Agreements and disagreements on indication and continuity of enteral nutritional therapy in palliative care patients with non-communicable diseases
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Abstract
Non-communicable diseases (NCD) are the leading cause of hospital admissions, result in socioeconomic impacts and prejudice on quality of life due to after-effects and disabilities, justifying the importance and the increasing need to associate palliative care with curative treatment. This narrative review aims to introduce agreements and disagreements on indication and continuity concerning enteral nutritional therapy (ENT) in palliative care patients with NCD. This paper was based on official publications related to the topic and 15 articles found on LILACS, SciELO, PubMed, MEDLINE, Cochrane Library and Science Direct databases, between the years 2005 and 2016. In these patients, the objective of nutritional support in palliative care varies according to the evolution of the disease. Oral nutritional supplement is indicated to supplement insufficient oral food intake, reducing hospital costs and favoring clinical and functional improvements. When food intake is less than 60% and without evolution prospects, ENT is indicated within the first 3 days, but withholding and withdrawing it in advanced diseases remains controversial. In terminal phase, comfort and relief of symptoms are the priority instead of nutritional adequacy. On this stage, artificial nutrition and hydration may not be beneficial. Therefore, nutrition in palliative care is individualized, depends on the stage of the disease and aims to promote life quality. Decisions must be taken considering patient and relatives’ will, principles of autonomy, beneficence, no maleficence and justice.
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Malta DC, Moura L, Prado RR, Escalante JC, Schmidt MI, Duncan BB. Mortalidade por doenças crônicas não transmissíveis no Brasil e suas Regiões, 2000 a 2011. Epidemiol Serv Saúde. 2014;23(4):599-8. http://dx.doi.org/10.5123/S1679-49742014000400002
Brasil. Ministério da Saúde. Secretaria em Vigilância em Saúde. Departamento de Análise de Situação em Saúde. Plano de ações estratégicas para o enfrentamento das doenças crônicas não transmissíveis (DCNT) no Brasil 2011-2022. Brasília: Ministério da Saúde; 2011.
Silva Filho SRB, Lôbo RR, Lima NKC, Ferriolli E, Moriguti JC. Cuidados paliativos em enfermaria de clínica médica. Medicina. 2010;43(2):126-33.
Holmes S. Importance of nutrition in palliative care of patients with chronic disease. Primary Care. 2010;21(6):31-9. http://dx.doi.org/10.7748/phc2011.07.21.6.31.c8606
Conselho Regional de Medicina do Estado de São Paulo (CREMESP). Cuidado Paliativo. Disponível em: http://www.cremesp.org.br. Acesso em 17 abr. 2015.
World Health Organization (WHO). Palliative care for older people: better practices. Disponível em: http://www.euro.who.int. Acesso em 17 abr. 2015.
Druml C, Ballmer PE, Druml W, Oehmichen F, Shenkin A, Singer P, et al. ESPEN guideline on ethical aspects of artificial nutrition and hydration. Clinical Nutrition 2016;35(3):545-56. http://dx.doi.org/10.1016/j.clnu.2016.02.006
Côrrea PH, Shibuya E. Administração da terapia nutricional em cuidados paliativos. Rev Bras Cancerol. 2007;53(3):317-23.
Benarroz MO, Faillace GBD, Barbosa LA. Bioética e nutrição em cuidados paliativos oncológicos em adultos. Cad Saúde Pública. 2009;25(9):1875-82. http://dx.doi.org/10.1590/S0102-311X2009000900002
Botelho LLR, Cunha CCA, Macedo M. O método da revisão integrativa nos estudos organizacionais. Gestão Soc. 2011;5(11):121-36.
Academia Nacional de Cuidados Paliativos (ANCP). Manual de cuidados paliativos. Rio de Janeiro: Diagraphic; 2012.
Brasil. Ministério da Saúde. Instituto Nacional do Câncer (INCA). Consenso Nacional de Nutrição Oncológica. Rio de Janeiro: INCA; 2011.
August DA, Huhmann MB, American Society for Parenteral and Enteral Nutrition (ASPEN). A.S.P.E.N. Clinical Guidelines: Nutrition Support Therapy During Adult Anticancer Treatment and in Hematopoietic Cell Transplantation. J Parent Enter Nutr. 2009;33(5):472-500. http://dx.doi.org/10.1177/0148607109341804
Northamptonshire Healthcare (NHS). Nutritional Screening in Palliative Care. [Internet]. Disponível em: http://www.nht.nhs.uk/ mediaFiles/downloads/13103460/CLPg010%20Nutritional%20Screening%20in%20Palliative%20Care%20review%20May%2016.pdf. Acesso em: 28 jul. 2016
Choudhuri AH. Palliative Care for Patients with Chronic Obstructive Pulmonary Disease: Current Perspectives. Indian J Palliat Care. 2012;18(1):6-11. http://dx.doi.org/10.4103/0973-1075.97342
Planas M, Álvarez J, Gárcia-Peris PA, de la Cuerda C, Lucas P, Castella M, et al. Nutritional support and quality of life in stable chronic obstructive pulmonary disease (COPD) patients. Clin Nutr. 2005;24(3):433-41. http://dx.doi.org/10.1016/j.clnu.2005.01.005
Campos LN. Qual a utilização de suplementos orais na prática clínica hospitalar no Brasil e no mundo? [Internet]. 2010. Disponível em: http://humanaalimentar.com.br/custom/308/uploads/pdf/artigoscientificos/suplementosoraisnobrasil.pdf. Acesso em: 26 ago. 2015
Sampson EL, Candy B, Jones L. Enteral tube feeding in older people with advanced dementia: Findings from a Cochrane systematic review. Cochrane Database Syst Rev. 2009;15(2):CD007209. http://dx.doi.org/10.1002/14651858.CD007209.pub2
American Geriatrics Society Ethics Committee and Clinical Practice and Models of Care Committee. American Geriatrics Society feeding tubes in advanced dementia position statement. J Am Geriatr Soc. 2014;62(8):1590-93. http://dx.doi.org/10.1111/jgs.12924
Fernadéz BA, Gárcia-Ordoñez MA, Manzanares CM, Huelgas RG. Survival of a cohort of elderly patients with advanced dementia: nasogastric tube feeding as a risk factor for mortality. Int J Geriatr Psychiatry. 2005;20(4):363-70. http://dx.doi.org/10.1002/gps.1299
Reiriz AB, Motter C, Buffon VR, Scatola RP, Fay AS, Manzini M. Cuidados paliativos – Há benefícios na nutrição do paciente em fase terminal? Rev Soc Bras Clin Med. 2008;6(4):150-5.
Pasman HRW, Onwuteaka-Philipsen BD, Kriegsman DM, Ooms ME, Ribbe MW, van der Wal G. Discomfort in nursing home patients with severe dementia in whom artificial nutrition and hydration is forgone. Arch Intern Med. 2005;165(15):1729-35. http://dx.doi.org/10.1001/archinte.165.15.1729
Grilo A, Santos CA, Fonseca J. Percutaneous endoscopic gastrostomy for nutritional palliation of upper esophageal cancer unsuitable for esophageal stenting. Arq. Gastroenterol. 2012;49(3):227-31. http://dx.doi.org/10.1590/S0004-28032012000300012