Table 2.
Characteristics of the articles included in this review (N = 14).
| Study Reference | Country of Study | Study Type/Design | Sample Size | Age (Years) | Aim/Objective | Interventions Including Type of Tube and/or Enteral Feeding | Results of QoL Scores Following Interventions | Conclusion |
|---|---|---|---|---|---|---|---|---|
| The effect of early versus late enteral tube placement/feeding on QoL | ||||||||
| Baker et al. (2015) [26] | Australia | Phase III multicenter, randomized clinical trial | Intervention N = 53 Standard care N = 56 Total N = 109 |
Mean (SD) Intervention: 61.8 (11.4) Standard care: 63.7 (12.7) |
Whether early postoperative enteral nutrition for malnourished women with advanced epithelial ovarian cancer can improve their QoL compared to Standard care | Nasojejunal tube: Early enteral feeding versus Standard care |
Baseline EQ5D Index (SD) Intervention = 0.70 (0.20) Standard care = 0.65 (0.22) 6 weeks Postoperatively EQ5D Index: Intervention = 0.78 (0.22) Standard care = 0.76 (0.15) 30 days Post-chemotherapy EQ5D Index Intervention = 0.85 (0.13) Standard care = 0.78 (0.16) Baseline VAS (SD) Intervention = 60 (23) Standard care = 51 (20) 6 weeks Postoperatively VAS (SD) Intervention = 69 (20) Standard care = 61 (21) 30 days Post-chemotherapy VAS Intervention = 72.8 (15.2) Standard care = 65.2 (19.2) |
Early enteral feeding did not significantly improve patient’s QoL compared to standard care but may improve nutritional status |
| Morton et al. (2009) [29] |
New Zealand | Retrospective chart review over a 24-month period. | N = 36 | Median = 52 | To examine the factors associated with PEG insertion and the effects of PEG use on QoL and functional outcomes in head and neck cancer (HNC) patients receiving chemoradiotherapy | PEG insertion: (1) tube inserted before treatment or within 1 month of commencement of treatment (2) tube inserted 1 month or more after start of treatment |
Patients who still had PEG in situ at the time of the survey had a significantly worse total QoL score (p = 0.006) Overall QoL Score: Nutrition mode at time of study = 0.363 (p = 0.063) PEG in situ at time of study = 0.518 (p = 0.006) Longer PEG duration predicted poor overall QoL (p < 0.01) |
Early PEG insertion and shorter PEG duration are associated with more favorable QoL-related outcomes |
| Quality of Life of patients on gastrostomy compared with standard care | ||||||||
| Bannerman et al. (2000) [27] | United Kingdom | Cross-sectional and prospective cohorts | Prospective study: N = 54 | Median = 58 | To determine the impact of gastrostomy on QoL | Patients were assessed prior to gastrostomy (endoscopic or radiological) placement at baseline, 1, 6 and 12 months | No significant difference in SF-36 scores at the time of tube placement and 1, 6, 12 months follow-up (p > 0.05), except for physical function score (Mean ± SD) Baseline scores = 43.8 (34.9) 6 months = 14.7 (20.9) p = 0.01. No significant difference in the proportion of patients showing that gastronomy had a positive impact on their QoL (p > 0.05). Based on the PEG-Qu assessment, at 6 and 12 months: 71% and 75% of patients respectively expressed a positive overall effect on their QoL |
Most patients can cope adequately with the care of gastrostomy, despite considerable impairment of physical function. QoL of patients fed via gastrostomy is independent of nutritional outcome. Overall, the positive impact of gastrostomy on QoL was perceived in 55% of patients and 80% carers |
| Hossein et al. (2011) [30] |
Iran | Cross-sectional study | N = 100 | Mean (SD) 59.73 ± 18.16 |
To assess the perspectives of patients regarding the acceptability of PEG tube placement and evaluate the outcomes | PEG tube |
QoL index scores (Mean) Pre-PEG: 19.25 ± 11.85 6 months after: 32.08 ± 27.74 When comparing the mean QoL index scores before and after PEG placement there was significant improvement (p < 0.005) after PEG placement |
PEG tube is a minimally invasive gastrostomy method with low morbidity and mortality rates, and is easy to follow-up and to replace when blockage occurs |
| Kurien et al. (2017) [31] |
United Kingdom | Prospective multicenter cohort study | N = 100 (patients) N = 100 (caregivers) N = 200 (control) |
Mean (SD) Patients: 67 (14.7) Caregivers: 65 (12.2) Control: 60 (10.1) |
To determine how gastrostomies affect QoL in patients and caregivers | PEG (55%) + RIG (45%) |
Baseline (before gastrostomy) versus 3 months post insertion (Mean ± SD) No significant longitudinal changes in mean EuroQoL index scores for patients (0.70 before vs. 0.710 after; p = 0.83) or caregivers (0.95 before vs. 0.95 after; p = 0.32) following gastrostomy insertion |
QoL did not significantly improve after gastrostomy insertion for patients or caregivers. Gastrostomies may help maintain QoL |
| Rogers et al. (2007) [32] |
United Kingdom | Cross-sectional survey | N = 243 | Mean (SD) 65 (12) |
To devise, pilot and survey a PEG specific questionnaire and relate outcomes to QoL | PEG | Global measures score (0–100) QoL (Mean; SE) as measured by UW-QoL Never had PEG: 63 (1) PEG removed at 7 months: 68 (3) Still has PEG at 34 months: 41 (4) |
Patients with PEGs reported significant deficits in all UW-QOL domains compared to non-PEG or PEG-removed patients and reported a much poorer QoL |
| Salas et al. (2009) [33] |
France | Randomized, controlled study | N = 39 No systematic gastrostomy (standard group) = 18 Systematic gastrostomy (experimental group) = 21 |
Mean (SD) Standard = 60.0 ± 4.5 Experimental = 58.7 ± 7.7 |
To assess the impact of prophylactic gastrostomy on the 6-month QoL, and to determine the factors related to this QoL | Systematic percutaneous gastrostomy versus no systematic gastrostomy | QoL at Inclusion SF36 Score Standard: 49.4 ± 25.1 Experiment: 59.2 ± 21.8 (p = 0.19) EORTC (QLQ-C30): Standard: 57.8 ± 25.8 Experiment: 63.0 ± 24.1 (p = 0.37) QoL at 6 months was significantly higher in the group receiving systematic prophylactic gastrostomy (p = 10−3) |
Prophylactic gastrostomy improves post-treatment QoL for unresectable head and HNC, after adjusting for other potential predictive QoL factors |
| The effect of Enteral tube feeding on QoL | ||||||||
| Donohoe et al. (2017) [34] | Ireland | Prospective cohort study | N = 149 | Mean (SD) 62 ± 9 |
To analyze the impact of supplemental HEN post-esophageal cancer surgery on quality of life | HEN |
QoL measured at baseline, preoperatively, and at 1, 3, and 6 months Mean Global QoL decreased (p < 0.01) from 82 to 72. Global QoL (follow-up long-term) was not significantly different in those with <10% vs. >10% weight respectively (68.7 ± 20.6 vs. 70.95 ± 17.5, p = 0.519). With persistent weight loss (3–6 months postoperative, n = 12) there was clinically relevant decrease in QoL in physical (76.7 vs. 87.5, p = 0.066) and social function (76.4 vs. 87.8, p = 0.034) |
Weight loss and negative consequences on QoL occurs despite supplemental enteral nutrition in majority of patients |
| Guo et al. (2013) [35] |
China | Uncontrolled pilot clinical trial | N = 13 | Mean (SD) 26.1 (3.8) |
To determine the effect of exclusive enteral nutrition (EEN) on patients QoL in adults with active Crohn’s disease | Enteral nutrition | There were significant improvements in total IBDQ scores after 4-week EEN treatment (Mean ± SD) 128.3 ± 15.8 to 182.9 ± 24.2 (p < 0.001) |
A 4-week treatment of EEN improves QoL significantly in adults with active Crohn’s disease and was acceptable by most patients |
| Loeser et al. (2003) [36] |
Germany | Prospective cross-sectional (Study 1) Prospective longitudinal (Study 2: follow-up 4 months) |
Cross-sectional N = 155 Longitudinal N = 56 |
Mean (SD) 64.3 ± 13.1 |
To assess QoL in patients on HETF. | HETF HETF/PEG insertion | Study 1: When compared with EORTC reference data, functional scales were lower in HETF patients and QoL was significantly lower in non-competent patients. Study 2: QLQ-C30 (N = 26) PEG insertion: 44.2 ± 19.7 2 months: 46.5 ± 16.0 4 months: 50.6 ± 1 Lower QoL was observed in non-competent than in competent patients |
QoL is decreased in patients on HETF. Part of this explained by malnutrition. HETF can prevent further weight loss and improve some aspects of QoL |
| Roberge et al. (2000) [37] |
France | Prospective study | N = 39 | Mean = 58 | To evaluate the impact of HETF on QoL in patients treated for head and neck or esophageal cancer. Evaluations were carried out 1st week and 3rd week post hospital discharge |
HETF/PEG insertion |
QLQ-C30 Mean (SD) Global health status: 45(19). Overall, QoL slightly improved 3 weeks post-discharge; some symptoms significantly improved (p < 0.05): constipation, coughing, social functioning and body image/sexuality |
Home enteral tube feeding is a physically well accepted technique although some of the patients may experience psychosocial distress |
| Schneider et al. (2000) [38] |
France | Cross-sectional study | N = 38 | Mean (SEM) 56 ± 5 |
To assess both the QoL of long-term patients on HEN (for 25 ± 5 months) and the evolution of QoL after initiation of HEN | HEN vs. general population |
EQ-5D index HEN: 0.54 ± 0.07 vs. General: 0.85 ± 0.0 (p < 0.05) Visual Analogue Scale HEN: 54.1 ± 4.2 vs. General: 82.5 ± 0.3 (p < 0.05) SF-36 (Mental Component Scale) HEN: 46.2 ± 2.6 vs. General: 51.8 ± 0.3 SF-36 (Physical Component Scale) HEN: 37.1 ± 2.1 vs. General: 46.5 ± 1.2 (p < 0.05) |
QoL is poor in HEN patients compared to age and sex matched general population. Most patients describe an improvement in their QoL following the initiation of HEN |
| Wu et al. (2018) [39] |
China | Single-center, prospective, non-randomized study | N = 142 | Median (Range) Minimally invasive esophagectomy/laparoscopic jejunal feeding tube+HEN (MIE): 62 (45–80) Open esophagectomy/ nasojejunal feeding tube (OE): 61 (43–80) |
To investigate the effect of 3 months HEN on QoL and nutritional status of esophageal cancer patients who were preoperatively malnourished. | MIE vs. OE | QoL (Global health status) (Mean ± SD) Preoperative MIE:69.9 (9.1) OE:70.1(10.3), p = 0.546 2 weeks MIE: 19.6 (7.5) OE: 18.4 (7.0), p = 0.821 3 months MIE: 55.7 (7.4) OE: 41.8 (7.0), p = 0.001 |
MIE and subsequent treatment with 3 months HEN can improve QoL and reduce the risk of malnutrition in preoperatively malnourished patients |
| Zeng et al. (2017) [40] |
China | Non-Randomized Clinical trial | N = 60 HEN: N = 30 Control (Standard Care): N = 30 |
Mean (SD) HEN: 61.7 ± 8.4 Control: 59.3 ± 10.4 |
To characterize the effect of HEN on nutritional status and QoL of esophageal cancer patients who underwent Ivor Lewis esophagectomy for cancer | HEN vs. standard care |
Combined use of QLQ-C30 and QLQ-ES18 Compared to the control group, the HEN group achieved higher Global QoL scores, and most of their functional index scores were better. However, 24 weeks after surgery, QoL indexes did not differ significantly between the two groups |
HEN can reduce the incidence of malnutrition or latent malnutrition and help restore QoL in the patients with esophageal cancer in the early period (24 weeks) after surgery |
Abbreviations: EEN (Exclusive Enteral Nutrition); EQ5D Index (EuroQoL 5D) and EQ5D Visual Analogue Scale (VAS); SF-36 (Short-form 36); PEG (Percutaneous Endoscopic gastrostomy); PEG Qu (10 questions, specific about gastrostomy tube and QoL); EORTC (European Organization for Research and Treatment of Cancer) quality of life questionnaire (QLQ-C30) and QLQ-OES19 (esophageal cancer specific); HEN (Home Enteral Nutrition); HETF (Home Enteral Tube Feeding); HNC (Head and Neck Cancer); IBDQ (Inflammatory Bowel Disease Questionnaire); MIE (Minimally Invasive Esophagectomy); OE (Open Esophagectomy); PG-SGA (Patient Generated Subjective Global Assessment); QoL (Quality of Life); QLQ-ES18 (Esophageal module 18 questionnaire); RIG (Radiologically Inserted Gastrostomy); SD (Standard Deviation); SEM (Standard Error of Mean); UW-QoL (University of Washington Quality of Life questionnaire).