Parenteral Nutrition Prolongs the Survival of Patients Associated With Malignant Gastrointestinal Obstruction

Fan, Bo-Guang

doi:10.1177/0148607107031006508

Cited by 55 publications

(39 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…14, 159 The majority of deaths from HPN (both malignant and nonmalignant) are related to the underlying disease with separate centres reporting only 9% of patients dying of HPN-related complications. 48,157 Deaths related to the underlying disease tend to occur during the first 2 years of treatment, whereas HPN-related deaths often occur after this.…”

Section: Survivalmentioning

confidence: 99%

Review article: the management of long‐term parenteral nutrition

Dibb

Teubner

Theis

et al. 2013

Aliment Pharmacol Ther

140

108

View full text Add to dashboard Cite

SummaryBackgroundHome parenteral nutrition (HPN) is currently the management of choice for patients with chronic intestinal failure.AimTo summarise the major issues in delivering long‐term parenteral nutrition (>3 months) and assess outcome as per complications, mortality and quality of life. To assess the evidence for the therapeutic use of trophic factors such as teduglutide and to review evolving therapeutic options in the treatment of chronic intestinal failure.MethodsA literature search using PubMed and MEDLINE databases was performed.ResultsSafe delivery of HPN relies upon individualised formulations of parenteral nutrition administered via carefully maintained central venous catheters by trained patients or carers, supported by a skilled multidisciplinary team. Early diagnosis and treatment of complications including catheter‐associated blood stream infection (reported incidence 0.14–0.83 episodes/patient‐year on HPN) and central venous thrombosis (reported incidence 0.03 episodes/patient‐year) is important to minimise mortality and morbidity. There is a significant variation in the reported incidence of both hepatobiliary complications (19–75%) and advanced liver disease (0–50%). Five‐year survival rates in large centres are reported between 60% and 78% with survival primarily related to underlying diagnosis. Long‐term survival remains higher on HPN than with intestinal transplantation. The role of intestinal lengthening procedures is yet to be validated in adults.ConclusionsHome parenteral nutrition delivered by skilled nutrition teams has low incidences of catheter‐related complications. Most deaths relate to the underlying disease. Therapies such as teduglutide and small bowel transplantation appear promising, but home parenteral nutrition appears likely to remain the bedrock of management in the near term.

show abstract

Section: Survivalmentioning

confidence: 99%

Review article: the management of long‐term parenteral nutrition

Dibb

Teubner

Theis

et al. 2013

Aliment Pharmacol Ther

140

108

View full text Add to dashboard Cite

show abstract

“…Patients with advanced cancer and GI obstruction are more frail and therefore are expected to suffer more greatly from the consequences of starvation. Fan described a group of 115 patients with malignant GI obstruction, where the mean survival of patients was 6.5 months [8], Hoda et al described a 20-year experience, in a series of 52 patients with similar survival of 5 months [9]. TPN as part of a palliative treatment plan began at our institute in 2003, and since then, the number of patients being treated by HTPN has risen steadily.…”

Section: Discussionmentioning

confidence: 99%

Home parenteral nutrition (HTPN) for incurable patients with cancer with gastrointestinal obstruction: do the benefits outweigh the risks?

et al. 2010

View full text Add to dashboard Cite

Patients with cancer may suffer from malnutrition due to cachexia, this maybe secondary to treatment, psychological factors and/or gastrointestinal (GI) obstruction. GI obstruction indicates a need for TPN. Does this apply to patients with incurable terminal cancer? How does TPN affect longevity and quality of life in this group of patients? What is the course of TPN treatment compared with patients receiving TPN due to nonmalignant GI failure (NMGIF). The aim of this work was to help define the role of TPN in patients with incurable cancer and GI obstruction. Data of all patients treated by home TPN (HTPN) 2003-2009 were collected prospectively and analyzed. Sixty-eight patients were treated with HTPN, 30 of them for NMGIF. Mean age was 52 years (37-87). Primary sites of cancer were ovary (9), stomach (8) and others (11). Median survival of patients with malignant GI failure (MGIF) was 140 days (20-783) with no difference with regard to age, gender, primary diagnosis, BMI, percentage of weight loss and albumin level. Patients with MGIF and a higher performance score had longer survival. Patients with MGIF suffered significantly higher rates of overall and infectious complications per treatment days [P < 0.001]. TPN for MGIF incurable patients with cancer prolongs survival but at the cost of frequent complications. TPN is indicated in a selected group of MGIF. We do not have the tools to predict in which patients the benefits will outweigh the cost, but we found variables which may assist caregivers to make clinical and empathic decisions individually.

show abstract

“…Although PN use has been reported to be associated with eating difficulties, nausea, vomiting, and fatigue rather than gastrointestinal problems (8), the most common indications in advanced cancer patients are a nonfunctioning gastrointestinal tract or severe dysphagia (1,9).…”

Section: Discussionmentioning

confidence: 99%

“…Although some studies suggest that PN may prolong survival (9), no strong evidence exists supporting PN for the majority of advanced cancer patients (10,11). Several guidelines have been published on the use of PN in advanced cancer patients.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Mercadante

Caruselli

Villari

et al. 2015

Nutrition and Cancer

View full text Add to dashboard Cite

The aim of this study was to estimate the use of parenteral nutrition (PN) in advanced cancer patients enrolled in an acute pain relief and palliative care unit of a comprehensive cancer center and the appropriateness of the criteria to select patients for PN. Fourteen out of 750 patients (1.8%) admitted to an acute palliative care unit were administered PN. Patients were referred from various settings. The mean age was 58 yr (range 37-79), and 9 were males. The mean hospital stay was 7.7 days (range 3-14), and the mean Karnofsky level was 35 (range 10-50). The principal indication was bowel obstruction. Ten patients (71%) were already receiving PN before admission, and 2 of them discontinued the treatment during admission. Four patients (29%) started PN during hospital admission as decided by the staff. Twelve patients (85%) were discharged on PN. One week after hospital discharge, 9 patients were still receiving PN, 4 patients died, and no data were available for 1 patient. One month after hospital discharge only 2 patients of these were still on PN, 2 patients discontinued PN, and 5 patients died. This study shows that decisions to start or to stop PN were individually based on multiple considerations, not only clinical. Goals may vary from expected clinical benefits to compassionate use. The administration of PN should be assessed carefully and individually approached.

show abstract

Parenteral Nutrition Prolongs the Survival of Patients Associated With Malignant Gastrointestinal Obstruction

Abstract: PN can be expected to obtain a longer survival for the patient with GI tract obstruction caused by advanced cancer.

Cited by 55 publications

References 16 publications

Review article: the management of long‐term parenteral nutrition

Review article: the management of long‐term parenteral nutrition

Home parenteral nutrition (HTPN) for incurable patients with cancer with gastrointestinal obstruction: do the benefits outweigh the risks?

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

Contact Info

Product

Resources

About