Use of parenteral nutrition in patients with advanced cancer.
The purpose of this study is to describe patient-related variables in a cohort of advanced cancer patients (ACPs) enrolled in a home parenteral nutrition (HPN) program. This study reviewed the cohort of ACPs enrolled in the Northern Alberta Home Total Parenteral Nutrition Program (NAHTPNP). Thirty-eight ACPs received HPN during the study period, 24% of all patients admitted for PN. Of these, 27 (71%) were female. Mean age was 48.76 y (SD 13.8 y). Bowel obstruction was the most common indication for initiating HPN (84%, 32) and ovarian cancer was the most common malignancy (34%, 13). Patients who began HPN with a Karnofsky performance status (KPS) of greater than 50 (median of 70) were found to have a longer duration of life (median: 6 months) compared with patients who began HPN with a KPS of 50 or below (median=50; median 3 months; p=0.01; two-tailed). There was no difference in survival between malignancy type (p=NS). Advanced cancer is the fastest growing indication for enrollment in the HPN program. ACP demonstrated a 3% average annual increase proportionate to all indications for HPN starts, accounting for 7%-48% of HPN starts from 1999-2006. HPN is an increasingly used therapy for patients with advanced cancer, most commonly for intestinal failure in the setting of bowel obstruction. Initiation of HPN at a higher KPS was associated with a longer duration of life. Further studies are needed to validate the use of TPN in end-stage cancer patients.
Soo
Isaac
I
Faculty of Medicine, University of Alberta, Edmonton, AB T6G 2E1.
Gramlich
Leah
L
D000328:Adult; D000416:Alberta; D015331:Cohort Studies; D005260:Female; D005767:Gastrointestinal Diseases / Q000178:diet therapy / Q000209:etiology / Q000401:mortality; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000178:diet therapy* / Q000209:etiology* / Q000401:mortality; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000401:mortality; D010166:Palliative Care / Q000379:methods*; D016331:Parenteral Nutrition, Home; D012189:Retrospective Studies; D016019:Survival Analysis