Poster Topical Area: Nutritional Epidemiology
Location: Hall D
Poster Board Number: 804
Objective: Amyotrophic lateral sclerosis (ALS) is a chronic, degenerative neurological disease affecting the brain and spinal cord. Feeding tubes are used to maintain adequate nutrition in patients with dysphagia, upper extremity motor disabilities, and/or hypermetabolic states that may cause malnutrition. This study assessed the epidemiology of feeding tube placement and end of life care in patients with ALS.
Methods: A retrospective chart review was conducted of all patients who died between January 2010 and December 2015 who had received care from an ALS Clinic at a single U.S. Veterans Administration (VA) Medical Center. Abstracted data included: date of feeding tube placement (when available), date of initiation of enteral nutrition, survival (from first ALS appointment), location of death, complications related to the tube or feedings, and use of hospice care. Statistics included chi-squared, Z-score, and Student's T-test.
Results: Of the 139 patients who did with ALS, 88 (63.3%) had received a gastrostomy tube. Tube placement was more common among younger patients, e.g. under 70 years of age. The mean / median time from initial ALS appointment to tube insertion was 247 / 145 days (N=72). The mean / median survival after feeding tube placement was 352.5 / 258 days (range 4 -2196). The patients with and without tubes did not differ significantly in survival from initial VA ALS Clinic appointment, location of death, or rate of use of hospice. See figures. There were seven deaths within 60 days after tube placement. Three patients received feeding tubes after enrollment in hospice.
Conclusion: This VA ALS Clinic had a higher rate of tube placement than reported previously. Use of a feeding tube does not appear affect decisions about enrollment in hospice or location of death. Lack of evidence of a survival benefit associated with use of feeding tubes in ALS in this and prior studies suggests their use should be better targeted to some sub-population(s) of patients with ALS that future research might identify. Further study of quality of life among patients with ALS and a feeding tube may also be needed to justify widespread use of feeding tubes in this population.
Minneapolis VA Medical Center Spinal Cord Injury and Disorder (SCI/D) Center
Golden Valley, Minnesota