Background Parenteral Nutrition (PN) is the intravenous administration of nutrition and can be used in patients whose gastrointestinal tract is unable to function. It is a treatment that is relatively easy to initiate, but it is a difficult treatment to continue outside of hospital and can also be, ethically and morally, a difficult treatment to stop. Recent ESPEN guidelines (2016) state that ‘the bioethical aspects of feeding patients with advanced disease should be considered.... There are data showing benefits of home artificial nutrition in cancer patients .... even in advanced cancer patients. Home parenteral nutrition is a complex therapy and selecting patients for this treatment a demanding task’.
Method Patients for whom home parenteral nutrition had been a goal were identified. A retrospective review of these patients‘ clinical records was undertaken.
Results Between 2014 and 2019 six palliative patients had PN commenced at Milton Keynes University Hospital, a medium sized District General Hospital. One further patient had PN started at a tertiary centre. All patients had ongoing bowel obstruction secondary to peritoneal metastases. The mean age of patients was 49 years (range 35–81 years). The average time from starting PN to hospital discharge was 47 days for the MKUH patients compared to 14 days for the patient who was started on PN at a tertiary centre. The average time from staring PN to death was 435 days (range 28 – 1825 days). One patient remains alive, 2 died in the hospital, 2 in the hospice, 2 at home.
Conclusion Carefully selected palliative patients can benefit from home PN, but in a district general hospital this requires a lengthy hospital admission to achieve. The decision to start PN should be multidisciplinary and the goals of treatment should be clearly defined and reviewed regularly.
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