Adherence to Oral Nutritional Supplements in Patients With Gastrointestinal Cancer: A Mixed-Method Study.

BACKGROUND: Oral nutritional supplements (ONS) is a cost-effective nutritional therapy in patients with gastrointestinal cancer. However, information is lacking about adherence to ONS in general clinical settings. Figuring out adherence to ONS and related factors will provide evidence for the improvement of ONS usage practice. OBJECTIVE: The aim of this study was to survey adherence to ONS in gastrointestinal cancer patients with an ONS prescription and the factors associated with it. METHODS: A mixed-method prospective study was conducted. Multivariate analysis and semistructured interviews were performed to identify factors that affected patient adherence to ONS. RESULTS: Of 111 gastrointestinal cancer patients provided with an ONS prescription, the median of adherence to ONS was 50.00% (interquartile range, 28.57%-91.67%). Multivariate analysis indicated that participants with low weight showed higher adherence to ONS than those with normal weight (ß = -2.61, P = .011) or overweight (ß = -3.25, P = .002). Semistructured interviews on 14 participants suggested that factors related to adherence to ONS were needs perception and benefits, clarity of the target daily ONS intake, tolerance to ONS, the impact of disease or treatment, personal preference, and professional support. CONCLUSION: This study reveals poor adherence to ONS in patients with gastrointestinal cancer and factors related to it in current clinical settings. IMPLICATIONS FOR PRACTICE: Our findings could provide evidence for the development of strategies to improve ONS usage practice. It suggests that the practice in ONS should be improved from aspects of nutritional assessment, education, tolerance, and symptom management, as well as follow-up and monitoring of patients.

Clinicopathological features of He Shou Wu-induced liver injury: This ancient anti-aging therapy is not liver-friendly.

BACKGROUND & AIMS: Polygonum Multiflorum Thumb (PMT), an ancient anti-aging Chinese herb known traditionally as He Shou Wu, has side effects of liver toxicity. To determine the main clinical and pathological characteristics of liver toxicity induced by PMT and the clinical course after its cessation. METHODS: Data of patients, diagnosed as drug-induced liver injury and hospitalised in Beijing Friendship Hospital from August 2005 to August 2017, were retrospectively reviewed. Clinical, pathological data and outcome after cessation of He Shou Wu were obtained and analysed. Kruskal-Wallis and Chi-square (χ2 ) tests were performed. RESULTS: Twenty-nine patients with He Shou Wu-induced liver injury were enrolled. The median age was 53 years (range 15-74) and 75.9% (22/29) were women. The most common symptom was jaundice (79.3%, 23/29). Of nine patients with liver biopsies, six showed acute cholestatic hepatitis, two acute, and one chronic hepatocellular injury pattern. The latency, liver chemistries and outcomes were comparable between pure He Shou Wu (5 patients) and its compounds (24 patients). Twenty-five of 29 patients (86.2%) had normal serum alanine aminotransferase levels after 45 days (range: 10-138 days) and total bilirubin of 46 days (range: 0-551 days). One patient was rechallenged with He Shou Wu and two developed autoimmune features. One patient died of liver failure and three had chronic persistent liver injury. CONCLUSIONS: The main clinicopathological injury pattern of He Shou Wu-induced liver injury is moderate to severe hepatitis with or without cholestasis. Most patients recover completely; however, chronic disease and death do occur.