Outcome Assessment of Home Parenteral Nutrition in Patients with Gynecologic Malignancies: What Have We Learned in a Decade of Experience?

A.S.P.E.N. Clinical Guidelines: Nutrition Support Therapy During Adult Anticancer Treatment and in Hematopoietic Cell Transplantation

“…88 There are limited data on the use of PN in palliative care. 8,[89][90][91][92][93][94][95][96] Although the adverse events caused by PN may actually worsen quality of life and overall palliative care of some patients, home PN may lengthen survival 89,92 and improve quality of life in carefully selected patients. 90,91,94 Examples of patients who have demonstrated a favorable response to PN include patients with a good performance status, such as Karnofsky score >50, those with inoperable bowel obstruction, those with minimal symptoms from disease involving major organs such as brain, liver, and lungs, and those with indolent disease progression.…”

“…8,[89][90][91][92][93][94][95][96] Although the adverse events caused by PN may actually worsen quality of life and overall palliative care of some patients, home PN may lengthen survival 89,92 and improve quality of life in carefully selected patients. 90,91,94 Examples of patients who have demonstrated a favorable response to PN include patients with a good performance status, such as Karnofsky score >50, those with inoperable bowel obstruction, those with minimal symptoms from disease involving major organs such as brain, liver, and lungs, and those with indolent disease progression. 88,97 If patients are to benefit from this complex, intrusive, and expensive therapy they (1) must be physically and emotionally capable of participating in their own care; (2) should have an estimated life expectancy of >40-60 days; (3) require strong social and financial support at home, including a dedicated in-home lay care provider; and (4) must have failed trials of less invasive medical therapies such as appetite stimulants and enteral feedings.…”

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

“…However, in highly selected cases, such as Shirley's situation, in which she has relatively isolated bowel dysfunction, published data suggest that TPN can improve the clinical outcome for some patients with inoperable malignant bowel obstruction [8][9][10]. Some small studies suggest an improvement in median survival from the initiation of parenteral feeding between 53 and 89 days [8][9][10].…”

Aggressive Management of Recurrent Ovarian Cancer – the Challenge of Individualizing Cancer Therapy Illustrated by a Case Report

“…Malignant bowel obstruction is the most frequent cause of death and the management of this complication has to be individualized. A good nutritional status generally determines not only the quality of life but is associated with decreased morbidity and mortality as well as increased efficacy of the antineoplastic therapy [11,12]. TPN can be administered at night, thus allowing the patient to be mobile during the day.…”