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Open Access Study protocol

Six weeks of home enteral nutrition versus standard care after esophagectomy or total gastrectomy for cancer: study protocol for a randomized controlled trial

David J Bowrey1*, Melanie Baker1, Vanessa Halliday2, Anne L Thomas3, Ruth Pulikottil-Jacob4 and Karen Smith5

Author Affiliations

1 Department of Surgery, University Hospitals of Leicester NHS Trust, Level 6 Balmoral Building, Leicester Royal Infirmary, Leicester LE1 5WW, UK

2 School of Health and Related Research, University of Sheffield, 30 Regent St, Sheffield S1 4DA, UK

3 Department of Oncology, Clinical Sciences Building, University of Leicester, Leicester LE1 5WW, UK

4 Department of Health Economics, Room A101, University of Warwick, Warwick CV4 7AL, UK

5 Department of Health Sciences, University of Leicester, 22-28 Princess Rd West, Leicester LE1 6TP, UK

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Trials 2014, 15:187  doi:10.1186/1745-6215-15-187

Published: 24 May 2014

Abstract

Background

Each year approximately 3000 patients in the United Kingdom undergo surgery for esophagogastric cancer. Jejunostomy feeding tubes, placed at the time of surgery for early postoperative nutrition, have been shown to have a positive impact on clinical outcomes in the short term. Whether feeding out of hospital is of benefit is unknown. Local experience has identified that between 15 and 20% of patients required ‘rescue’ jejunostomy feeding for nutritional problems and weight loss while at home. This weight loss and poor nutrition may contribute to the detrimental effect on the overall quality of life (QoL) reported in these patients.

Methods/Design

This randomized pilot and feasibility study will provide preliminary information on the routine use of jejunostomy feeding after hospital discharge in terms of clinical benefits and QoL. Sixty participants undergoing esophagectomy or total gastrectomy will be randomized to receive either a planned program of six weeks of home jejunostomy feeding after discharge from hospital (intervention) or treatment-as-usual (control). The intention of this study is to inform a multi-centre randomized controlled trial. The primary outcome measures will be recruitment and retention rates at six weeks and six months. Secondary outcome measures will include disease specific and general QoL measures, nutritional parameters, total and oral nutritional intake, hospital readmission rates, and estimates of healthcare costs. Up to 20 participants will also be enrolled in a qualitative sub-study that will explore participants’ and carers’ experiences of home tube feeding.

The results will be disseminated by presentation at surgical, gastroenterological and dietetic meetings and publication in appropriate peer review journals. A patient-friendly lay summary will be made available on the University of Leicester and the University Hospitals of Leicester NHS Trust websites. The study has full ethical and institutional approval and started recruitment in July 2012.

Trial registration

UKClinical Research Network ID #12447 (Main study); UKCRN ID#13361 (Qualitative sub study); ClinicalTrials.gov #NCT01870817 (First registered 28 May 2013)

Keywords:
Enteral nutrition; Feasibility; Gastrectomy; Gastric cancer; Jejunostomy; Qualitative; Esophageal cancer; Esophagectomy