Introduction There is controversy about the indications for home parenteral nutrition (HPN) during the palliative phase of malignancy causing inoperable gastrointestinal obstruction (IBO). This is partly due to uncertainty about the survival of patients. This study aimed to establish the survival characteristics of these patients in order to inform decisions about the use of HPN.
Methods A systematic review with meta-analyses were carried out in accordance with the Cochrane protocol for adult patients (>18 years) with a confirmed diagnosis of malignancy causing IBO (in at least 80% of the patients) being treated with palliative HPN. A literature search was carried out in April 2013 using Medline, EMBASE, CINALH and Web of knowledge. Whenever possible, individual patient data were extracted to allow meta-analyses.
Results 11 studies involving 420 patients, met the inclusion criteria. 3 studies reported individual patient data, 4 studies represented this using Kaplan Meier, one study using scatter plot and 3 studies only reported averages for survival length. The extraction procedure which gathered individual information on 220 patients from 8 studies, allowed a random effects model meta-analysis to be carried out. The mean age of patients within individual studies ranged between 45–61 years. 64% of patients were female. The underlying primary malignancy was gastrointestinal (53%), gynaecological (25%) (accounting for the female predominance), and others (22%). Four studies reported use of palliative chemoradiotherapy with 39–100% of the patients under going at least one cycle of treatment. Figure 1 shows the survival at monthly intervals for six months. The overall median survival is 83 days. 24% were still alive at 6 months but only about 2% at year.
Conclusion This is first systematic review showing the survival in patients with malignant inoperable bowel obstruction receiving HPN during the palliative phase of care. We show, using the largest published cohort to date, that the median survival is only 83 days. The described variability in survival length between studies and between patients can be substantial. This information can help inform clinician decisions about the use of HPN in such patients.
Disclosure of Interest None Declared.