Home Parenteral Nutrition Prolongs Survival in Incurable Malnourished Cancer Patients: A Prospective Cohort Study

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Background: Guidelines recommend home parenteral nutrition (HPN) if incurable cancer patients are unable to meet their nutritional requirements by oral/enteral route and are at risk of death due to malnutrition. However, the evidence base is lacking and recommendation has been the result of expert consensus. The aim of this study was the comparison of incurable malnourished cancer patients who received HPN with a similar group of patients, equally eligible for HPN, who did not receive HPN for logistic reasons or refusal by the patient. Methods: In this prospective longitudinal cohort study, patients were assessed for HPN eligibility following the European guidelines. In the eligible population, those who received both HPN and chemotherapy were excluded, those receiving only HPN were included as the study group (HPN+ group) while who received neither HPN nor chemotherapy but only artificial hydration were included as the control group (HPN- group). The primary outcome was overall survival. Findings: Between October 1, 2012, and September 30, 2015, 301 patients were assessed for HPN eligibility and 86 patients (28·6%) were excluded for having severe organ dysfunction or Karnofsky Performance Status <50. In outcome analysis, 90 patients (29·9%) were excluded for receiving both HPN and chemotherapy while 125 (41·5%) were included, 89 in HPN+ group (29·5%) and 36 in HPN- group (12%). The survival of the two groups showed a significant difference favouring patients on HPN (median overall survival: 4·3 vs 1·5 months, p<0·001); HR 0·028 [95% CI 0·015-0·059]). The multivariate analysis of the risk factors for mortality showed that not receiving HPN accounted for the strongest one (HR 25·72 [95% CI 13·65-48·44]). Interpretation: Survival of incurable malnourished cancer patients is significantly correlated with HPN administration which produces a threefold survival increase. These data support the recommendation that HPN should be considered to prolong survival in these patients. Funding Statement: Regional Public Healthcare Office (Piedmont Region, Italy). Declaration of Interests: PC reports grants from the Regional Public Healthcare Office (Piedmont Region, Italy). PC reports honoraria for speaking and teaching from Baxter. The other authors declare that they have no competing interests. Ethics Approval Statement: Ethics Committee approval was obtained and written informed consent was obtained from each patient prior to any procedures. The consent to participate was obtained from the chief investigator (PC). The study was conducted in compliance with the Institutional Review Board/Human Subjects Research Committee requirements.