Introduction: Patients with advanced upper gastrointestinal (UGI) cancer experience multiple nutrition impact symptoms and are at high risk of malnutrition. Consensus guidelines recommend consideration of enteral tube feeding to prevent or treat malnutrition in patients with a prognosis of over three months, however in practice is not routinely provided. This review examines the effect of enteral tube feeding on nutrition status, survival and quality of life (QOL) in adults with advanced UGI cancer.
Methods: Five databases were systematically searched for eligible studies. Meta-analysis was not possible hence a narrative synthesis was undertaken due to the large variation in outcomes.
Results: Five studies were eligible for inclusion (retrospective cohort (n=4), non-randomised experimental (n=1)). Most participants were male (n=205, 88%) and had oesophageal cancer (n=4 studies). Sample size ranged from 16-131, and there was considerable variability in outcomes, statistical calculations, and comparators with subsequently contradictory results. The quality of the studies was assessed as neutral (n=4) or negative (n=1), reflecting methodological and analytical issues across the studies. Enteral tube feeding was associated with stable nutrition status in three studies, and lean body mass increase in one study. The impact of enteral tube feeding on survival outcomes was mixed, with two studies reporting survival benefit compared to other treatments such as oesophageal stent insertion or comfort care, and another study reporting no survival differences between those with or without a PEG tube for enteral tube feeding. Only one study examined QOL, reporting significant improvements in global and role functioning following jejunal tube feeding during three chemotherapy cycles.
Conclusions: Malnutrition is a significant predictor of reduced survival and QOL in advanced cancer, yet this review demonstrates that enteral tube feeding is poorly investigated in this population. Urgent high-quality research is required to understand the potential benefits of enteral tube feeding in advanced UGI cancer.