Longitudinal study of quality of life in advanced cancer patients on home parenteral nutrition

Abstract

Since there is little knowledge regarding the quality of life (QoL) of cancer patients on home parenteral nutrition (HPN), we planned a prospective, longitudinal, double‐center study to investigate the changes of QoL in these patients. One hundred and eleven adult cancer patients who were candidates for HPN following the indications of the European guidelines were consecutively enrolled. For QoL analysis, EORTC QLQ‐C30 questionnaires were filled at the HPN start and after 1, 2, 3, and 4 months, and scores changes over time were analyzed according to the univariate mixed‐effects linear model for repeated measures. Most patients had gastrointestinal cancers, were severely malnourished, and were in stage IV; two‐thirds were still receiving oncologic treatments. Median weight loss over 3 months and body mass index were 11.7% and 20.7, respectively. Median survival was 4.7 (1–42) months; 67 and 34% of patients survived 3 and 6 months, respectively. Global QoL, physical functioning, role functioning, emotional functioning, appetite loss, and fatigue scores had a statistically significant trend over time (P < 0.001, P < 0.001, P = 0.007, P < 0.001, P = 0.004, P = 0.022, respectively). At the univariate analyses, the determinants significantly associated with changes in trend over time for physical, role, and emotional functioning were oncologic treatments (P < 0.001, P = 0.014, P = 0.040, respectively) and for appetite loss they were weight loss and Karnofsky performance status (P = 0.003, P = 0.023, respectively). Global QoL, physical, role, and emotional functioning improved during HPN even in advanced cancer patients on oncologic treatments.

Bioelectrical impedance analysis for monitoring cancer patients receiving chemotherapy and home parenteral nutrition

“…In the current study, HPN not only provided a source of calories but also was associated with an increased oral intake with a 50% increase in oral calorie and protein intake after 90 days, possibly due to improved patient appetite and decreased side effects of the disease and treatments. This is consistent with previous studies investigating HPN in cancer patients, which reported a decrease in fatigue and appetite loss after 3 months of HPN [ 42 , 43 ], as well as an association between HPN and improved nutritional status, QoL, and KPS [ 42 ].…”

“…Improving nutritional status is critical in cancer patients: treating malnutrition has been shown to improve symptoms including fatigue and appetite loss [ 42 , 43 ]; improve the effectiveness of chemotherapy by reducing the likelihood of toxicity [ 17 ]; improve patient QoL [ 42 – 45 ]; and improve survival [ 16 , 18 ].…”

Home parenteral nutrition increases fat free mass in patients with incurable gastrointestinal cancer. Results of a randomized controlled trial

“…Improvement of QoL and nutritional status in patients with cancer receiving sHPN was demonstrated in a longitudinal study by Vashi et al [6], in which improvement of overall QoL was found after twelve weeks. A longitudinal observational study [33] on patients with incurable cancer receiving HPN due to obstructive disease in the intestine, reported on an improvement in overall QoL during the four months study. This corresponds well with our findings, with significant improved overall QoL after 12 weeks in the sHPN group.…”

Nutritional Therapy in Cancer Patients Receiving Chemoradiotherapy: Should We Need Stronger Recommendations to Act for Improving Outcomes?

“…For ethical reasons the benefit of HPN has not been investigated in RCTs. However, over the last ten years several prospective and retrospective observational studies in advanced cancer patients with inadequate oral intake receiving chemoradiotherapy showed that HPN improves QoL [48][49][50][51][52][53][54] and prolongs survival [46,[55][56][57][58].…”

“…In particular, in a prospective study in 111 advanced cancer patients on HPN, those receiving anticancer treatments (65%) showed higher QoL scores than patients with no treatment [53]. Therefore, it is possible that in these patients the benefits of HPN outweighed the adverse effects of anticancer treatments.…”