Palliative home parenteral nutrition in patients with ovarian cancer and malignant bowel obstruction: experiences of women and family caregivers

Sowerbutts, Anne Marie; Lal, Simon; Sremanakova, Jana; Jayson, Gordon C; Teubner, Antje; Hardy, Lisa; Todd, Chris; Raftery, Anne-Marie; Sutton, Eileen; Morgan, Robert D.; Vickers, Alexander J.; Burden, Sorrel

doi:10.1186/s12904-019-0507-5

Cited by 35 publications

(99 citation statements)

References 31 publications

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“…Change in QoL represents another crucial issue in patients with cancer receiving HPN. Clinicians should identify cancer patients who might benefit from HPN and balance the potential advantages with HPN without prolonging life in those with no chance of improvement [ 80 ]. In a longitudinal study in advanced cancer patients, even those not receiving anticancer treatment, HPN was shown to significantly improve global QoL, physical, role, and emotional functioning [ 81 ].…”

Section: Parenteral Nutritionmentioning

confidence: 99%

“…Orrevall et al described the sense of relief and security of both patients and relatives when the nutritional requirements were met through HPN [ 89 ]. Patients with ovarian cancer on HPN experienced a burden of treatment that did not mitigate the benefits of HPN; in particular, in the interviews, they stated that the motivation to live outweighed the constraints imposed, and patients and relatives recognized HPN as a lifeline and were grateful for it [ 80 ].…”

Section: Nutritional Support and Burden For Patients And Familiesmentioning

confidence: 99%

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The Role of Nutritional Support for Cancer Patients in Palliative Care

et al. 2021

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The role of nutritional support for cancer patients in palliative care is still a controversial topic, in part because there is no consensus on the definition of a palliative care patient because of ambiguity in the common medical use of the adjective palliative. Nonetheless, guidelines recommend assessing nutritional deficiencies in all such patients because, regardless of whether they are still on anticancer treatments or not, malnutrition leads to low performance status, impaired quality of life (QoL), unplanned hospitalizations, and reduced survival. Because nutritional interventions tailored to individual needs may be beneficial, guidelines recommend that if oral food intake remains inadequate despite counseling and oral nutritional supplements, home enteral nutrition or, if this is not sufficient or feasible, home parenteral nutrition (supplemental or total) should be considered in suitable patients. The purpose of this narrative review is to identify in these cancer patients the area of overlapping between the two therapeutic approaches consisting of nutritional support and palliative care in light of the variables that determine its identification (guidelines, evidence, ethics, and law). However, nutritional support for cancer patients in palliative care may be more likely to contribute to improving their QoL when part of a comprehensive early palliative care approach.

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Section: Parenteral Nutritionmentioning

confidence: 99%

Section: Nutritional Support and Burden For Patients And Familiesmentioning

confidence: 99%

The Role of Nutritional Support for Cancer Patients in Palliative Care

et al. 2021

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“…This was a qualitative study underpinned by phenomenology; a method that allows description and interpretation of complex processes. This study forms part of a programme of work examining parenteral nutrition in advanced ovarian cancer; patients' views and clinical details have been reported elsewhere [8][9][10].…”

Section: Methodsmentioning

confidence: 99%

Discharging Women with Advanced Ovarian Cancer on Home Parenteral Nutrition: Making and Implementing the Decision

et al. 2020

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Increasingly, patients with advanced ovarian cancer in bowel obstruction are receiving home parenteral nutrition (HPN). Little is known about making and implementing the decision. This study explored the decision-making process for HPN and investigated the barriers and facilitators to implementation. This was a qualitative study underpinned by phenomenology involving 93 longitudinal in-depth interviews with 20 patients, their relatives and healthcare professionals, over 15 months. Participants were interviewed a maximum of four times. Interview transcripts were analysed thematically as per the techniques of Van Manen. We found variance between oncologists and patients regarding ownership of the HPN decision. The oncologists believed they were engaging in a shared decision-making process. However, patients felt that the decision was oncologist-driven. Nevertheless, they were content to have the treatment, when viewing the choice as either HPN or death. In implementing the decision, the principal mutable barrier to a timely discharge was communication difficulties across professional disciplines and organisations. Facilitators included developing a single point-of-contact between organisations, improving communication and implementing standardised processes. Oncologists and patients differ in their perceptions of how treatment decisions are made. Although patients are satisfied with the process, it might be beneficial for healthcare professionals to check patients’ understanding of treatment.

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“…The study is part of a larger project investigating HPN in women with ovarian cancer, which involved interviewing patients, relatives and healthcare professionals (9,(17)(18)(19)(20) this report focusses on patients' relationship with food whilst being on parenteral nutrition. Participants had advanced ovarian cancer (≥ stage III) and were admitted to an oncology hospital with inoperable malignant bowel obstruction between October 2016 and December 2017.…”

Section: Methodsmentioning

confidence: 99%