Outcome of cancer patients receiving home parenteral nutrition

Background: Indication for home parenteral nutrition (HPN) in cancer patients is controversial because intestinal failure and malnutrition are often only two of the many problems found in such patients that may deserve priority of treatment. Methods: This was a retrospective study of 75 cancer patients from nine institutions included in the Italian HPN Registry. The patients had a mean weight loss of 12.5%, serum albumin of 3.1 g/dL, lymphocyte count of 1150/mm(3), and serum total iron-binding capacity of 190 mu g/dL. The main indication for HPN was intestinal obstruction (66%); 72% of the patients had metastatic disease. A series of demographic, oncologic, and nutritional characteristics were analyzed in an attempt to predict a possible benefit of HPN. Results: A total of 9897 days of HPN were delivered to 75 cancer patients, for a median of 4 months (range 1 to 15 months) per patient. Sixty-nine patients died while receiving HPN, five had a remission of their intestinal failure, and one chose to stop the treatment. Complications related to parenteral nutri tion were as follows: 19 cases of sepsis, 6 catheter occlusions, 4 catheter dislocations, and 2 metabolic imbalances. HPN preserved nutritional status and slightly improved weight, lymphocyte count, serum albumin, and Karnofsky performance status in patients who survived >3 months. Quality of life during HPN was judged by the clinicians to have improved in only 9% of those who survived <3 months, but in 68% of the patients who survived for >3 months. Karnofsky performance status >50 at the start of HPN was correlated with longer survival (p = .02). Conclusions: Our study demonstrated a positive effect of HPN on nutritional status and quality of life in patients who survived >3 months and suggests that HPN should be avoided when Karnofsky performance status is <50.