Parenteral Nutrition information, tips and advice

To further investigate this important topic, a study was undertaken to investigate changes in the QOL in cancer patients during HPN, and to determine whether it is possible to predict length of survival in these patients before administering HPN. A prospective study was conducted including 69 adult cancer patients over a period of three years. The main symptoms/signs reported by patients were gastrointestinal obstruction-related symptoms, asthenia, pain, edema, and dyspnea. The majority of patients were treated with HPN because they had chronic obstruction, were expected to die of starvation rather than from tumor spread.

All patients were given a daily infusion with the purpose of reaching a calorie load of about 30 non-protein kcal/kg/day. The main characteristics of the nutritional regimen were as follows: glucose--300 g/day median (range: 160-500); lipid--60 g/day median (range 42-100); nitrogen--12 g/day median (range: .7). Patient data were collected using a basic form including age, sex, data on oncological status, weight loss, main indication for HPN, nutritional status (body weight, serum albumin, serum lymphocyte count, serum transferrin), KPS, administration of oncological therapy, and presence of symptoms unrelated to malnutrition or to food intake. Patients were followed monthly. The QOL was assessed using the Rotterdam symptoms checklist (RSCL) questionnaire that was filled out by the patients at the start of HPN and then monthly at home. It includes 39 questions exploring well-being, psychological state, physical state, and level of activity. Death was used as an endpoint and survival time was measured in months starting from the date of the first administration of HPN until the time of death.

Results revealed that the nutritional indices maintained stable until death in all patients. Median survival was four months (range 1 to 14) and about one-third of patients survived more than seven months. QOL parameters remained stable until approximately two to three months before death.

It appears that HPN may benefit a limited percentage of patients who may survive longer than the time allowed by a condition of starvation and depletion. If the patients survive longer than three months, there is some evidence that QOL remains stable for some months and acceptable to the patients being treated.

F. Bozetti, L. Cozzaglio, E. Biganzoli, et al. Quality of life and length of survival in advanced cancer patients on home parenteral nutrition. Clinical Nutrition 21:281-288 (August, 2002). [Correspondence: F. Bozzetti, Istituto Nazionale per Io Studio e la Cura del Tumori, Via Venezian, 1, 20133 Milano, Italy].