled trials comparing EN and PN with respect to one or more of four endpoints: (1) infection, (2) nutrition support complications, (3) major complications and (4) mortality. A meta-analysis was conducted to generate summary effect estimates. Analysis was stratified by paediatric (≤21 years old) versus adults (>21 years old) patients. Subgroup analyses were conducted, based on including patients with (vs without) protein–energy malnutrition (PEM) and type of EN. Cumulative meta-analysis and leave-one-out analysis was conducted. Type I error was set at 0.05.

Results 49 studies reporting on 6361 patients were included: 41 reported on adults and 8 on children. Among adults, the infection rate was higher for PN compared with EN (risk ratio=1.07, 95% CI: 1.00 to 1.14), with no differences in rates of nutrition support complications, major complications or mortality. Among children, there were no differences in all four endpoints. On cumulative meta-analysis, EN was overall marginally superior to PN for infection, although results fluctuated over time between superiority and no difference. Subgroup analysis found no differences in effects among patients with (vs without) PEM and patients provided with EN options of standard care versus TF.

Discussion From the perspective of complications, EN and PN are equivalent, with EN demonstrating marginal superiority for infection among adults.

  • Cancer
  • Cachexia

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/spcare-2024-005244

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • X @https://x.com/RonaldCChow, @ElizabethPrsic, @https://x.com/ZimmTeamLab, @https://x.com/BrueraEduardo

    • Contributors RC is responsible for study conception and design. RC, LM-T, JHBI and CW are responsible for acquisition of data. All authors (RC, JHBI, JA, EDF, LM-T, DQ, SB, CW, GW, ML, EP, LE, CZ and EB) contributed significantly and substantially to the conduct and reporting, and all authors are guarantors.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.