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USE OF HOME PARENTERAL NUTRITION IN PATIENTS WITH ADVANCED CANCER

I Soo, H Ames, L Gramlich
Division of Gastroenterology, University of Alberta, Edmonton, Alberta

BACKGROUND: Home parenteral nutrition (HPN) may improve quality of life in patients with advanced cancer. Palliative patients with a non-functional gastrointestinal tract and duration of life expectancy greater than six weeks are most likely to benefit from HPN. There is relatively little data on the utilization of HPN in advanced cancer patients (ACP) in Canada.
OBJECTIVES: The purpose of this study was to describe patient related variables associated with ACP enrolled in a HPN program.
METHODS: This is a retrospective cohort study of ACP enrolled in the Northern Alberta Home Total Parenteral Nutrition Program (NAHTPNP). The study duration includes the first inception of formal guidelines for ACP utilizing HPN in 1999 to 2006 (www.palliative.org).
RESULTS: 38 ACP received HPN during the study period. 71% (27) were female. Mean age was 48.76 (SD 13.8). Malignancies included ovarian (71%, 16), gastric / gastroesophageal (21%, 8), colonic / colorectal (18%, 7), and other (18%, 7). Bowel obstruction was the most common indication for initiating HPN (87%, 33). Median duration of therapy was 3.5 months (IQR 2.3-6). The maximum duration of therapy was 33 months. Mean Karnofsky Performance Scale (KPS) at initiation of therapy was 63 (SD 18.0). Patients who began HPN with a KPS of 50 or greater (mean of 67.7) were found to have a longer duration of life (6.2 months) compared to patients who began HPN with a KPS below 50 (mean = 40; 1.5 months; p=0.01; two-tailed). There was no difference in survival between malignancy type (p=NS). Advanced cancer is the fastest growing indication for enrollment in the HPN program. ACP demonstrated a 3% average annual increase proportionate to all indications for HPN starts, accounting for 7-48% of HPN starts from 1999-2006.
CONCLUSION: HPN is an increasingly utilized therapy for patients with advanced cancer, most commonly for intestinal failure in the setting of bowel obstruction. Median duration of therapy was longer than would be expected of death from starvation which occurs at approximately 6 weeks. Initiation of HPN at a higher KPS was associated with a longer duration of life. Further studies are needed to validate the use of TPN in end-stage cancer patients.

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