We describe a retrospective cohort study of patients with malignant bowel obstruction to examine their nutritional care pathways between 1.1.16 and 31.12.16 with readmissions until 31.12.17. Data were analyzed by comparing patients who were referred (R) and not referred (NR) for PN. We identified 72 patients with 117 MBO admissions (mean ± SD age:63.1 ± 13.1yrs, 79% female). 24/72 patients were in R group. Predominant primary malignancies were gynaecological and lower-gastrointestinal cancers (76%). 83% patients had metastases (61% sub-diaphragmatically). All patients were at high-risk of malnutrition and baseline mean weight loss was 7%. Discussion of PN at multidisciplinary team meeting (MDT) (22% vs.5%, P = 0.02) and dietetic contact (94% vs. 41%, P < 0.0001) were more likely to occur in the R group. In 13/69 MBO admissions in NR group, reasons for non-referral were unclear. Median baseline and follow-up weight was similar (55-55.8 kg). Overall survival was 4.7 (1.4-15.2)months, with no differences by referral groups. We compared a sub-sample of patients who 'may have' required PN (n = 10) vs. those discharged on home PN (n = 10) and found greater survival in the HPN group (323vs.91 day, P < 0.01). Our findings highlight disparity in care pathways suggesting that nutritional care should be integrated into clinical management discussion(s) at MDT to ensure equal access to nutritional services.

The use of home parenteral nutrition (HPN) in patients with incurable cancer remains controversial with significant variation worldwide. We aimed to systematically evaluate the literature from 1960 to 2018 examining the use of HPN in advanced cancer patients for all intestinal failure indications and assess the potential benefits/burdens of HPN in this cohort of patients. The primary end point was survival and secondary end points were quality of life and nutritional/performance status. Meta-analysis was performed with a random effects model, where suitable. Of 493 studies retrieved, 22 met the quality inclusion criteria. Studies were mainly conducted in Western countries (Italy, USA, Canada, Germany), including a total of 3564 patients (mean age 57.8 years). Mean duration for HPN was 5.0 months. Mean overall survival was 7.3 months. Patients with improved performance status survived for longer on HPN. Quality of life was sparsely reported though there was no observed negative impact of PN. HPN-related complications were reported in eight studies only and were mainly catheterrelated blood stream infections. In conclusion, HPN is used for several indications in advanced cancer, though there is significant heterogeneity of results. Disparities in geographical distribution of the studies may reflect variation in accessing HPN.

IntroductionThe use of Home Parenteral Nutrition (HPN) in patients (pts) with advanced cancer who cannot meet their nutritional requirements by oral or enteral routes, remains controversial with significant variation worldwide. Cancer cachexia is an irreversible process. Timely commencement of HPN is crucial to prevent malnutrition-related morbidity and mortality in these patients. To review data from literature and identify the potential benefit of HPN in pts with advanced cancer. Our aim was to review data from literature and identify the potential benefit of HPN in pts with advanced cancer.MethodArticles on HPN in advanced cancer from 2002 to 2016 were scrutined in PubMED. Primary end point was survival, secondary end points were quality of life (QoL) and nutritional/performance (Karnofsky score, KPS) status.ResultsOf 175 studies, 18 met the quality inclusion criteria (11 retrospective, 7 prospective and 2 randomised). Overall survival was primary endpoint in 15 papers. Study characteristics are reported in table 1. Due to data heterogeneity and the small number of randomised studies a meta-analysis was not performed. Studies were mainly conducted in Western countries (30% in Italy, 15% in USA, 10% in Canada and Germany), including overall 3066 patients. Mean age was 57,2±6,4 years. Most common cancer site were GI tract, ovary, breast, head and neck. Main indication for HPN was bowel obstruction or cachexia. Mean duration of HPN was 3,8±1,4 months. Median overall survival was 4,6±2,4 months (1,5 month in a selected cohort with peritoneal carcinomatosis, 8 months in a study including only advanced ovarian cancer). At baseline, mean weight was Kg 57,6±5,1, mean BMI 20,7±0,8 and mean KPS 55±5. After 1–5 months of HPN, mean weight and mean BMI increased to 61,9±5.3 and 21,2±0,5 respectively. KPS increased in 2 studies, stable in 2 studies. QoL was analysed through validated scales in 5 studies and resulted significantly increased after HPN. On average, HPN related complications were reported in 13%±6% of the pts.ConclusionIndications for HPN and overall survival (3,8±1,4 months) in advanced cancer was in accordance with prognostic parameters specified in European and American guidelines. Variation in clinical practice is evident in different countries. The cost effectiveness and impact of HPN on nutritional/performance status and QoL in these patients has not been adequately assessed and further prospective studies are required. A cultural change and education of healthcare professionals is required to ensure early access to HPN for appropriate patients.Disclosure of InterestNone DeclaredAbstract PTU-109 Figure 1

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