Availability of Frozen Foods and an In-Room Freezer for Terminally Ill Patients with Malignancies in a Palliative Care Unit

Dear Editor:

A special meal service for terminally ill patients (TIPs) can not only relieve their stress but also support their strength to live and help improve their spiritual quality of life (QOL).^1–3 However, few studies have investigated the importance of eating, regardless nutrition, in the terminal care setting.

We prospectively observed all TIPs with advanced malignancies who were admitted in single rooms in our palliative care unit (PCU) between July and August 2018. An in-room freezer (IRF) was prepared for 6 of 11 rooms, whereas the patients without IRF used a shared freezer. The patients described every instance at which the patient had consumed frozen food (FF) using a form. We examined their preference of FF and compared the frequency in intake of FF between with and without IRF. The inclusion criteria were patients admitted for palliation of symptoms originating from malignancies, and who agreed to participate in this study.

Twelve of 14 patients agreed to attend this study. The patients' characteristics and their FF intake are outlined in Table 1. Six of eight (75%) and one of four (25%) patients with and without IRF, respectively, had a preference for FF. Three of four (75%) and one of three (33%) patients with and without IRF, respectively, who were suffering from anorexia enjoyed FF. The average daily FF intake was 0.067 and 0.077 times for patients with and without IRF, respectively.

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Table 1.

Patients' Characteristics and Their Frozen Food Intake

	With freezer, N (%)	Without freezer, N (%)	p
N	8	4
Gender, male	3 (37)	2 (50)	0.848
Median age, years (range)	78 (61–92)	78 (74–87)	0.865
Performance status (ECOG)			0.905
3	5 (63)	3 (75)
4	3 (37)	1 (25)
Mean dietary intake
Median, % (range)	70 (0–97)	35 (27–88)	0.439
Impossible	1 (12)	0
Location
Stomach	2 (25)	1 (25)
Colorectum	2 (25)	1 (25)
Pancreas	0 (0)	2 (50)
Lung	2 (25)	0 (0)
Breast	1 (12)	0 (0)
Malignant lymphoma	1 (12)	0 (0)
Disease state			0.678
Postoperative recurrence	6 (75)	2 (50)
Unresectable	2 (25)	2 (50)
Distant metastasis
Yes	7 (87)	4 (100)	1
Previous chemotherapy
Yes	6 (75)	2 (50)	0.678
Concurrent chemotherapy
Yes	2 (25)	1 (75)	1
Concurrent radiotherapy
Yes	1 (12)	1 (25)	0.969
Receiving narcotics
Yes	5 (63)	3 (75)	0.905
Main symptom (overlapped)
Anorexia	4 (50)	3 (75)
Pain	3 (37)	2 (50)
Nausea	3 (37)	1 (25)
Dyspnea	3 (37)	1 (25)
Fatigue	1 (12)	0 (0)
Dry mouth	1 (12)	1 (25)
Median duration, days (range)	30 (18–62)	20 (4–32)	0.089
Outcome
Hospitalization	5 (63)	3 (75)
Discharge	2 (25)	0 (0)
Death	1 (13)	1 (25)
Patients with frozen food intake	6 (75)	1 (25)	0.282
Number of times frozen foods were eaten, total	20	6
Ice cream	10	0
Piece of ice	9	2
Shaved ice	1	0
Sherbet	0	4
Number of times frozen foods were eaten per day	0.067	0.077	0.082

ECOG, Eastern Cooperative Oncology Group.

The majority of patients suffering from anorexia sampled FF, which is easy to eat and digest ⁴ and can also deliver a refreshing cool feeling. Furthermore, enjoying FF may not only relieve the stress of the patients and their family, but also help improve their spiritual QOL due to the satisfaction and comfort derived from eating. However, the frequency of FF intake was not very high as patients' tastes may change depending on their condition and mood. Therefore, we should pay attention to patients' favorite foods and establish systems to prepare such meals in a timely manner to make their limited life more comfortable.

The ratio of patients with IRF who had eaten FF was higher than that of patients without IRF. Of note, the majority of patients without IRF who were suffering from anorexia never ate any FF. To remove FF from IRF by themselves whenever patients want to eat without any hesitation may be a crucial point to consider for TIPs, as their condition, preferences, and mood are unstable. Furthermore, being able to eat something on their own may also encourage patients who find themselves unable to do many things by themselves as their disease progresses. Room appliances, such as a refrigerator and a pot, can also broaden the meal options and allow patients to immediately indulge in a craving whenever they please, which can promote their comfort and relieve their stress. ³

In conclusion, TIPs suffering from anorexia may prefer FF. IRF in the PCU can facilitate the intake of FF. The availability of these appliances and a timely food serving system according to each patient's tastes can promote their comfort and relieve their stress.

Informed Consent

Informed consent was obtained from the patients. This study followed the ethical guidelines for studies involving human subjects based on the Helsinki Declaration. The study protocol was approved by the institutional review board of Kyoto Okamoto Memorial Hospital.

Data Availability

The authors declare that data supporting the findings of this study are available within the article.