Efficacy of Parenteral Nutrition in Patients at the Palliative Phase of Cancer.

Study Overview
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Brief Summary
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In malnourished patients in the palliative phase of cancer, the question is raised of the relevance of implementing artificial nutritional assistance instead of oral feeding when this is possible. Medical prescription and implementation of artificial nutrition at this stage of the illness seem less governed by data acquired by science than by subjective reasons (related to beliefs, to a cultural or religious tradition, to the symbolic role of eating, to the deeply ingrained fear of dying of hunger, to a portrayal of care, etc.) while interacting with teams, the patient and his family and relatives. And yet, the benefits/risk balance and the effect on quality of life of parenteral nutrition in a palliative situation for patients presenting with a normal alimentary tract is poorly understood. The discomfort and risks of central venous or nasogastric artificial nutrition require that the benefits of artificial nutrition be proven. The nature of these benefits relate first and foremost to the quality of life experienced by the patient in such a context. Only a controlled randomized study may lead to an optimal palliative nutritional management of undernutrition to be determined, and to inform the patient and his/her relatives clearly in order for them to express their preferences. We hypothesize that abstaining from artificial parenteral central venous nutrition and associated hydration for nutritional purposes improves quality of life without significant loss of survival compared to implementing artificial nutrition, when considered, in the absence of any specific curative treatment in anorexic patients in the palliative phase of cancer. To test this hypothesis, we propose to carry out a multicenter, prospective, controlled, randomized study in order to evaluate the efficacy of implementing parenteral nutrition compared to abstaining from doing so on the quality of life of undernourished patients in the palliative phase of cancer. The effect on overall survival and the nutritional parameters will be evaluated. The ALIM K trial will be carried out in 13 centres specializing in supportive and onco-hematology care .

Official Title
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Prospective, Multicenter, Randomized Controlled Study Evaluating the Efficacy of Parenteral Nutrition on the Quality of Life and Overall Survival in Patients in the Palliative Phase of Cancer.

Conditions
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Nutrition Aspect of Cancer, End Stage Cancer

Intervention / Treatment
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* Other: Parenteral nutrition


Participation Criteria
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Eligibility Criteria
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Inclusion criteria are: adult patients (aged >18 years) suffering from cancer at the palliative stage, i.e. patients in whom the main aim of treatment is to limit pain and discomfort curative treatment has either been discontinued, or may still be ongoing but with little expected benefit in terms of overall survival patients must already have a functional central venous catheter in place present malnutrition defined as a body mass index (BMI) <18.5 kg/m² in patients aged <70 years or <21 kg/m² in patients aged ≥70 years; or weight loss of 2% in 1 week, 5% in 1 month, or 10% in 6 months patients must have a functional digestive tract patients able to express themselves easily in French and answer questionnaires Exclusion Criteria: Any condition that prevents orally feeding (especially patients with cancer of the upper aero-digestive tract, esophagus, obstructive stomach) Peritoneal carcinomatosis if it causes symptoms of sub-occlusion or bowel obstruction Non functional digestive tract (bowel obstruction, tumor compression) Patients with haematological cancers undergoing bonemarrow transplant, Life expectancy is less than 1 month Any contraindications to the parenteral nutrition prescription Parenteral nutrition that is ongoing or dating from less than one month; Presence of gastrostomy or jejunostomy; Persisting sensation of hunger in aphagic patients Patients participating in another ongoing clinical trial Adult Patients under legal guardianship

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Parenteral nutrition<br>Parenteral nutrition will be administered to the patients | Other: Parenteral nutrition<br>* Administration of standard intravenous nutritional products. The products are commonly used in the department where the research is conducted<br>|
| No Intervention: Normal per os nutrition<br>The patients will eat orally | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| QLQ-C15-Pal to assess Quality of Life through the physical functioning, Global Health Status and fatigue subscales | The EORTC -The European Organisation for Research and Treatment of Cancer QLQ-C15-Pal - Quality of Life Questionnaire Core 15 Palliative is used. Physical functioning, global health status and fatigue are compared between the 2 groups. | Time until definitive quality of life score deterioration | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| QUAL-E Measuring Quality of Life at the end of Life | Questionaire for patients who believe they are nearing the end of life and comparison between the 2 groups. | Time until definitive quality of life score deterioration | 
| Overall survival | Comparison of overall survival between the 2 groups | Time from randomization to death | 
| Other (non-primary-end point) domains of the QLQ-C15-PAL questionnaire (pain, emotional function, nausea/vomiting, appetite, dyspnea, constipation, and sleep) | Comparison of other domains of the QLQ-C15-PAL questionnaire between the 2 groups. | Time until definitive quality of life score deterioration | 
| Body weight | Body weight will be compared between the 2 groups . | Time until definitive quality of life score deterioration | 
| Body Mass Index | Body Mass Index will be compared between the 2 groups . | Time until definitive quality of life score deterioration | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Palliative Phase of Cancer, Quality of life, Parenteral nutrition, Undernutrition