Parenteral Nutrition in Patients With Advanced Cancer: Merging Perspectives From the Patient and Healthcare Provider

Abstract

The decision to utilize parenteral nutrition in patients with advanced cancer is difficult. There are variable opinions in the literature. Those who routinely care for cancer patients often confront the challenges of discussing these interventions with patients and their families. We review results from previous randomized controlled trials, published guidelines, and recent work that describes the emotional challenges patients and families face as they make such decisions with their healthcare provider.

When Is Parenteral Nutrition Appropriate?

“…The syndrome of anorexia and cachexia serves as a marker of advanced disease that is refractory to antineoplastic and nutrition intervention 4 . ‐ 6 PN administration in patients with advanced cancer does not improve nutrition status, reverse cachexia, or improve survival 3 , 4 , 6 , 7 . Within the context of palliative care, the aim of nutrition care shifts away from maintaining or restoring nutrition status to maintaining or increasing comfort, by alleviating gastrointestinal symptoms, for example 6 , 8 .…”

“…Within the context of palliative care, the aim of nutrition care shifts away from maintaining or restoring nutrition status to maintaining or increasing comfort, by alleviating gastrointestinal symptoms, for example 6 , 8 . In addition to concerns regarding the lack of benefit, PN may also contribute to complications and other adverse events, such as central venous access device infection and hepatic dysfunction 7 , 9 …”

“…Requests by patients or family members for more aggressive nutrition intervention suggests a need for renewed efforts by the healthcare team to help patients deal with these difficult issues. At this point, prescribing PN to alleviate emotional distress would not serve the best interest of the patient 7 …”

Frequency and Indications of Parenteral Nutrition in an Acute Palliative Care Unit

“…Several guidelines have been published on the use of PN in advanced cancer patients. These guidelines overlap to some extent, but mostly suggest the limited value of PN in this setting (12). PN in the last week of life has been found to be a frequent practice, ranging 3-53% of cancer patients.…”

“…The mean age was 58 yr (range 37-79), and 9 were males. The mean hospital stay was 7.7 days (range [3][4][5][6][7][8][9][10][11][12][13][14], and the mean Karnofsky level was 35 (range 10-50). The principal indication was bowel obstruction.…”