C-reactive protein and white blood cell count are adverse prognostic markers for patients with advanced cancer on parenteral nutrition in a palliative care unit setting: A retrospective cohort study

Abstract

Background: Parenteral nutrition is controversial in patients with advanced cancer. Nevertheless, this treatment is common practice near the end of life. Aim: We aimed to identify factors which were associated with the outcome of patients on parenteral nutrition at an academic tertiary palliative care unit. Design: In this retrospective cohort study patients were assigned to two groups according to parenteral nutrition treatment. Inferential statistics were used to assess whether the dynamics of laboratory variables over 2 weeks of parenteral nutrition were associated with survival. Setting/Participants: Patients admitted to the Department of Palliative Medicine at the Medical University of Vienna between 2016 and 2018 were included in this study. Results: Of 443 patients, 113 patients received parenteral nutrition. Patients had a lower body mass index, lower levels of bilirubin, γ-glutamyltransferase, alkaline phosphatase, and were of younger age compared to patients which did not receive parenteral nutrition. No difference in survival as measured from admission to death was found when comparing the two groups. Levels for γ-glutamyltransferase, alkaline phosphatase, and C-reactive protein significantly increased during 2 weeks of parenteral nutrition. Among patients with parenteral nutrition, an increase in C-reactive protein or white blood cell count levels was associated with lower survival. Conclusion: Patients who responded with an increase of C-reactive protein or white blood cell count during 2 weeks after reinitiation or start of parenteral nutrition had a worse survival. Our findings might support clinicians and patients in their decision to forgo parenteral nutrition in a palliative care setting.

Routine laboratory parameters to support decision on parenteral nutrition in palliative care

“…Based on their findings, they suggested a systematic use of the CRP/ albumin score before initiating PN (17). Other studies have also shown that for patients receiving PN, an increase in CRP, as well as white blood cell count and worsening of renal function parameters, are linked to a worse outcome (18,19).…”

“…With regard to inflammatory activity, higher levels of CRP were shown to be significantly associated with a negative outcome in terms of OS in different patients receiving PN (17). However, there is a lack of predictive markers that might help in the decision of suspending PN in the palliative setting (17)(18)(19).…”

Experiences of dialogue in advance care planning educational programs

“…13 However, Japanese people have a cultural tendency to avoid expressing their intentions clearly and understand others' intentions by reading the context. 14,15 This may reduce opportunities of dialogue with others about one's value, which results in a lack of understanding about the experience of dialogue. Thus, clarifying how dialogue with others, a central element of ACP, is experienced may provide deeper insights into the ACP process and may facilitate the process effectively.…”