Using research to change practice: enteral feedings for pediatric oncology patients

This report details a study whose purpose was to show the safety of and describe the clinical and financial outcomes of nasogastric (NG) and nasojejeunal (NJ) tube feedings for nutritional support during and after intensive treatment for cancer. During a 17-month period, NG or NJ tubes were inserted in 25 patients who experienced, or were anticipated to experience, suboptimal nutrition during or after their chemotherapy (n = 14), radiation therapy (n = 2), or chemotherapy plus radiation (n = 5), after bone marrow transplant (n = 2), and as a result of neurological impairment (n = 2). Patient ages ranged from 1 month to 14 years. NG/NJ tubes were used for a total of 1415 patient days (median 40 days). Of those, 756 days occurred in the hospital (median, 18 days) and 659 were outpatient days (median = 12 days). Total parenteral nutrition (TPN) was used during 104 patient days (range, 1 to 35 days), and combination NG/NJ feedings were given with TPN for a total of 101 days. A comparable number of days of TPN therapy for the NG-fed patients would have cost $177,390 (average $135/day), compared with $65,700 (average, $50/day) for enteral feedings, for a savings of $111,690. Ten patients experienced grade 2 to 3 diarrhea and/or vomiting during the study. No untoward outcomes were identified. Enteral feedings were found to be a safe and cost-effective method for providing nutrition to these children with cancer.