ESPEN practical guideline: Home parenteral nutrition

Pironi, Loris; Boeykens, Kurt; Bozzetti, Federico; Joly, Francisca; Kłęk, Stanisław; Lal, Simon; Lichota, Marek; Mühlebach, Stefan; Gossum, A. Van; Wanten, Geert; Wheatley, Carolyn; Bischoff, Stephan C.

doi:10.1016/j.clnu.2022.12.003

Cited by 25 publications

(11 citation statements)

References 154 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Enteral nutrition (EN) is recommended if oral nutrition remains inadequate despite ONS, and parenteral nutrition is recommended if EN is not sufficient or feasible [2]. Early introduction of MNT, including dietary counselling and the use of appropriate ONS with the proper daily dose and duration of therapy, are crucial for the effectiveness of the intervention [1,2,22,23]. The majority of clinical research focus on early initiation and daily dosing, with length of therapy being a less researched area.…”

Section: Discussionmentioning

confidence: 99%

Positive correlation between persistence of medical nutrition therapy and overall survival in patients with head and neck cancer

Molnár,

Pálfi,

Belák

et al. 2024

Pathol. Oncol. Res.

View full text Add to dashboard Cite

Background: Several factors can affect overall survival of head and neck cancer (HNC) patients, including characteristics of the cancer disease and response to treatments. However, patients’ nutritional status and the effectiveness of medical nutrition therapy (MNT) can also impact overall survival. The primary goal of our research was to collect real-life data on the use of MNT in HNC patients and to specifically investigate the correlation between survival and the duration of uninterrupted (persistent) nutrition.Method: The data of this retrospective, analytical, cohort study was collected from electronic healthcare records from the Hungarian National Health Insurance Fund Management. Overall, 38,675 HNC patients’ data of the period between 2012 and 2021 was used. We applied multi-step exclusions to identify patient groups accurately and to avoid biasing factors. Statistical analysis was done by the Kaplan-Meier method, log-rank test, and Cox regression analysis.Results: Throughout the investigated period 16,871 (64%) patients received MNT therapy out of 26,253 newly diagnosed patients (≥18 years). In terms of the persistence of MNT, we divided the patients into three groups (1–3; 4–6; ≥7-month duration of MNT). When comparing these groups, we found that patients receiving long-term (≥7 months) MNT had a significantly longer overall survival (p < 0.0001) than those who received MNT for a shorter duration, both in locally advanced and recurrent/metastatic cases.Conclusion: The main outcome of the study is that there is a positive correlation between the persistence of MNT and the overall survival in HNC patients when nutritional intervention lasts several months. It highlights the responsibility of the specialists during the patient journey to use MNT early and to continue its use for as long as it is beneficial to the patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Positive correlation between persistence of medical nutrition therapy and overall survival in patients with head and neck cancer

Molnár,

Pálfi,

Belák

et al. 2024

Pathol. Oncol. Res.

View full text Add to dashboard Cite

show abstract

“…Present day, short-term use of PN is readily available in most tertiary hospitals particularly in the postoperative setting; however, transitioning to home (life-long) PN remains a restrictive endeavour but is feasible and offers good survival and valuable quality of life. 6 Among its uses, PN is the single most important treatment for conditions in which a majority, or the entire, small bowel requires removal (subtotal enterectomy). Patients develop short bowel syndrome, which includes inadequate absorptive capacity of macronutrients and micronutrients, electrolytes, and fluids.…”

mentioning

confidence: 99%

“…Close monitoring for complications necessitates a well-funded and coordinated multidisciplinary team of physicians, specialist nurses, dietitians and others, which is challenging in the outpatient setting. 6 As dialysis has seen a myriad of improvements over the last century, one would maintain optimism that similar progress will occur for PN to reduce complications and complexity and improve patient survival and, importantly, quality of life. This may be achieved by addressing the key challenges.…”

mentioning

confidence: 99%

“…This pivotal moment in management of gastrointestinal failure led to subsequent refinements of PN solution composition, development of safer catheter placement techniques, and conception of protocols to broaden the applicability of PN. Present day, short‐term use of PN is readily available in most tertiary hospitals particularly in the postoperative setting; however, transitioning to home (life‐long) PN remains a restrictive endeavour but is feasible and offers good survival and valuable quality of life 6 …”

mentioning

confidence: 99%

“…Further, the responsibility of managing lifesaving therapy can be psychologically taxing. Close monitoring for complications necessitates a well‐funded and coordinated multidisciplinary team of physicians, specialist nurses, dietitians and others, which is challenging in the outpatient setting 6 …”

mentioning

confidence: 99%

See 2 more Smart Citations

Shifting the paradigm of long‐term total parenteral nutrition: Lessons from renal dialysis

Sarofim,

Ahmadi,

Morris

2024

J Parenter Enteral Nutr

View full text Add to dashboard Cite

Parenteral nutrition (PN) stands analogous to renal dialysis in its role as replacement therapy to artificially substitute a failed organ system. Both therapies are lifesaving and allow patients to manage chronic conditions that would otherwise be fatal: just as dialysis circumvents compromised renal function to filter waste and excess fluid, PN bypasses a nonfunctional or absent gastrointestinal tract by delivering essential nutrients, protein, and fluid directly into the bloodstream. Through the lens of history, there have been many remarkable achievements of modern medicine. Renal dialysis is

show abstract

Can we improve the management of inoperable malignant bowel obstruction? Results of a feasibility study of elemental diet as an alternative to parenteral nutrition in patients with advanced gynaecological cancer

Allan,

Skene,

Eastley

et al. 2024

Support Care Cancer

View full text Add to dashboard Cite

Purpose Nutrition support in inoperable bowel obstruction (IBO) remains challenging. Parenteral nutrition (PN) is recommended if the prognosis is > 2 months. An elemental diet (ED) is licensed for strictures in Crohn’s disease but has not been used in malignant bowel obstruction. The aim of this study was to evaluate the use of ED in patients with IBO and provide a proof of concept of ED as an acceptable feeding option. Methods This was a mixed-methods single-arm feasibility study. The primary endpoint was to provide a ‘proof of concept’ of ED as an acceptable feeding option for patients with IBO. Secondary endpoints included taste acceptability, incidences of vomiting and pain, the proportion of women who tolerated ED, the number of cartons drunk, quality of life (QOL) and the number of women treated with chemotherapy. Patients (> 18 years) with CT-confirmed IBO who could tolerate 500 ml of liquid in 24 h remained on the trial for 2 weeks. Results A total of 29 patients were recruited; of those, 19 contributed to the analysis for the primary endpoint; 13 (68.4%) participants tolerated the ED; 26 patients contributed to MSAS and EORTC QLQ questionnaires at baseline to allow for the assessment of symptoms. At the start of the study, 18 (69%) of patients experienced vomiting, reducing to 4 (25%) by the end of day 15 of the study; 24 (92%) of patients reported pain at consent, reducing to 12 (75%) by the end of day 15. QOL scores improved from 36.2 (95% CI 27.7–44.7) at baseline to 53.1 (95% CI 40.3–66) at the end of day 15; 16 (84%) participants commenced chemotherapy within the first week of starting ED. The number of cartons across all participants showed a median of 1.3 cartons per day (range 0.8 to 2.5). Conclusion ED is well tolerated by patients with IBO caused by gynaecological malignancies and may have a positive effect on symptom burden and QOL.

show abstract

ESPEN practical guideline: Home parenteral nutrition

Cited by 25 publications

References 154 publications

Positive correlation between persistence of medical nutrition therapy and overall survival in patients with head and neck cancer

Positive correlation between persistence of medical nutrition therapy and overall survival in patients with head and neck cancer

Shifting the paradigm of long‐term total parenteral nutrition: Lessons from renal dialysis

Can we improve the management of inoperable malignant bowel obstruction? Results of a feasibility study of elemental diet as an alternative to parenteral nutrition in patients with advanced gynaecological cancer

Contact Info

Product

Resources

About