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Original research
High-protein compared with standard parenteral nutrition in palliative cancer care
  1. Charlotte Goodrose-Flores1,
  2. Anna Schedin2,
  3. Johan Nelander2,
  4. Agneta Almerud2,
  5. Ylva Trolle-Lagerros1,3,
  6. Stephanie Bonn1 and
  7. Linda Björkhem-Bergman4,5
  1. 1 Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
  2. 2 Palliative Home Care and Hospice Ward, ASIH Stockholm Södra, Älvsjö, Sweden
  3. 3 Academic Specialist Center, Obesity Center, Stockholm County Council, Stockholm, Sweden
  4. 4 Palliative Home Care and Hospice Ward, Stockholms Sjukhem, Stockholm, Sweden
  5. 5 Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Huddinge, Sweden
  1. Correspondence to Dr Linda Björkhem-Bergman, Palliative Home Care and Hospice Ward, Stockholms Sjukhem, Stockholm, Sweden; linda.bjorkhem-bergman{at}ki.se

Abstract

Objectives High-protein parenteral nutrition (PN) has been developed to counteract muscle loss in patients with cancer treated with PN. Nevertheless, it is not clear if high-protein PN is as safe as standard PN in patients with palliative cancer. Our primary aim was to compare the proportion of patients with elevated liver enzymes between high-protein and standard PN in patients with palliative cancer enrolled to Medical Home Care. Our secondary aim was to compare the two treatments with regard to weight and albumin levels during treatment.

Methods Medical records from 2016 to 2018 were retrospectively reviewed to identify palliative cancer patients that had received PN for more than 3 weeks. Data on weight, height, albumin, liver enzymes, socioeconomic factors and dietitian consultations were collected at baseline and after 3–8 weeks of PN treatment. The odds of having elevated liver enzymes or having a maintained weight and/or stable albumin levels were calculated using logistic regression.

Results 20 patients treated with high-protein PN were compared with 104 patients treated with standard PN. Patients treated with high-protein PN had a significantly higher weight at follow-up compared with patients treated with standard PN (p<0.05). There was no significant difference in the proportion of patients with elevated liver enzymes (OR 0.20; 95% CI 0.02 to 1.86), or maintained weight and/or albumin levels (OR 1.62; 95% CI 0.46 to 5.76) between high-protein and standard PN.

Conclusion High-protein PN was as safe, and at least as effective, as standard PN to patients with palliative cancer.

  • cachexia
  • gastrointestinal (lower)
  • gastrointestinal (upper)
  • head and neck
  • home care

Data availability statement

Data are available on reasonable request. The raw data are available from the corresponding author on request.

https://doi.org/10.1136/bmjspcare-2019-002139

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    Data availability statement

    Data are available on reasonable request. The raw data are available from the corresponding author on request.

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    Footnotes

    • Contributors CG-F, AS, AA, SB and LB-B contributed to the conception and design of the research.

      CG-F, AS, JN, AA, YT-L, SB and LB-B contributed to the acquisition and analysis of the data; CG-F, SB, Y-TL and LB-B contributed to the interpretation of the data. CG-F, SB and LB-B drafted the manuscript. All authors critically revised the manuscript, agree to be fully accountable for ensuring the integrity and accuracy of the work, and read and approved the final manuscript.

    • Funding This study was financially supported by grants from Stockholm County Council (ALF 20160036 and 20180320), the Swedish Cancer Society (CAN 2017/233 and CAN 2018/316), Stockholms Sjukhems Jubileumsfond and ASIH Stockholm Södra.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.