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Home parenteral nutrition versus artificial hydration in malnourished patients with cancer in palliative care: a prospective, cohort survival study
  1. Paolo Cotogni1,2,
  2. Marta Ossola1,3,
  3. Roberto Passera4,
  4. Taira Monge1,3,
  5. Maurizio Fadda3,
  6. Antonella De Francesco3 and
  7. Federico Bozzetti5
  1. 1Internal Medicine, Unit of Parenteral Nutrition in Oncology, Molinette Hospital, Turin, Italy
  2. 2Anesthesia, Intensive Care and Emergency, Pain Management and Palliative Care, Molinette Hospital, University of Turin, Turin, Italy
  3. 3Internal Medicine, Clinical Nutrition, Molinette Hospital, Turin, Italy
  4. 4Radiology, Nuclear Medicine Division, Molinette Hospital, Turin, Italy
  5. 5Faculty of Medicine, University of Milan, Milan, Italy
  1. Correspondence to Dr Paolo Cotogni, Department of Anesthesia, Intensive Care and Emergency, Pain Management and Palliative Care, Molinette Hospital, University of Turin, Turin, Italy; paolo.cotogni{at}unito.it

Abstract

Objective The evidence base for home parenteral nutrition (HPN) in patients with advanced cancer is lacking. To compare the survival of malnourished patients with cancer undergoing palliative care who received HPN with a homogeneous group of patients, equally eligible for HPN, who did not receive HPN.

Design Prospective, cohort study; tertiary university hospital, home care, hospice.

Methods Patients were assessed for HPN eligibility according to the guidelines. In the eligible population, who received both HPN and chemotherapy was excluded, while who received only HPN was included in the HPN+ group and who received neither HPN nor chemotherapy but artificial hydration (AH) was included in the HPN− group.

Results 301 patients were assessed for HPN eligibility and 86 patients (28.6%) were excluded for having severe organ dysfunction or Karnofsky performance status <50. In outcome analysis, 90 patients (29.9%) were excluded for receiving both HPN and chemotherapy, while 125 (41.5%) were included, 89 in HPN+ group (29.5%) and 36 in HPN− group (12%). The survival of the two groups showed a significant difference favouring patients receiving HPN (median overall survival: 4.3 vs 1.5 months, p<0.001). The multivariate analysis of the risk factors for mortality showed that not receiving HPN accounted for the strongest one (HR 25.72, 95% CI 13·65 to 48.44).

Conclusions Comparative survival associated with the use of HPN versus AH showed significantly longer survival in malnourished patients with advanced cancer receiving HPN. These data support the guideline recommendation that HPN should be considered when malnutrition represents the overriding threat for the survival of these patients.

  • supportive care
  • home care
  • cancer
  • end of life care
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Footnotes

  • Contributors PC was chief investigator. PC and MO designed the trial and developed the protocol. PC, MO and TM participated in recruitment of patients. PC, RP and MF developed and carried out the statistical analysis plan. PC, MO, TM and ADF coordinated the data collection and regulatory and governance requirements. PC, MO, RP, MF, ADF and FB interpreted the data. PC wrote the draft manuscript. All authors contributed to the review and amendments of the manuscript for important intellectual content and approved this final version for submission.

  • Funding The study was partially supported by grants (19700/27.001, 1837/27.001) from the Regional Public Healthcare Office (Piedmont Region, Italy).

  • Competing interests PC reported grants (19700/27.001, 1837/27.001) from the Regional Public Healthcare Office and reported honoraria for speaking and teaching from Baxter. The other authors declare that they have no competing interests.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by our Institutional Ethics Committee. Approval for the study was also received from Regional Public Healthcare Office (reference no. 13-7456; 19.11.2007). The chief investigator submitted an update report monthly to the regional competent authority and annually to the approving research ethics committee.

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

  • Data availability statement Data are available on reasonable request. The data that support the findings of this study are available from the corresponding author on reasonable request.

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