Intake and Nutritional Adequacy in Patients with Cancer Diagnosed with Malignant Bowel Obstruction: A secondary analysis of a randomized trial

Cynthia A Thomson; Kathryn B Arnold; Garnet Anderson; Virginia Sun; Angeles Alvarez Secord; Angela Yung; Mazin Al-Kasspooles; Valentine N Nfonsam; Marcia Grant; Gary B Deutsch; Jeremiah L Deneve; Robert S Krouse

doi:10.1016/j.jand.2024.11.011

Intake and Nutritional Adequacy in Patients with Cancer Diagnosed with Malignant Bowel Obstruction: A secondary analysis of a randomized trial

J Acad Nutr Diet. 2024 Nov 25:S2212-2672(24)00988-2. doi: 10.1016/j.jand.2024.11.011. Online ahead of print.

Authors

Affiliations

¹ Professor, Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, 3450 S. Country Club Road, Suite 330, Tucson, Arizona 85714.
² Statistical Research Associate, SWOG Statistics and Data Management Center, Fred Hutchinson Cancer Center, Seattle, WA 98109.
³ Senior Vice President and Director Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA 98109.
⁴ Professor, Division of Nursing Research and Education, Department of Population Sciences, City of Hope, Duarte, CA 91010.
⁵ President, Society of Gynecologic Oncology, Director of Gynecologic Oncology Clinical Trials, Associate Director, Clinical Research, Gynecologic Oncology Program, Duke Cancer Institute, Division of Gynecologic Oncology; Department of Ob/Gyn.
⁶ Operations Manager, Behavioral Measurement and Interventions Resource, University of Arizona Cancer Center, Tucson, AZ, 85721.
⁷ University of Kansas Medical School, Kansas City, KS, 66160.
⁸ Professor and Chair, Isidore Cohn Jr., MD Endowed Chair in Surgery, LSU Health, Department of Surgery, New Orleans, LA, 70112.
⁹ Emeritus professor, Division of Nursing Research and Education, Department of Population Sciences, City of Hope, Duarte, CA.
¹⁰ Chief, Surgical Oncology - South Shore University Hospital, Director, South Shore University Hospital General Surgery Residency Program, Director, Northwell Complex General Surgical Oncology Fellowship Program, Associate Professor of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549.
¹¹ Associate Professor of Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC 27599.
¹² Chief of Surgery, Philadelphia and Wilmington VAMC, Professor of Surgery, University of Pennsylvania, Philadelphia, PA, 19104.

PMID: 39603592
DOI: 10.1016/j.jand.2024.11.011

Abstract

Background: Malignant bowel obstruction (MBO) is experienced by many with advanced cancer. Patients with MBO cannot eat and may have reduced ability to eat once the acute process has resolved. Sparse data exist to describe oral intake capacity and adequacy of nutrition in MBO patients. These data are critical to developing effective supportive care nutrition therapy for patients with MBO.

Objective: To describe the ability to consume food/liquids orally estimating nutritional adequacy of diet in a sample of patients who received surgical or non-surgical treatment for MBO.

Design: A descriptive secondary data analysis of repeated dietary intake measures from S1316, a pragmatic comparative effectiveness trial of surgical and non-surgical treatment for MBO. Participant enrollment occurred between 2015 and 2020. Ability to eat was assessed through self-reported telephone survey and intake was estimated using telephone-based 24-hour recalls, applying USDA multi-pass methodology.

Participants/setting: The primary trial was conducted within the SWOG Cancer Research Network and included recruitment sites across the U.S. and Latin America. Eligible participants were diagnosed with, and hospitalized for, MBO.

Main outcome measures: The main outcomes measures were self- or caregiver reported ability to eat, as well as overall nutrient intake.

Statistical analysis: Descriptive statistics were used to report patient characteristics, intake, and nutrient adequacy. Nutrient intake was presented by tertiles of gastrointestinal symptom severity and assessed.

Results: 221 participants were registered; 199 were eligible and included. At Week 1, 51% of patients with MBO reported consuming some solid food orally; 34% reported no oral intake; 13% were on enteral feeding only. For patients alive and responsive to recalls at 13 weeks (n=57), 82% (n=47) reported consuming solid food. Compared to recommendations, mean reported intake was inadequate for most nutrients.

Conclusions: Oral intake is reported in more than half of patients diagnosed with MBO. Medical nutrition therapy should be tailored to patients' tolerance for eating and with consideration or patient's desire to address nutritional inadequacies.

Keywords: Malignant bowel obstruction; cancer; dietary intake; nutrient adequacy; supportive care.