Indirect Calorimetry-Guided Parenteral Nutrition Prescribing in Oncology Patients

Percentage of Participants in the Indirect Calorimetry Arm Completing at Least 50% of Scheduled Indirect Calorimetry Measurements

Feasibility will be assessed as the proportion of participants randomized to the indirect calorimetry intervention arm who complete at least 50% of scheduled indirect calorimetry measurements during the 8-week intervention period. Scheduled measurements will occur weekly while inpatient and every 4 weeks while outpatient per protocol.

Participant Acceptability of Indirect Calorimetry Measured by a 5-Point Likert Questionnaire

Acceptability will be assessed using a 7-item participant questionnaire developed for this study evaluating comfort, understanding, satisfaction, and willingness to undergo indirect calorimetry again. Five items are scored on a 5-point Likert scale ranging from 1 (Strongly disagree) to 5 (Strongly agree). Higher scores indicate greater acceptability of indirect calorimetry. Acceptability will be summarized using mean questionnaire scores and the percentage of participants reporting agreement or strong agreement with overall acceptability.

Percentage Change in Prescribed Parenteral Nutrition Energy Dose Following Indirect Calorimetry Measurement

The outcome will assess the percentage change in prescribed parenteral nutrition caloric dose (kcal/day) after indirect calorimetry measurement compared with the initial weight-based prescription. Changes in PN dosing attributable to indirect calorimetry-guided resting energy expenditure measurements will be recorded at each reassessment.

Incidence of Parenteral Nutrition Access-Related Infections

PN access-related infections will be identified through chart review using clinical documentation, ICD-10 diagnosis codes, antibiotic treatment, and timing of infection relative to PN administration.

Incidence of Parenteral Nutrition-Related Edema or Ascites

PN-related edema or ascites will be assessed through chart review, imaging findings, physical examination findings, need for paracentesis/thoracentesis, changes in diuretic therapy, and CTCAE grade 2 or higher fluid-related adverse events.

Incidence of Parenteral Nutrition-Related Metabolic Abnormalities

Metabolic abnormalities related to PN administration, including hyperglycemia, hypertriglyceridemia, liver function abnormalities, or transaminitis, will be assessed through laboratory review and clinical documentation.

Number of Hospital Admissions During Parenteral Nutrition Therapy

Hospital admissions and reasons for admission will be collected through electronic medical record review and outside hospital records when available.