A Prospective Observational Study Assessing Home Parenteral Nutrition in Patients With Gastrointestinal Cancer: Benefits for Quality of Life

Sénesse, Pierre; Tadmouri, Abir; Culine, Stéphane; Dufour, Patrick; Seys, P.; Radji, Abderraouf; Rotarski, M.; Balian, Axel; Chambrier, C.

doi:10.1016/j.jpainsymman.2014.05.016

Cited by 33 publications

(55 citation statements)

References 21 publications

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“…One study that explored the various components of QOL in depth noted that patients often expressed more positive opinions of the impact of HPN, seeing the therapy as a “lifeline” or “safety net.” 19 A small qualitative study of HPN recipients reported that PN improved QOL despite the burdens associated with treatment 21 . These findings are comparable to studies of HPN use in oncology patients, who generally have a favorable perception of the impact of HPN on QOL 22 , 23 . In some cases, QOL may be related to the inability to eat, rather than dependence on the therapy itself.…”

Section: Question 10: Which Patients Are Appropriate For Home Pn Thermentioning

confidence: 86%

“…Information regarding the incidence of PN‐related complications is not uniformly reported, but problems related to the vascular access device—most notably, infectious and mechanical complications—have been reported 7 . A recent study reported a low incidence of PN‐related complications, including zero cases of line‐related sepsis, but whether this outcome reflects current standards for PN management and care of the vascular access device or other factors is not known 31 . The presence of a venting gastrostomy tube, which is often used in tandem with PN to manage obstructive symptom, has been linked to a relatively high rate of complications 16 .…”

Section: Question 9: Is Pn Appropriate For Patients In Palliative Care?mentioning

confidence: 99%

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When Is Parenteral Nutrition Appropriate?

Worthington

Balint

Bechtold

et al. 2017

J Parenter Enteral Nutr

160

187

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Parenteral nutrition (PN) represents one of the most notable achievements of modern medicine, serving as a therapeutic modality for all age groups across the healthcare continuum. PN offers a life-sustaining option when intestinal failure prevents adequate oral or enteral nutrition. However, providing nutrients by vein is an expensive form of nutrition support, and serious adverse events can occur. In an effort to provide clinical guidance regarding PN therapy, the Board of Directors of the American Society for Parenteral and Enteral Nutrition (ASPEN) convened a task force to develop consensus recommendations regarding appropriate PN use. The recommendations contained in this document aim to delineate appropriate PN use and promote clinical benefits while minimizing the risks associated with the therapy. These consensus recommendations build on previous ASPEN clinical guidelines and consensus recommendations for PN safety. They are intended to guide evidence-based decisions regarding appropriate PN use for organizations and individual professionals, including physicians, nurses, dietitians, pharmacists, and other clinicians involved in providing PN. They not only support decisions related to initiating and managing PN but also serve as a guide for developing quality monitoring tools for PN and for identifying areas for further research. Finally, the recommendations contained within the document are also designed to inform decisions made by additional stakeholders, such as policy makers and third-party payers, by providing current perspectives regarding the use of PN in a variety of healthcare settings. (JPEN J Parenter Enteral Nutr. 2017;41:324-377) The etiology-based nutrition diagnoses in adults in clinical practice settings are as follows: Starvation-related malnutrition: Chronic starvation without inflammation (eg, anorexia nervosa). Chronic disease-related malnutrition: Inflammation is chronicand of mild to moderate degree (eg, organ failure, pancreatic cancer, rheumatoid arthritis, sarcopenic obesity). Acute disease or injury-related malnutrition:Inflammation is acute and of severe degree (eg, major infection burns, trauma, closed head injury). 2,3Malnutrition, pediatric: An imbalance between nutrient requirement and intake, resulting in cumulative deficits of energy, protein, or micronutrients that may negatively affect growth, development, and other relevant outcomes. It is recommended that growth charts based on a standard deviation z score system be used to track and assess nutrition status in children. 4,5Nutritionally-at-risk: Consider the individual nutritionally-atrisk if any of the following is present. Nutritionally-At-Risk Adult Summary of RecommendationsThese consensus recommendations are designed to identify best practices, guide day-to-day clinical decisions, reduce variations in practice, and enhance patient safety. They are not intended to supersede the judgment of the healthcare professional based on the circumstances of the individual patient.

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Section: Question 10: Which Patients Are Appropriate For Home Pn Thermentioning

confidence: 86%

Section: Question 9: Is Pn Appropriate For Patients In Palliative Care?mentioning

confidence: 99%

When Is Parenteral Nutrition Appropriate?

Worthington

Balint

Bechtold

et al. 2017

J Parenter Enteral Nutr

160

187

View full text Add to dashboard Cite

show abstract

“…Culine and Senesse et al described cohorts of HTPN patients (767 with various cancers and 370 with GI cancers, respectively) (Culine et al, 2014;Senesse et al 2015). Vashi et al described a cohort of 52 patients with advanced cancer, treated by TPN (Vashi et al, 2014).…”

Section: Discussionmentioning

confidence: 99%

Parenteral Nutrition in Patients with Advanced Cancer and Gastrointestinal Failure or Obstruction

Chermesh

Haim

Agarwal

et al. 2016

CCO

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Malnutrition in patients with advanced cancer and gastrointestinal failure (ACGIF) is inevitable. This is a prospective study of a cohort of patients with ACGIF who were treated by home parenteral nutrition (HPN).Included were all patients with ACGIF treated with HPN since January 2003. Data concerning the primary disease, demographics, functional capacity, and PN-related complications were obtained.125 patients, age's 60±12.9 years, were included. Seven (6%) had KPS<50. Median survival was 3.2 months. Cumulative survival was 0.95, 0.50, 0.25, and 0.09 at two weeks, three and six months, and one year after initiation of HPN, respectively. Multivariate analysis revealed higher mortality associated with male gender (HR 1.48 95% CI 1.03-2.14; p<0.05), albumin level<2.5 gr% (HR 1.73 95% CI 1.18-2.54 p<0.05), and low functional capacity (KPS<50) (HR 2.63 95% CI 1.21-5.74; p<0.05). Survival was not associated with age or BMI.More than 50% of patients survived more than three months, and more than 95% survived longer than two weeks. We cautiously suggest that HPN has prolonged survival and prevented starvation-related manifestations. The decision to initiate HTPN must be reached based on individual considerations, taking into account patient's preferences.

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“…In cancer patients, depending on the type of primary tumour and degree of disease, weight loss and malnutrition in the range of 20% and 85% can develop (Aria Guerra et al, ; Bozzetti et al, ; Culine et al, ; Dreesen et al, ; Girke et al, ) and especially for patients with gastrointestinal system cancers or for cancer patients at the end of their lives, there is a requirement for Total Parenteral Nutrition (TPN) due to nausea vomiting and lack of oral intake (Bozzetti et al, ; Chermesh et al, ; Cotogni et al, ; Culine et al, ; Drissi et al, ; Higuera et al, ; Senesse et al, ). Patients having nausea and vomiting contact emergency services due to insufficient oral intake and thus are admitted to the hospital, or in countries such as Canada, Spain and USA Home Parenteral Nutrition (HPN) is offered (Ang et al, ; Gomez‐Candela et al, ; Higuera et al, ; Hong et al, ; Kunisawa, Fushimi, & Imanaka, ; Mackenzie & Gramlich, ; Merchant et al, ; Shatnawei et al, ; Weaver et al, ).…”

Section: Introductionmentioning

confidence: 99%

“…However, depending on the HPN implementation, certain complications are expected. When the studies being conducted were investigated, it was found that infection and mechanical obstruction are the most commonly reported problems (Botella‐Carretero et al, ; Cotogni et al, ; Culine et al, ; Drissi et al, ; Elfassy et al, ; Senesse et al, ). The indicators to consider if HPN is safe are quality of life, nutritional status, personal performance and complication rates.…”

Section: Introductionmentioning

confidence: 99%

Is home parenteral nutrition safe for cancer patients? Positive effects and potential catheter‐related complications: A systematic review

2019

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Purpose Total Parenteral Nutrition began to be applied frequently in the houses of patients starting from the 1990s and is stated in literature as Home Parenteral Nutrition (HPN). The purpose of this review is to answer the question of whether or not HPN is safe for cancer patients. Methods Searches were conducted in Cochrane, CINAHL, PubMed, Springer, Google Scholar, and the Web of Science databases. Results The 1,949 articles were accessed in the total, and 20 articles have been included in the review. In the studies being evaluated, it can be determined that HPN has influenced the quality of life, performance status, and the nutrition level of cancer patients positively. Most frequently seen complications were infections relating to the catheter, the mechanical obstruction in the catheter and venous thrombosis. For each 1,000 days with HPN or a catheter, infections in the interval of 0.05 and 3.08, mechanical problems in the interval of 0.07 and 2.13, and thrombosis in the interval of 0.05 and 0.20 were determined. Conclusions While HPN influenced quality of life, nutrition, and the personal performance of cancer patients positively, the rate of complications is at a level that can be managed at home.

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A Prospective Observational Study Assessing Home Parenteral Nutrition in Patients With Gastrointestinal Cancer: Benefits for Quality of Life

Abstract: HPN could provide benefit for malnourished patients with gastrointestinal cancer. However, randomized controlled studies are required to confirm this benefit and the safety profile.

Cited by 33 publications

References 21 publications

When Is Parenteral Nutrition Appropriate?

When Is Parenteral Nutrition Appropriate?

Parenteral Nutrition in Patients with Advanced Cancer and Gastrointestinal Failure or Obstruction

Is home parenteral nutrition safe for cancer patients? Positive effects and potential catheter‐related complications: A systematic review

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