Predictors of survival in terminal-cancer patients with irreversible bowelobstruction receiving home parenteral nutrition

Clinical, anthropometric, hematologic, and biochemical variables, evaluated immediately before starting nutritional treatment, were related to surviva l in 76 terminal-cancer patients with irreversible bowel obstruction receiv ing home parenteral nutrition. At baseline, abnormally low values were obse rved in the following percentages of patients: 40.8% for body mass index, 5 9.2% for serum albumin, 84.2% for hemoglobin, 48.7% for lymphocyte count, a nd 60% for serum cholesterol. Survival on home parenteral nutrition ranged between 6 and 301 d, with a median of 74 d. Hemoglobin, serum albumin and s erum cholesterol were lower in patients with a survival of less than 3 mo. With regard to Karnofsky performance status, median survival times were 63 d for a score below or equal to 50 and 128 d for a score between 60 and 70. Albumin and a Karnofsky score above 50 (but not age, weight, body mass ind ex, lymphocyte count, or cholesterol) emerged (with a positive sign) as pre dictors of survival. In conclusion, terminal-cancer patients with irreversi ble bowel obstruction are often malnourished, showing a high prevalence of anemia and hypoalbuminemia. Survival differs widely and can be predicted on ly to a limited extent from initial values of serum albumin and Kamofsky pe rformance status. (C) Elsevier Science Inc. 2001.