Introduction The use of Home Parenteral Nutrition (HPN) in patients (pts) with advanced cancer who cannot meet their nutritional requirements by oral or enteral routes, remains controversial with significant variation worldwide. Cancer cachexia is an irreversible process. Timely commencement of HPN is crucial to prevent malnutrition-related morbidity and mortality in these patients. To review data from literature and identify the potential benefit of HPN in pts with advanced cancer. Our aim was to review data from literature and identify the potential benefit of HPN in pts with advanced cancer.
Method Articles on HPN in advanced cancer from 2002 to 2016 were scrutined in PubMED. Primary end point was survival, secondary end points were quality of life (QoL) and nutritional/performance (Karnofsky score, KPS) status.
Results Of 175 studies, 18 met the quality inclusion criteria (11 retrospective, 7 prospective and 2 randomised). Overall survival was primary endpoint in 15 papers. Study characteristics are reported in table 1. Due to data heterogeneity and the small number of randomised studies a meta-analysis was not performed. Studies were mainly conducted in Western countries (30% in Italy, 15% in USA, 10% in Canada and Germany), including overall 3066 patients. Mean age was 57,2±6,4 years. Most common cancer site were GI tract, ovary, breast, head and neck. Main indication for HPN was bowel obstruction or cachexia. Mean duration of HPN was 3,8±1,4 months. Median overall survival was 4,6±2,4 months (1,5 month in a selected cohort with peritoneal carcinomatosis, 8 months in a study including only advanced ovarian cancer). At baseline, mean weight was Kg 57,6±5,1, mean BMI 20,7±0,8 and mean KPS 55±5. After 1–5 months of HPN, mean weight and mean BMI increased to 61,9±5.3 and 21,2±0,5 respectively. KPS increased in 2 studies, stable in 2 studies. QoL was analysed through validated scales in 5 studies and resulted significantly increased after HPN. On average, HPN related complications were reported in 13%±6% of the pts.
Conclusion Indications for HPN and overall survival (3,8±1,4 months) in advanced cancer was in accordance with prognostic parameters specified in European and American guidelines. Variation in clinical practice is evident in different countries. The cost effectiveness and impact of HPN on nutritional/performance status and QoL in these patients has not been adequately assessed and further prospective studies are required. A cultural change and education of healthcare professionals is required to ensure early access to HPN for appropriate patients.
- Home parenteral nutrition
- Systematic review
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