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Original Articles
- An Evaluation of Nutrition Support for Terminal Cancer Patients at Teaching Hospitals in Korea
- Do Yeun Kim, Sang Min Lee, Kyoung Eun Lee, Hye Ran Lee, Jee Hyun Kim, Keun-Wook Lee, Jong Seok Lee, Soon Nam Lee
- Cancer Res Treat. 2006;38(4):214-217. Published online December 31, 2006
- DOI: https://doi.org/10.4143/crt.2006.38.4.214
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Abstract
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ePub Purpose We wanted to analyze the use of nutrition support for terminal cancer patients, the effect of discussing withdrawal of nutrition support and do-not-resuscitate (DNR) consent on the use of intravenous nutrition during the patient's last week of life and at the time of death.
Materials and Methods The study involved 362 patients with terminal cancer from four teaching hospitals, and they all died between January 1 2003 and December 31 2005. The basic demographic data, the use of intravenous nutrition during the patient's last week of life and at death, discussion of terminal nutrition withdrawal and DNR consent were evaluated.
Results In the week before death, the patients received artificial nutrition such as total parenteral nutrition (31%), intravenous albumin infusion (25%), and feeding tube placements (9%). A discussion concerning withdrawal of nutrition support was limited to 25 (7%) patients. DNR consent was obtained from 294 (81%) patients. None of the patients were directly involved in any of these decisions. The discussion about withdrawal of terminal nutrition and DNR consent with the patient's surrogates did not have any effect on reducing the use of parenteral nutrition.
Conclusion The majority of patients dying of terminal cancer were still given potentially futile nutritional support. Modern clinical guidelines and ethical education about nutritional support at the end of life care is urgently needed in Korean medical practice to provide proper administration of terminal nutrition for end of life care.
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Citations
Citations to this article as recorded by
- Report of the Lancet Commission on the Value of Death: bringing death back into life
Libby Sallnow, Richard Smith, Sam H Ahmedzai, Afsan Bhadelia, Charlotte Chamberlain, Yali Cong, Brett Doble, Luckson Dullie, Robin Durie, Eric A Finkelstein, Sam Guglani, Melanie Hodson, Bettina S Husebø, Allan Kellehear, Celia Kitzinger, Felicia Marie Kn
The Lancet.2022; 399(10327): 837. CrossRef - A National Study of Life-Sustaining Treatments in South Korea: What Factors Affect Decision-Making?
So-Youn Park, Bomyee Lee, Jeong Yeon Seon, In-Hwan Oh
Cancer Research and Treatment.2021; 53(2): 593. CrossRef - The Trend of Aggressive Treatments in End-of-Life Care for Older People With Dementia After a Policy Change in Taiwan
Ying Hsin Hsu, Ming Yueh Chou, Hsiu-Min Chen, Wei-Cheng Chang, Che Sheng Chu, Yu-Chun Wang, Chiao-Lin Hsu, Chih-Kuang Liang, Ching-Chih Lee, Yu Te Lin
Journal of the American Medical Directors Association.2020; 21(6): 858. CrossRef - Implication of the Life-Sustaining Treatment Decisions Act on End-of-Life Care for Korean Terminal Patients
Jung Sun Kim, Shin Hye Yoo, Wonho Choi, Yejin Kim, Jinui Hong, Min Sun Kim, Hye Yoon Park, Bhumsuk Keam, Dae Seog Heo
Cancer Research and Treatment.2020; 52(3): 917. CrossRef - Nutrition Intervention through Interdisciplinary Medical Treatment in Hospice Patients: From Admission to Death
Hyelim Kang, Yu Jin Yang, Juyeon Park, Gyu Jin Heo, Jeong-Im Hong, Hye-Jin Kim
Clinical Nutrition Research.2018; 7(2): 146. CrossRef - Evidence for overuse of medical services around the world
Shannon Brownlee, Kalipso Chalkidou, Jenny Doust, Adam G Elshaug, Paul Glasziou, Iona Heath, Somil Nagpal, Vikas Saini, Divya Srivastava, Kelsey Chalmers, Deborah Korenstein
The Lancet.2017; 390(10090): 156. CrossRef - A Randomized Phase II Study To Assess the Effectiveness of Fluid Therapy or Intensive Nutritional Support on Survival in Patients with Advanced Cancer Who Cannot be Nourished via Enteral Route
So Yeon Oh, Hyun Jung Jun, Sung Jae Park, In Ki Park, Ga Jin Lim, Yeonsil Yu, Sung-Ja Cho, Aeran Song
Journal of Palliative Medicine.2014; 17(11): 1266. CrossRef - Evaluation of parenteral nutritional support in the surgical and medical wards of a referral teaching hospital
Samaneh Bairami, Sepideh Elyasi, Hossein Khalili, Saeed Reza Jamali-Moghadam
DARU Journal of Pharmaceutical Sciences.2012;[Epub] CrossRef - Awareness and Attitude Change after End-of-Life Care Education for Medical Students
Hyun Kyung Kim, Eunmi Nam, Kyoung Eun Lee, Soon Nam Lee
The Korean Journal of Hospice and Palliative Care.2012; 15(1): 30. CrossRef - Charactersitics and issues of guideline to withdrawal of a life-sustaining therapy
Younsuck Koh, Dae-Seog Heo, Young Ho Yun, Jeong-Lim Moon, Hyoung Wook Park, Ji Tae Choung, Hyo Sung Jung, Bark Jang Byun, Yoon-Seong Lee
Journal of the Korean Medical Association.2011; 54(7): 747. CrossRef - Nasogastric feeding at the end of life: A virtue ethics approach
Lalit Krishna
Nursing Ethics.2011; 18(4): 485. CrossRef - Chinese Familial Tradition and Western Influence: A Case Study in Singapore on Decision Making at the End of Life
Zheng Jie Marc Ho, Lalit Kumar Radha Krishna, Chung Pheng Alethea Yee
Journal of Pain and Symptom Management.2010; 40(6): 932. CrossRef
- Report of the Lancet Commission on the Value of Death: bringing death back into life
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- Effect of Oral Nutritional Support During Radiation Therapy in Patients with Thoracic and Gead/Neck Cancer
- Mi Sun Chun, Seung Hee Kang, Hye Kyung Kwon, Young Taek Oh, Joo Ri Kim, Hyun Joo Lee, Soon Young Lee, Sun Jeong Choi
- J Korean Cancer Assoc. 1998;30(4):781-789.
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Abstract
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- PURPOSE
This study was designed to evaluate the role of oral nutritional support and nutritional counseling by dietician during radiation therapy.
MATERIALS AND METHODS
This study included total 58 patients with head/neck, lung, or esophageal cancers who received radiation therapy with radical purpose between February and December, 1996. They were randomized either into nutrient supplement group (Group I) or control group (Group II). In Group I, the dietician advised patients to take high density nutrient supplement (NuCare, 250 kcal/can, Miwon co., LTD) based on dieticians initial evaluation for oral intake from initiation to completion of radiation therapy. In Group II, patients received nutritional support other than high density nutrient supplement only when patients lose weight more than 2 Kg during radiation treatment. All patients were evaluated for nutritional status and diet pattern and received nutritional counseling before radiation therapy and then weekly during treatment.
RESULTS
Total 45 patients (22 patients in group I, 23 patients in group II) were available. In group I, all patients received average 3 cans (2~4 cans) a day. The calory from nutrient supplement was 43.9% of their daily energy intake (25.9~68.7%). About 72.7% of patients in Group I could keep up with their oral intake over 80% of daily requirement energy comparing to only 12.3% for patients in Group II(p<0.05). The patients in Group I started to lose weight 2 weeks later and lost weight more than 3 Kg less often than patients in Group II (5/22 vs 8/23, p>0.05).
CONCLUSION
There was less significant weight loss in patients who started oral nutritional supplement based on the daily requirement energy early in radiation therapy. We think it is better to recommend nutritional supplement before weight loss started because radiation induced side effects such as esophagitis and oral mucositis prohibited patients to continue to take nutrient supplement.
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