The effect of total parenteral nutrition on the survival of terminally ill ovarian cancer patients.
OBJECTIVE
Total parenteral nutrition (TPN) for terminal ovarian cancer patients remains controversial. In this study, we compared survival from time of terminal intestinal obstruction (TIO) diagnosis in patients who received TPN versus those who did not.


METHODS
A historical cohort of 55 patients with stage IIIC/IV epithelial ovarian cancer hospitalized for TIO between 1994 and 2002 was studied. All patients were previously treated with paclitaxel/platinum following cytoreductive surgery. Exposure was administration of TPN after TIO. The primary outcome was survival from TIO diagnosis to death. Number of chemotherapy cycles completed after TIO diagnosis, major complications of TPN, and demographics were measured. Survival analysis was performed using Kaplan-Meier methods.


RESULTS
The median survival from time of TIO diagnosis was 72 days (range 16-485) for patients receiving TPN and 41.0 days (range 4-133) for those not receiving TPN (P = 0.05), but no difference in survival was observed when adjusting for chemotherapy. Overall survival [median 23 (range 6-67) vs. 35 months (range 8-67), P = 0.03] was shorter for the TPN group. Demographic data were similar in both groups. Patients receiving TPN after obstruction were more likely to undergo concurrent chemotherapy (64 vs. 26%, P = 0.004). One major TPN-related complication was found.


CONCLUSIONS
Ovarian cancer patients with TIO receiving TPN had a median survival benefit of 4 weeks. This benefit decreased when patients were treated with concurrent chemotherapy. Issues of cost, quality of life, and human values need to be investigated to assess the full impact of TPN in this patient population.
Department of Obstetrics and Gynecology, Women and Infants' Hospital, Brown University, 101 Dudley Street, Providence, RI 02905, USA. lbrard@wihri.org
Laurent
L
Brard
Sherry
S
Weitzen
Suzanne L
SL
Strubel-Lagan
Narasimha
N
Swamy
Mary E
ME
Gordinier
Richard G
RG
Moore
Cornelius O
CO
Granai
D015331:Cohort Studies; D004847:Epithelial Cells / Q000473:pathology; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000150:complications / Q000628:therapy*; D008875:Middle Aged; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000150:complications / Q000473:pathology / Q000628:therapy*; D010289:Parenteral Nutrition, Total; D012189:Retrospective Studies; D015996:Survival Rate; D013727:Terminal Care