title: Parenteral nutrition for patients with advanced ovarian malignancy.
abstract: BACKGROUND
  Parenteral nutrition (PN) in patients with disseminated ovarian cancer remains controversial. The role of PN in providing nutrition and improving quality of life is unclear. The present study aimed to determine the pattern of prescribing in a large teaching hospital, and to identify subgroups where the use of PN was justified.
  
  
  METHODS
  Sixty-five patients with advanced ovarian carcinoma received PN between January 2002 and May 2008. A retrospective case note review was undertaken to retrieve data on PN prescribing and outcomes in terms of duration of PN provision, complications, and survival.
  
  
  RESULTS
  Three subgroups were identified. Group I consisted of 18 (28%) patients who received PN for a median [interquartile range (IQR)] of 5 (2-11) days. The majority of these 18 patients (n = 13, 72%) had disease-related terminal bowel obstruction. Out of 18 of these patients, 17 (95%) had poor performance status. The median (IQR) survival was 12 (6-28) days. Group II consisted of 40 (61%) patients who were re-established on enteral nutrition. The median (IQR) duration of PN administration was 10 (6-17) days. The most common indication of PN was protracted ileus (n = 25, 63%). Out of 40 of these patients, 35 (88%) patients had good performance status. The median (IQR) survival was 264 (96-564) days. The third group of patients required home PN (n = 7, 11%). Four (58%) patients had short bowel syndrome and three (42%) had terminal intestinal obstruction. All of the patients had good performance status. The median (IQR) duration of PN administration and survival was 241 (90-305) days.
  
  
  CONCLUSIONS
  Administration of PN appears to be justified in those patients with a good performance status (i.e. patients capable of self-care), which constituted three-quarters of this cohort. In the remaining patients with poor performance status, and particularly those with terminal intestinal obstruction, PN administration was difficult to justify. PN should not be denied based purely on the pathology, although cautious judgment is required to select those who are most likely to benefit.
authors.affiliation: Academic Unit of Surgery, St James's University Hospital, Leeds, UK. umbm@leeds.ac.uk
authors.forename: B M
authors.initials: BM
authors.lastname: Madhok
authors.forename: S
authors.initials: S
authors.lastname: Yeluri
authors.forename: K
authors.initials: K
authors.lastname: Haigh
authors.forename: A
authors.initials: A
authors.lastname: Burton
authors.forename: T
authors.initials: T
authors.lastname: Broadhead
authors.forename: D G
authors.initials: DG
authors.lastname: Jayne
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004750:Enteral Nutrition; D005260:Female; D017408:Guidelines as Topic; D006784:Hospitals, Teaching; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000628:therapy; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000150:complications* / Q000401:mortality; D010288:Parenteral Nutrition / Q000009:adverse effects / Q000379:methods*; D010818:Practice Patterns, Physicians'; D055656:Prescriptions; D012189:Retrospective Studies; D012648:Self Care; D012778:Short Bowel Syndrome / Q000209:etiology / Q000628:therapy; D016896:Treatment Outcome; D055815:Young Adult