Nutrition intervention includes both nutrition counselling, and the use of artificial nutrition. Artificial nutrition may consist of dietary supplements to be taken orally, or to be given by other routes, such as parenterally or via gastrostomy tubes. There are significant risks and burdens associated with artificial feeding, which increase with the invasiveness of the route chosen. 

What is known 

• Weight losing patients who achieve weight stabilisation have longer survival and improved quality of life when compared to those who continue to lose weight. [1] 
• EPA (omega 3 fatty acid from fish oil) has been studied as part of a nutritional supplement in patients with cachexia anorexia from pancreatic cancer. Despite promising results in several studies, a systematic review has not shown it to be better at improving weight or quality of life than a nutritional supplement without EPA. [2] 
• Weight loss due to primary cachexia anorexia syndrome from progressive malignancy is not reversed by supplying additional nutrition. [3] 
• Few studies have examined the impact of medically assisted nutrition on survival or quality of life in palliative care patients. [4-5] 
• In patients with advanced dementia and cachexia artificial feeding (by tube) does not prolong life or prevent aspiration. [6-7]

What it means in practice 

• The optimal timing and strategy for providing nutritional support is not known.
• There is limited evidence about the effects of nutritional counseling on palliative care patients, but non-sustained improvements in intake have been shown in one study. [8] 
• Weight stabilization with effective nutrition counseling may improve survival and quality of life. 
• Decisions about artificial nutrition in palliative care patients should include an assessment of both the benefit and burden of all treatments offered. 
• The use of enteral and parenteral nutrition in terminally ill cancer patients approaching the end of life is rarely indicated. Dying patients lose their ability to swallow safely in the last few days of life. Studies support the view that dying patients require only minimal amounts of food and fluids to reduce thirst and hunger. [3-4] 
• The use of enteral and parenteral nutrition in patients with advanced cancer and a life expectancy of months or more is controversial [3]. Clinical guidelines for use of parenteral nutrition in the palliative care setting are evolving. [9] The proposed guidelines suggest criteria for identifying who might benefit, including nutritional criteria, life expectancy, quality of life, and functional capability. Patients with secondary cachexia (due to obstruction or swallowing difficulties, without the inflammatory processes of the cancer cachexia syndrome) may benefit from a trial of enteral or parenteral nutrition. 
• Artificial feeding in advanced dementia does not provide good palliation, and the focus should instead be on offering whatever oral intake the patient will accept, and on good mouth care. However families and aged care staff may both require support and education in this area. [7, 10]

Finding out more
Guidelines

This page was created on 6 May 2008
Last updated13 December 2010