OUTCOME OF CANCER-PATIENTS RECEIVING HOME PARENTERAL-NUTRITION

Background: Indication for home parenteral nutrition (HPN) in cancer p atients is controversial because intestinal failure and malnutrition a re often only two of the many problems found in such patients that may deserve priority of treatment. Methods: This was a retrospective stud y of 75 cancer patients from nine institutions included in the Italian HPN Registry. The patients had a mean weight loss of 12.5%, serum alb umin 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 inte stinal obstruction (66%); 72% of the patients had metastatic disease. A series of demographic, oncologic, and nutritional characteristics we re analyzed in an attempt to predict a possible benefit of HPN. Result s: A total of 9897 days of HPN were delivered to 75 cancer patients, f or 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 inte stinal failure, and one chose to stop the treatment. Complications rel ated to parenteral nutri tion were as follows: 19 cases of sepsis, 6 c atheter occlusions, 4 catheter dislocations, and 2 metabolic imbalance s. HPN preserved nutritional status and slightly improved weight, lymp hocyte count, serum albumin, and Karnofsky performance status in patie nts who survived >3 months. Quality of life during HPN was judged by t he clinicians to have improved in only 9% of those who survived <3 mon ths, 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 eff ect of HPN on nutritional status and quality of life in patients who s urvived >3 months and suggests that HPN should be avoided when Karnofs ky performance status is <50.