Doctor, Does This Mean I'm Going to Starve to Death?

Whitworth, Melissa; Whitfield, Andrea; Holm, Søren; Shaffer, John W.; Makin, Wendy; Jayson, Gordon C

doi:10.1200/jco.2004.02.056

Cited by 35 publications

(25 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Eleven patients survived 12 months or longer, and 2 patients were alive 4 years after initiating PN 24 . Patients and caregivers frequently associate PN administration with a sense of well‐being and improved or stable quality of life 3 , 11 , 25 . ‐ 28 …”

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

175

202

View full text Add to dashboard Cite

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.

show abstract

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

175

202

View full text Add to dashboard Cite

show abstract

“…[5]. This study followed 28 patients with MGIF from the time of TPN initiation to time of death (with the exception of two patients who are alive at time of analysis).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2010

View full text Add to dashboard Cite

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.

show abstract

“…For example, such considerations might include whether patients with bowel obstructions should undergo palliative surgery, receive total parenteral nutrition, or whether women with ascites should undergo repeated paracentesis. [95][96][97] In addition, some women with ovarian cancer may not be willing to switch to palliative care despite worsening prognosis.…”

Section: Palliative Carementioning

confidence: 99%

Quality of life for patients with epithelial ovarian cancer

2007

View full text Add to dashboard Cite

Ovarian cancer is the sixth most common cancer worldwide and the seventh most common cause of deaths from cancer in women. Recent annual worldwide figures reflect 204,000 new cases of ovarian cancer and 125,000 deaths. Treatment of advanced ovarian cancer involves a combination of surgery and chemotherapy, both of which may impact a woman's physical, social, and emotional well-being. A woman's quality of life (QOL) is affected by disease site, and treatment-specific and patient-specific factors, but other common QOL issues include changes in physical functioning owing to side effects of treatment, psychological distress caused by fear and anxiety of recurrence, sexual dysfunction associated with anatomic and physiologic changes of treatment, and for younger women, loss of childbearing potential. As new diagnostic and treatment strategies for gynecologic malignancies are developed, research efforts should include QOL consequences. Further studies are needed to develop strategies for identifying women at risk for serious QOL disruption so that effective interventions to assist these women can be designed.

show abstract

Doctor, Does This Mean I'm Going to Starve to Death?

Cited by 35 publications

References 9 publications

When Is Parenteral Nutrition Appropriate?

When Is Parenteral Nutrition Appropriate?

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

Quality of life for patients with epithelial ovarian cancer

Contact Info

Product

Resources

About