: Are Enhanced Recovery After Surgery (ERAS) Protocols Beneficial for adult Cancer Patients?

Abstract

Background: Older adults requiring surgery for cancer often experience nutritional challenges that further impact their recovery from the disease as well as their quality of life. It is imperative that evidence-based approaches are implemented that will have a significant impact on improving nutritional status and overall wellbeing. Objective: The primary objective of the systematic review is to determine the effectiveness of the Enhanced Recovery After Surgery (ERAS) protocol for adult cancer patients using enteral or parental nutritional support while receiving chemotherapy treatment. Methods: For the systematic review, the Cochrane Central Register of Controlled Trials (CENTRAL), Wiley online library, PubMed/MEDLINE, and Elsevier were systematically searched for Randomized Controlled Trials and cohort studies published between 2011-2019. Results: The systematic review included fourteen studies, 13 of which are RCTs and an additional cohort study. Eight out of 14 studies reported significant improvements when following the ERAS program intervention including the EN and PN nutrition support intervention for cancer patients during chemotherapy treatment (P<0.001). Furthermore, six out of 14 studies reported a significant improvement in QOL with ERAS and nutrition support using enteral and parenteral options (P=0.05). Other outcomes to reduce complications were significantly different with ERAS and EN and PN nutrition for cancer patients(P=0.05). Conclusion: With the systematic review method using randomized controlled trials, it was determined that additional therapies beyond surgery may be necessary such as chemotherapy that may further compromise nutritional status in the target population group. The ERAS protocol may benefit some older adults based upon the type of cancer that is present as well as other factors that affect patients. In addition, the significance of a dietitian-based intervention for patients is important in improving nutritional status but requires additional evaluation to address measures that impact patient safety. Future studies should explore ERAS for older adults with other forms of cancer and evaluate the application of enteral and parenteral nutritional options across different population groups.