Abstract
BackgroundMalnutrition is a problem in advanced cancer, particularly ovarian cancer where malignant bowel obstruction (MBO) is a frequent complication. Parenteral nutrition is the only way these patients can received adequate nutrition and is a principal indication for palliative home parenteral nutrition (HPN). Giving HPN is contentious as it may increase the burden on patients. This study investigates patients’ and family caregivers’ experiences of HPN, alongside nutritional status and survival in patients with ovarian cancer and MBO.MethodsThis mixed methods study collected data on participant characteristics, clinical details and body composition using computed tomography (CT) combined with longitudinal in-depth interviews underpinned by phenomenological principles. The cohort comprised 38 women with ovarian cancer and inoperable MBO admitted (10/2016 to 12/ 2017) to a tertiary referral hospital. Longitudinal interviews (n = 57) were carried out with 20 women considered for HPN and 13 of their family caregivers.ResultsOf the 38 women, 32 received parenteral nutrition (PN) in hospital and 17 were discharged on HPN. Nutritional status was poor with 31 of 33 women who had a CT scan having low muscle mass, although 10 were obese. Median overall survival from admission with MBO for all 38 women was 70 days (range 8–506) and for those 17 on HPN was 156 days (range 46–506).Women experienced HPN as one facet of their illness, but viewed it as a “lifeline” that allowed them to live outside hospital. Nevertheless, HPN treatment came with losses including erosion of normality through an impact on activities of daily living and dealing with the bureaucracy surrounding the process. Family caregivers coped but were often left in an emotionally vulnerable state.ConclusionsWomen and family caregivers reported that the inconvenience and disruption caused by HPN was worth the extended time they had at home.
Highlights
Malnutrition is a problem in advanced cancer, affecting up to 80% of patients [1]
It is a particular problem in advanced ovarian cancer as a complication affecting between 20 and 50% of patients is malignant bowel obstruction (MBO) [2, 3]
A systematic review examining survival and quality of life of home parenteral nutrition (HPN) for people with inoperable MBO found the quality of evidence, as assessed using GRADE [6], very low and the effect of HPN on survival and quality of life continues to be inconclusive [7]
Summary
Malnutrition is a problem in advanced cancer, affecting up to 80% of patients [1] It is a particular problem in advanced ovarian cancer as a complication affecting between 20 and 50% of patients is malignant bowel obstruction (MBO) [2, 3]. The numbers of patients with cancer receiving home parenteral nutrition (HPN) in the UK is increasing, in patients with ovarian cancer [4]. Given these increasing numbers it is important to know the objective and subjective benefits. Malnutrition is a problem in advanced cancer, ovarian cancer where malignant bowel obstruction (MBO) is a frequent complication. This study investigates patients’ and family caregivers’ experiences of HPN, alongside nutritional status and survival in patients with ovarian cancer and MBO
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