Oral Nutritional Supplementation Following Upper Gastrointestinal Cancer Surgery: A Prospective Analysis Exploring Potential Barriers to Compliance

Abstract

Objective: Malnutrition is common in patients who underwent upper gastrointestinal cancer surgery. Our goal was to explore postoperative compliance with oral nutritional supplementation and define barriers to consumption in patients with esophageal, gastroesophageal junction, and gastric cancer.

Methods: Participants were prospectively recruited from September 2015 to November 2018. Preoperative nutritional status was assessed using the Patient Generated Subjective Global Assessment. Malnourished patients and patients at risk for malnutrition were offered oral nutritional supplementation at the time of hospital discharge. Compliance was evaluated 1 month after hospital discharge.

Results: A total of 78 patients were analyzed. Mean patient age was 62.8 ± 10.7 years and 83.3% were males. Εsophagectomy and gastrectomy were performed in 60.3% and 39.7% of the patients respectively. Twenty-eight (35.9%) participants reported consuming all prescribed supplements, whereas 50 (64.1%) patients were noncompliant with their prescribed oral nutritional supplementation regimen. The main barriers to oral nutritional supplementation compliance were bloating (compliant vs. noncompliant patients: 17.9% vs. 58%, p < 0.001), early satiety (compliant vs. noncompliant patients: 25% vs. 52.32%, p < 0.001), flavor or texture dislike (compliant vs. noncompliant patients: 7.1% vs. 34%, p < 0.001), and diarrhea (compliant vs. noncompliant patients: 10.7% vs. 24%, p < 0.001). No other statistically significant differences were identified between the two groups.

Conclusions: Postoperative compliance to oral nutritional supplementation is low in patients who underwent upper gastrointestinal cancer surgery. Patient education and support as well as providing a range of oral nutrition supplement flavors, texture, and compositions may be useful in increasing adherence to oral nutritional supplementation regimens.

Keywords:

• Stomach neoplasms
• esophageal neoplasms
• nutrition support
• patient compliance

Author contributions

Irene Lidoriki: conceived and designed the study, analyzed the data, interpreted the data, wrote the paper, reviewed the content of the article and approved the final version of the article. Dimitrios Schizas: designed the study, analyzed the data, interpreted the data, wrote the article, reviewed the content of the article and approved the final version of the article. Konstantinos Mylonas: analyzed the data, wrote the article, reviewed the content of the article and approved the final version of the article. Maximos Frountzas: analyzed the data, wrote the article, reviewed the content of the article and approved the final version of the article. Aikaterini Mastoraki: analyzed the data, wrote the article, reviewed the content of the article and approved the final version of the article. Emmanouil Pikoulis: reviewed the content of the article and approved the final version of the article. Theodoros Liakakos: conceived and designed the study, reviewed the content of the article and approved the final version of the article. Ioannis Karavokyros: interpreted the data, contributed to the drafting of the article, reviewed the content of the paper and approved the final version of the article.

Disclosure statement

No potential conflict of interest was reported by the author(s).