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

Abstract

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.

Nutritional Status and Quality of Life in Hospitalised Cancer Patients Who Develop Intestinal Failure and Require Parenteral Nutrition: An Observational Study

“…PS is an important indicator of a patient's ability to be functional and perform activities of daily living. The finding that decreased muscle strength could predict functional decline in hospitalised oncology patients is of utmost importance and also carries a prognostic value [14]. PS also reflects several behavioural patterns that are affected by NS.…”

“…Thus, in such cases where intestinal failure develops, parenteral nutrition (PN) may be indicated [12]. As PN is not without additional risks and costs to the patients (e.g., complex medical management, intravenous catheter care, and risk of serious infections), its provision needs to be carefully considered only in those with estimated survival of more than two months, willing to undergo this treatment option, and importantly willing to cope with the practicalities that go with it [13][14][15][16].…”

“…There is a surplus of research indicating that patients receiving PN in inpatient settings or at home (home parenteral nutrition (HPN)) have improved NS, QoL, reduced chemotherapy toxicity and prolonged survival [9]. However, the effect of PN in patients with advanced cancer remains unclear [13,14]. Impaired NS is independently and adversely associated with QoL, function and ultimately prognostication in cancer patients, and inflammation appears to be the underpinning cause [17].…”

Monitoring Response to Home Parenteral Nutrition in Adult Cancer Patients

“…For assessing the performance status, both the Karnofsky Performance Status (KPS) (0–100 points) and Eastern Cooperative Oncology Group (ECOG) scale (0–5 grades) can be used. Indications that higher KPS scores increase the probability of survival in these patients has been reported in observational [ 22 , 32 , 33 ] and survival prediction studies [ 34 ]. A prospective study found that after 90 days from starting HPN, the performance status of cancer patients improved (a median increase in KPS of 10 points) [ 31 ].…”

Nutritional Therapy in Cancer Patients Receiving Chemoradiotherapy: Should We Need Stronger Recommendations to Act for Improving Outcomes?

“…For ethical reasons the benefit of HPN has not been investigated in RCTs. However, over the last ten years several prospective and retrospective observational studies in advanced cancer patients with inadequate oral intake receiving chemoradiotherapy showed that HPN improves QoL [48][49][50][51][52][53][54] and prolongs survival [46,[55][56][57][58].…”