Standards, Options and Recommendations for home parenteral or enteral nutrition in adult cancer patients

Context. The "Standards, Options and Recommendations" (SOR) project, starte d in 1993, is a collaboration between the Federation of the French Cancer C entres (FNCLCC), the 20 French Cancer Centres and specialists from French P ublic Universities, General Hospitals and Private Clinics. The main objecti ve is the development of clinical practice guidelines to improve the qualit y of health care and outcome for cancer patients. The methodology is based on literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer rare delivery. Objective s. To develop clinical practice guidelines according to the definitions of the Standard, Options and Recommendations project for home parenteral or en teral nutrition in adult cancer patients. Methods. Data were identified by searching Medline (R), Cancerlit (R), web sites and using the personal refe rence lists of members of the expert groups. Once the guidelines were defin ed, the document was submitted for review to 72 independent reviewers. Resu lts. The main recommendations for home parenteral or enteral nutrition in a dult cancer patients are: 1) Home parenteral or enteral nutrition concerns cancer patients with malnutrition or with inadequate/impossible oral intake , during therapy of because of therapeutic after-effects (standard). Same i ndications apply for home and hospital artificial nutrition (standard). 2) Patients need a multidisciplinary follow-up (oncologists, nutritionists, an d pain specialists), and this follow-up will make treatment adaptations acc ording to the nutritional status possible (recommendation, expert agreement ). An active participation of patients and/or their family circle is very i mportant (standard). 3) The benefit of home parenteral or enteral nutrition on the quality of life of terminally ill patients (vs. hydration) has not been demonstrated. When life expectancy is below 3 months, and the Karnofsk y index below 50, the drawbacks of home artificial nutrition are more impor tant than its advantages. In this case, home parenteral or enteral nutritio n is not recommended (recommendation, expert agreement). 4) Prospective cli nical trials are recommended to evaluate the impact of home nutrition on qu ality of life in cancer patients (expert agreement). 5) The use of educatio nal booklets that mention the telephone number of a referent health care an d what to do when a problem happens (e.g. fever on home parenteral nutritio n) is recommended (expert agreement). In France, patients should be referre d to authorized home parenteral nutrition centres (recommendation, expert a greement).