Home parenteral nutrition (HTPN) for incurable patients with cancer with gastrointestinal obstruction: do the benefits outweigh the risks?

Patients with cancer may suffer from malnutrition due to cachexia, this maybe secondary to treatment, psychological factors and/or gastrointestinal (GI) obstruction. GI obstruction indicates a need for TPN. Does this apply to patients with incurable terminal cancer? How does TPN affect longevity and quality of life in this group of patients? What is the course of TPN treatment compared with patients receiving TPN due to nonmalignant GI failure (NMGIF). The aim of this work was to help define the role of TPN in patients with incurable cancer and GI obstruction. Data of all patients treated by home TPN (HTPN) 2003-2009 were collected prospectively and analyzed. Sixty-eight patients were treated with HTPN, 30 of them for NMGIF. Mean age was 52 years (37-87). Primary sites of cancer were ovary (9), stomach (8) and others (11). Median survival of patients with malignant GI failure (MGIF) was 140 days (20-783) with no difference with regard to age, gender, primary diagnosis, BMI, percentage of weight loss and albumin level. Patients with MGIF and a higher performance score had longer survival. Patients with MGIF suffered significantly higher rates of overall and infectious complications per treatment days [P < 0.001]. TPN for MGIF incurable patients with cancer prolongs survival but at the cost of frequent complications. TPN is indicated in a selected group of MGIF. We do not have the tools to predict in which patients the benefits will outweigh the cost, but we found variables which may assist caregivers to make clinical and empathic decisions individually.