MON-P068: An Updated Audit of Home Parenteral Nutrition (HPN) in Palliative Oncology Patients - A UK Single Centre Case Series with Survival Analysis

Keane, Niamh; Fragkos, Konstantinos; Patel, Pinal; Obbard, S.; Murray, K.; Guilvezan, S.; O’Hanlon, F; Kok, K.B.; Paulon, Emma; Di, Simona; Mehta, Sharad; Rahman, Farooq

doi:10.1016/s0261-5614(16)30702-6

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“…Predictable requirements might facilitate the use of off-the-shelf PN bags enabling faster discharge from hospital and ultimately the provision of a sustainable service despite the growing number of referrals. Multivariate analysis identified only baseline KPS score and GPS as significant predictors of survival (2,3,6,11,19,(34)(35)(36)(37)(38)(39). In a meta-analysis, Naghibi, Smith and Elia (6) reported that patients with a higher performance status (defined as KPS greater than 50) survived longer than those with a KPS score less than 50 (median survival 183 days vs 91 days, respectively) (40).…”

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confidence: 99%

Performance Status, Prognostic Scoring, and Parenteral Nutrition Requirements Predict Survival in Patients with Advanced Cancer Receiving Home Parenteral Nutrition

Keane

Fragkos

Patel

et al. 2017

Nutrition and Cancer

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We describe a cohort of Home Parenteral Nutrition (HPN) patients with advanced cancer in order to identify factors affecting prognosis. Demographic, anthropometric, biochemical and medical factors, Karnofsky Performance Status (KPS), Glasgow Prognostic Score (GPS), and PN requirements were recorded. Univariate and multivariate analyses were performed including Kaplan-Meier curves, Cox Regression, and correlation analyses. In total, 107 HPN patients (68 women, 39 men, mean age 57 yr) with advanced cancer were identified. The main indications for HPN were bowel obstruction (74.3%) and high output ostomies (14.3%). Cancer cachexia was present in 87.1% of patients. The hazard ratio (HR) for upper gastrointestinal and "other" cancers vs. gynaecological malignancy was 1.75 (p = 0.077) and 2.11 (p = 0.05), respectively. KPS score, GPS, PN volume, and PN potassium levels significantly predicted survival (HR = 0.47; HR = 3.19). In multivariate analysis, KPS and GPS remained significant predictors (p < 0.05), whilst PN volume reached borderline significance (p = 0.094). Survival was not significantly affected by the presence of metastatic disease, previous or concurrent surgery, chemo-radiotherapy, or indication for HPN (p > 0.05). Most patients passed away in their homes or hospice (77.9%). Performance status, prognostic scoring, and PN requirements may predict survival in patients with advanced cancer receiving HPN.

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