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Evaluation of Parenteral Nutrition Utilization in Oncology Patients

CPA-MPS Conference Malaysia 2007. Evaluation of Parenteral Nutrition Utilization in Oncology Patients. Sivakami Janahiraman , SM Yew, Che Ton Saari Pharmacy Division, Hospital Kuala Lumpur (HKL). INTRODUCTION. Parenteral Nutrition (PN) -therapeutic intravenous administration of nutrients

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Evaluation of Parenteral Nutrition Utilization in Oncology Patients

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  1. CPA-MPS Conference Malaysia 2007 Evaluation of Parenteral Nutrition Utilization in Oncology Patients Sivakami Janahiraman, SM Yew, Che Ton Saari Pharmacy Division, Hospital Kuala Lumpur (HKL)

  2. INTRODUCTION • Parenteral Nutrition (PN) -therapeutic intravenous administration of nutrients • Indicated in cases where oral or enteral feeding is:- • Insufficient • Impossible • Undesirable (Messing B, 2000; Giovanni F et al, 1999)

  3. INTRODUCTION • Malnutrition is a common manifestation of cancer which is often present with loss of appetite and ineffective utilization of nutrients. • Impact of malnutrition: • Higher risk of infection • Poorer tolerance and response to treatment • Lower quality of life • Shorter survival (Grant et al, 1994; Ottery, 1996; Nitenberg & Raynard, 2000)

  4. INTRODUCTION The use of nutritional therapy in cancer patients is tailored to complement the primary treatment • PN support in surgery • PN support during chemotherapy • PN in radiation therapy

  5. GENERAL OBJECTIVE To elucidate the appropriateness of PN support in cancer patients using the criteria of nutritional status and ultimate outcome

  6. SPECIFIC OBJECTIVES • To identify the demographic characteristics of cancer patients • To obtain the diagnosis or related medical problem of patients • To identify the method of PN delivery • To analyze the quantity of PN preparations and duration of nutritional support provided • To evaluate type of regimen administered to patients

  7. METHODOLOGY • Setting: Hospital Kuala Lumpur • Design: Retrospective study • Subjects: Cancer patients • Study location: Record Units - Wisma Kayu (K2) Surgical Out-Patient Dept Oncology and Radiotherapy Dept Urology and Nephrology Dept • Study period: January 2005 – December 2005

  8. SELECTION CRITERIA

  9. STUDY FLOW CHART SCREENING OF PATIENTS’ RECORD IN TPN PHARMACY (n=159) PATIENTS FIT INCLUSION / EXCLUSION CRITERIA SELECTED AS SUBJECTS (n=69) DATA COLLECTION RECORD UNIT

  10. STUDY FLOW CHART K 2, SOPD, RT & UN DATA COMPLETION (filling up incomplete details) INSUFFICIENTDATA COMPLETE DATA (n=56) DATA ANALYSIS REJECTED (n=13) CONCLUSION

  11. METHODOLOGY Nutritional status was determined by: • Serum albumin level < 35 g/L (Jeliffe 1966; Bishop et al 1981, Ireton J & Hasse J 1992) • Total protein < 60g/L (Jeliffe 1966, Bishop et al 1981, Kotler DP 2000 ) • Total lymphocyte count < 1.5 x 10-9/L (Jeliffe 1966; Bishop et al 1981) Ultimate outcome were one of the following: • Improved • Declined • Death

  12. RESULTS & DISCUSSION

  13. DEMOGRAPHIC Distribution of patients by age and gender • Mean age : female (23.2%) - 59.5 + 16.7years • male (76.8%) - 55.5 + 15.4 years • There was no significant association between age and gender (p = 0.424). • Majority of subjects were Malays(28) followed by Chinese(17) and Indians(11).

  14. Route of PN administration • Peripheral – 1 to 15 days (mean 5 + 7days) • Central – 1 to 25 days (mean 10 + 9days)

  15. Total PN preparations provided to patients

  16. 23% of the patients received compounded PN upon initiation (n=13).

  17. 93% malnourished 70% malnourished 73% malnourished

  18. 55% malnourished 48% malnourished 37% malnourished Nutritional status correlated positively with albumin, total protein and total lymphocyte count (r=0.312, p<0.01).

  19. No significant difference in nutritional status among cancer patients with regard to duration of PN provided {F(1,54) = 0.238, p>0.05}.

  20. No significant difference in outcome and duration of PN supplementation {F(1,54) = 0.238, p>0.05}.

  21. DISCUSSION • Prevalence of malnutrition in this study as identified by using serum albumin, total protein and TLC as indicator was comparable to that found in other studies • Bauer et al 2002 – prevalence of malnutrition in oncology inpatients ~ 76% • Results of nutritional status and outcomes differ from other similar studies • Neither adjunctive therapy nor supportive PN improved quality of life and ultimate outcome in terminally ill cancer patients (Giovanni et al 1999)

  22. CONCLUSION • Most oncology patients are malnourished before nutritional intervention • Early identification of patients at risk of malnutrition is necessary • Carefully targeted parenteral nutrition may benefit patients and improve outcome

  23. Thank You….

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