PTU-109 Home parenteral nutrition in patients with advanced cancer: a systematic review

Abstract

IntroductionThe use of Home Parenteral Nutrition (HPN) in patients (pts) with advanced cancer who cannot meet their nutritional requirements by oral or enteral routes, remains controversial with significant variation worldwide. Cancer cachexia is an irreversible process. Timely commencement of HPN is crucial to prevent malnutrition-related morbidity and mortality in these patients. To review data from literature and identify the potential benefit of HPN in pts with advanced cancer. Our aim was to review data from literature and identify the potential benefit of HPN in pts with advanced cancer.MethodArticles on HPN in advanced cancer from 2002 to 2016 were scrutined in PubMED. Primary end point was survival, secondary end points were quality of life (QoL) and nutritional/performance (Karnofsky score, KPS) status.ResultsOf 175 studies, 18 met the quality inclusion criteria (11 retrospective, 7 prospective and 2 randomised). Overall survival was primary endpoint in 15 papers. Study characteristics are reported in table 1. Due to data heterogeneity and the small number of randomised studies a meta-analysis was not performed. Studies were mainly conducted in Western countries (30% in Italy, 15% in USA, 10% in Canada and Germany), including overall 3066 patients. Mean age was 57,2±6,4 years. Most common cancer site were GI tract, ovary, breast, head and neck. Main indication for HPN was bowel obstruction or cachexia. Mean duration of HPN was 3,8±1,4 months. Median overall survival was 4,6±2,4 months (1,5 month in a selected cohort with peritoneal carcinomatosis, 8 months in a study including only advanced ovarian cancer). At baseline, mean weight was Kg 57,6±5,1, mean BMI 20,7±0,8 and mean KPS 55±5. After 1–5 months of HPN, mean weight and mean BMI increased to 61,9±5.3 and 21,2±0,5 respectively. KPS increased in 2 studies, stable in 2 studies. QoL was analysed through validated scales in 5 studies and resulted significantly increased after HPN. On average, HPN related complications were reported in 13%±6% of the pts.ConclusionIndications for HPN and overall survival (3,8±1,4 months) in advanced cancer was in accordance with prognostic parameters specified in European and American guidelines. Variation in clinical practice is evident in different countries. The cost effectiveness and impact of HPN on nutritional/performance status and QoL in these patients has not been adequately assessed and further prospective studies are required. A cultural change and education of healthcare professionals is required to ensure early access to HPN for appropriate patients.Disclosure of InterestNone DeclaredAbstract PTU-109 Figure 1

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

“…The overall median length of survival in our cohort of patients receiving HPN was 14 weeks, consistent with the ESPEN guidelines of expected survival longer than 8-12 weeks, confirming appropriate indication for HPN (1,27). Median duration of HPN in our study was 12.9 weeks consistent with reports from systematic reviews of 15 weeks (26). Finally, our study supports the hypothesis that a systemic inflammatory status, as assessed with higher GPS, CRP, and WCC is associated with a worse performance status (i.e.…”

“…However, some authors contend that HPN is a burden to patients and possibly feeds the tumour (2,6,18). Robust practical guidance is lacking in advanced cancer patients on HPN despite previous studies investigating prognostic factors (2,3,6,13,(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). In the present study, we aim to examine the prognostic significance of performance status, type and site of tumour, previous or concurrent chemo-radiotherapy, anthropometric characteristics, nutritional and inflammatory status, demographic characteristics, serum biochemistry and prognostic indices based on a large cohort of patients with advanced cancer receiving HPN at University College London Hospitals (UCLH), UK.…”