Parenteral Nutrition in Patients with Advanced Cancer and Gastrointestinal Failure or Obstruction

Malnutrition in patients with advanced cancer and gastrointestinal failure (ACGIF) is inevitable. This is a prospective study of a cohort of patients with ACGIF who were treated by home parenteral nutrition (HPN). Included were all patients with ACGIF treated with HPN since January 2003. Data concerning the primary disease, demographics, functional capacity, and PN-related complications were obtained. 125 patients, ageu0027s 60±12.9 years, were included. Seven (6%) had KPSu003c50. Median survival was 3.2 months. Cumulative survival was 0.95, 0.50, 0.25, and 0.09 at two weeks, three and six months, and one year after initiation of HPN, respectively. Multivariate analysis revealed higher mortality associated with male gender (HR 1.48 95% CI 1.03-2.14; pu003c0.05), albumin levelu003c2.5 gr% (HR 1.73 95% CI 1.18-2.54 pu003c0.05), and low functional capacity (KPSu003c50) (HR 2.63 95% CI 1.21-5.74; pu003c0.05). Survival was not associated with age or BMI. More than 50% of patients survived more than three months, and more than 95% survived longer than two weeks. We cautiously suggest that HPN has prolonged survival and prevented starvation-related manifestations. The decision to initiate HTPN must be reached based on individual considerations, taking into account patient’s preferences.