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[Artificial nutrition in advanced palliative situations : Issues and recommendations]
Mona Elamly1, Arthur Escher2, Alicia Rey1
1Centre de soins palliatifs, Villa St-François, Hôpital fribourgeois, 1708 Fribourg.
Revue Medicale Suisse
|March 20, 2022
Summary
Artificial nutrition (AN) is often not recommended for advanced cancer patients with low performance status or refractory cachexia. Exploring emotional factors is crucial when considering AN requests in palliative care.
Area of Science:
- Palliative Care
- Oncology
- Geriatrics
Background:
- Artificial nutrition (AN) decisions in advanced palliative care are complex.
- Oncological cachexia and performance status are key indicators for AN.
- Advanced dementia presents unique challenges for AN recommendations.
Purpose of the Study:
- To outline recommendations for artificial nutrition in advanced palliative situations.
- To identify key factors influencing AN decisions in oncology and dementia.
- To emphasize the importance of addressing emotional aspects in AN requests.
Main Methods:
- Review of current guidelines and clinical practices for AN in palliative care.
- Analysis of performance indexes (Karnofsky, ECOG) and cachexia staging.
- Consideration of patient and family expectations and fears.
Main Results:
- AN generally not advised for low performance indexes (Karnofsky ≤50%, ECOG ≥3) or refractory cachexia.
- Time-limited therapeutic trials for AN may be considered with measurable goals.
- AN is typically not recommended in advanced dementia.
Conclusions:
- AN recommendations in advanced palliative care depend on oncological staging and performance.
- Emotional and psychological factors significantly influence AN decisions and should be addressed.
- Individualized assessment is essential for appropriate AN management in complex palliative scenarios.
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