Parenteral Nutrition In Cancer Patients Research Articles

Parenteral nutrition in cancer patients outside of oncologic treatment: Bioethical perspective

The medical care of a patient with an end-stage disease focus on the pursuit of the patient's quality of life. Many treatments can be used to achieve this goal. In this study, the benefits, and burdens of providing parenteral nutrition to patients diagnosed with end-stage cancer were reviewed and analyzed from a bioethical perspective with the aim of issuing a useful recommendation for decision making. A qualitative convergent study through interviews and a multiple case study was performed. The study is on the decisions to provide parenteral nutrition as an end-of-life treatment for terminal cancer patients treated in Mexico City. Eight physicians specialized in Oncology and Palliative Care were interviewed and 10 clinical records of patients diagnosed with terminal cancer, who were out of oncologic treatment, who received palliative care and were prescribed parenteral nutrition at the end of life were analyzed. The physicians considered parenteral nutrition as an advanced life-sustaining medical treatment and, therefore, susceptible to not being initiated or being withdrawn, according to the patient's clinical situation. Minor complications secondary to parenteral nutrition were found in all the records reviewed, all these patients died in hospital instead of at home. When death is certain in the short term and cannot be avoided, the role of feeding and nutrition becomes questionable, especially in cancer patients at the end of life, where parenteral nutrition causes more burden than benefit.

Parenteral Nutrition in Advanced Cancer: The Healthcare Providers' Perspective.

IntroductionThe evidence base for parenteral nutrition (PN) in advanced cancer patients is limited. We studied healthcare providers’ (HCPs’) experiences with PN in cancer patients, focusing on perceived treatment benefits and challenges.MethodsAn 18-item online survey was emailed to HCPs attending one of three regional palliative care seminars held within a 6-month period. The survey included single-response items, multiple-response items, and free text boxes concerning PN. Descriptive statistics and qualitative thematic content analysis were applied.ResultsOne hundred and two seminar participants completed the survey. Ninety-three percent were female, 86% were nurses/oncological nurses, and 80% worked in primary care. Respondents reported a well-functioning collaboration across levels of care. They perceived that PN may increase the patients’ level of energy, improve the general condition, and reduce eating-related distress. On the downside, HCPs observed burdensome side effects, that the treatment was resource-demanding, and that decisions on PN withdrawal were difficult.ConclusionThe study results are based on the perspectives of more than 100 HCPs with comprehensive clinical experience with PN. Their knowledge represents an important experience base for improvement of healthcare services and advanced care planning. Supplementary InformationThe online version contains supplementary material available at 10.1007/s40487-022-00189-1.

SINPE Position Paper on the use of home parenteral nutrition in cancer patients

SINPE Position Paper on the use of home parenteral nutrition in cancer patients

Comparative Complication Rates of 854 Central Venous Access Devices for Home Parenteral Nutrition in Cancer Patients: A Prospective Study of Over 169,000 Catheter-Days.

Whether peripherally inserted central catheters (PICCs) are appropriate as safe and durable venous access devices (VADs) is still controversial. The aim of this 7-year, prospective cohort study was to compare the incidence rate differences of catheter-related complications (CRCs) among 4 types of central VADs in cancer patients receiving home parenteral nutrition (HPN). We enrolled all adult cancer outpatients who were candidates for HPN and who had a central VAD inserted during the study period, focusing on the incidence rate of CRCs. We evaluated 854 central VADs (401 PICCs, 137 nontunneled centrally inserted central catheters [CICCs], 118 tunneled-cuffed CICCs, and 198 ports) in 761 patients, for a total of 169,116 catheter-days. Overall, the rate of total CRCs was 1.08/1000 catheter-days. The incidence of catheter-related bloodstream infections was low (0.29/1000), particularly for PICCs (0.08/1000; P < .001 vs tunneled-cuffed CICCs) and for ports (0.21/1000; P < .019 vs tunneled-cuffed CICCs). The rates of mechanical complications (0.58/1000) and of catheter-related symptomatic thrombosis (0.09/1000) were low and similar for PICCs, tunneled-cuffed CICCs, and ports. In terms of duration and removal rate due to complications, PICCs were like tunneled-cuffed CICCs and ports. Altogether, PICCs had fewer total complications than tunneled-cuffed CICCs (P < .001), there was no difference in total complications between PICCs and ports. PICCs had significantly better outcomes than tunneled-cuffed CICCs and were safe and durable as ports. Our extensive, long-term study suggests that PICCs can be successfully used as safe and long-lasting VADs for HPN in cancer patients.

Enteral and parenteral nutrition in cancer patients, a comparison of complication rates: an updated systematic review and (cumulative) meta-analysis.

Weight loss in cancer patients is a worrisome constitutional change predicting disease progression and shortened survival time. A logical approach to counter some of the weight loss is to provide nutritional support, administered through enteral nutrition (EN) or parenteral nutrition (PN). The aim of this paper was to update the original systematic review and meta-analysis previously published by Chow et al., while also assessing publication quality and effect of randomized controlled trials (RCTs) on the meta-conclusion over time. A literature search was carried out; screening was conducted for RCTs published in January 2015 up until December 2018. The primary endpoints were the percentage of patients achieving no infection and no nutrition support complications. Secondary endpoints included proportion of patients achieving no major complications and no mortality. Review Manager (RevMan 5.3) by Cochrane IMS and Comprehensive Meta-Analysis (version 3) by Biostat were used for meta-analyses of endpoints and assessment of publication quality. An additional seven studies were identified since our prior publication, leading to 43 papers included in our review. The results echo those previously published; EN and PN are equivalent in all endpoints except for infection. Subgroup analyses of studies only containing adults indicate identical risks across all endpoints. Cumulative meta-analysis suggests that meta-conclusions have remained the same since the beginning of publication time for all endpoints except for the endpoint of infection, which changed from not favoring to favoring EN after studies published in 1997. There was low risk of bias, as determined by assessment tool and visual inspection of funnel plots. The results support the current European Society of Clinical Nutrition and Metabolism guidelines recommending enteral over parenteral nutrition, when oral nutrition is inadequate, in adult patients. Further studies comparing EN and PN for these critical endpoints appear unnecessary, given the lack of change in meta-conclusion and low publication bias over the past decades.

SUN-P079: Home Parenteral Nutrition in Cancer Patients: Trained Family Caregiver or General Home Nurse?

SUN-P079: Home Parenteral Nutrition in Cancer Patients: Trained Family Caregiver or General Home Nurse?

Comparison of Changes in Liver Function of the Fish Oil and Non-fish Oil based Total Parenteral Nutrition in Cancer Patients

Background : Malnutrition is common in cancer patients due to consequences of the dis- ease progression and treatments. It is necessary to consider administration of TPN (Total Parenteral Nutrition) for cancer patients who cannot sustain adequate nourishment status through enteral nutrition or diet, in order to improve prognosis and prevent malnutrition. Cancer patients are sus- ceptible to liver dysfunction, which is also a representative adverse reaction of TPN. Therefore, the

Enteral and parenteral nutrition in cancer patients: a systematic review and meta-analysis.

In cancer patients, weight loss is an ominous sign suggesting disease progression and shortened survival time. As a result, providing nutrition support for cancer patients has been proposed as a logical approach for improving clinical outcomes. Nutrition support can be given to patients through enteral nutrition (EN) or parenteral nutrition (PN). The purpose of the review was to compare the outcomes of PN and EN in cancer patients. A literature search was conducted in Ovid MEDLINE and OLDMEDLINE, Embase Classic and Embase, and Cochrane Central Register of Controlled Trials. Studies were included if over half of the patient population had cancer and reported on any of the following endpoints: the percentage of patients that experienced no infection, nutrition support complications, major complications or mortality. Risk ratios (RR) and 95% confidence intervals (CIs) using Review Manager Version 5.3 were calculated. Primary endpoints were stratified according to type of EN for subgroup analysis, grouping studies into either tube feeding (TF) or standard care (SC). Additionally, another subgroup analysis was conducted comparing studies with protein-energy malnutrition (PEM) patients and studies without PEM patients. The literature search yielded 674 articles of which 36 were included for the meta-analysis. There were no difference in the endpoints between the two study interventions except that PN resulted in more infection when compared with EN (RR =1.09, 95% CI: 1.01-1.18; P=0.03). Other than increased incidence of infection, PN has not resulted in prolonging the survival, increasing nutrition support complications, or major complications when compared with EN in cancer patients.

Adult cancer patients on home parenteral nutrition in Slovenia, data analysis by the Clinical Nutrition Unit of the Institute of Oncology in Ljubljana, in the period 2008–2012.

Introduction : Home parenteral nutrition (HPN) represents a kind of therapy for intestinal failure. The system of HPN for adult patients was established in Slovenia by the Clinical Nutrition Unit of the Institute of Oncology, Ljubljana in 2008. The aim of the article is to analyse Slovenian data on HPN in cancer patients in the four-year period from 2008 to 2012. Patients and Methods : In the time period from 2008 to 2012, 53 cancer patients were included in the HPN system in Slovenia–19 males and 34 females. Results : The average age of the patients at enrollment into the HPN system was 53 years. This represents 74.6 % of all patients on HPN who were registered in our unit in this period. Forty-four patients had advanced cancer and 9 patients had no recurrence of cancer during the observation period. In patients with advanced cancer, tumors of the gastrointestinal tract (15 patients stomach and esophagus, 11 patients colon and rectum) and gynecological cancers (10 patients) were represented most frequently.. Gastrointestinal obstruction (74 %) was the major indication for long-term parenteral nutrition in cancer patients. Thirty-seven patients died during the observation period. Median survival time of patients with advanced cancer was 8 months (95 % CI, 3.61 to 12.39 months). Twenty-seven patients received HPN during anti-cancer therapy (chemotherapy, radiotherapy, surgery). Medians for survival time of patients receiving an anticancer therapy and patients without any therapy were 11 months (95 % CI, 3.72 to 18.28 months) and 2 months (95 % CI, 1.26 to 2.74 months), respectively. The survival of patients with anticancer therapy was significantly longer (p < 0.001). The majority of patients (90 %) had HPN each day, 7 times per week. Twenty-eight patients (52 %) had venous access complications . The most common cause of complication was infection in 16 patients (30 %), which did not shorten the survival time of patients with advanced cancer. The number of VAP complications was time-independent and did not affect the survival of the observed patients. The significance value was 0.44 (95 % CI, 0.153–2.275). Conclusion : The results of the retrospective study represent the first Slovenian data on the survival time of cancer patients on HPN treatment for intestinal failure. The results are comparable to the results from European surveys, which are a direct indicator that inclusion criteria for HPN in cancer patients used in Slovenia are good. Introduction of HPN as a therapeutic option also offers a possibility to continue with anticancer therapy and improve the survival rate of patients with advanced cancer. They are also an indirect sign that the quality of HPN service is good and serves as a platform for further development of HPN in cancer patients in Slovenia, and at the same time for other patients who would need a replacement therapy in the form of HPN owing to intestinal failure.

Efectos adversos de la nutrición parenteral en pacientes oncológicos: revisión sistemática

Malnutrition in hospitals is of great concern in patients with cancer. This malnutrition in cancer leads to higher risk of complications, and worse response to treatments and outcomes. Parenteral nutrition (PN) in cancer is controversial due to the heterogeneous results found in scientific literature. This is the reason why the evaluation of adverse events of PN, its incidence and severity, is crucial when prescribing PN in cancer patients. This evaluation of adverse events of PN is the aim of the present systematic review of the randomized clinical trials (RCT) written in any language found in several databases. From the 74 articles found in our search, only 13 RCT (18 different types of cancer) met the criteria to be selected for the systematic review. These RCT included 669 patients receiving central PN in whom 225 adverse events (33.63%) of PN were described, and 92 patients with peripheral PN, with 54 adverse events (58.70%). There were no adverse events in a control group of 47 patients receiving parenteral fluids. We conclude that scientific literature is very heterogeneous and evaluate complications of parenteral nutrition only as a secondary aim. We think necessary that further research do define complications of parenteral nutrition homogeneously and study them as a main objective.

Adverse effects of parenteral nutrition in cancer patients: systematic review

Malnutrition in hospitals is of great concern in patients with cancer. This malnutrition in cancer leads to higher risk of complications, and worse response to treatments and outcomes. Parenteral nutrition (PN) in cancer is controversial due to the heterogeneous results found in scientific literature. This is the reason why the evaluation of adverse events of PN, its incidence and severity, is crucial when prescribing PN in cancer patients. This evaluation of adverse events of PN is the aim of the present systematic review of the randomized clinical trials (RCT) written in any language found in several databases. From the 74 articles found in our search, only 13 RCT (18 different types of cancer) met the criteria to be selected for the systematic review. These RCT included 669 patients receiving central PN in whom 225 adverse events (33.63%) of PN were described, and 92 patients with peripheral PN, with 54 adverse events (58.70%). There were no adverse events in a control group of 47 patients receiving parenteral fluids. We conclude that scientific literature is very heterogeneous and evaluate complications of parenteral nutrition only as a secondary aim. We think necessary that further research do define complications of parenteral nutrition homogeneously and study them as a main objective.

Parenteral nutrition in patients with cancer: recent guidelines and a need for further study

This review is intended to summarize previous data on the use of parenteral nutrition in cancer patients to acknowledge recent guidelines on this subject and to suggest a need for further research. Recent guidelines advise against parenteral nutrition in patients with incurable malignancies, although in some situations, patients with locally advanced cancers - not necessarily incurable cancers - might derive some benefit. Further study is indicated to better understand if other subgroups of patients might derive benefit and to understand quality of life issues. Recent guidelines are of value in clinical management but there remains a need to further study the role of parenteral nutrition in cancer patients.

Double-Lumen Central Venous Port Catheters: Simultaneous Application for Chemotherapy and Parenteral Nutrition in Cancer Patients

This study was designed to evaluate the clinical benefit of low-profile double-lumen port catheters in patients receiving simultaneous chemotherapy and parenteral nutrition (PN). Potential advantages, complications, and the durations of simultaneous and single use of the catheter were assessed. At a university teaching hospital, 10 patients received a double-lumen port catheter (5 men, 5 women; mean age 61.5 ± 12 years). All port implantations were performed under ultrasonographic and fluoroscopic guidance in the radiologic interventional suite. Procedure-related immediate, early, and late complications were recorded until removal of the device, patient's death, or completion of follow-up period. Application times and durations for chemotherapy or PN were determined. No immediate complications were observed. First use of the port system for chemotherapy was within 12 days (± 25 days, range 0-84 days) and within 17 hours (± 22 hours, range 0-72 hours) for PN on average. During the application of PN, no delay or interruption of chemotherapy was observed. The port catheter was used for the simultaneous application of chemotherapy and PN for a total of 1,216 hours. One port catheter was removed after 30 days due to suspected port infection. Central venous double-lumen port systems as a therapeutic option in patients requiring chemotherapy and PN can increase safety during those simultaneous applications, while offering improved patient comfort.

ESPEN Guidelines on Parenteral Nutrition: Non-surgical oncology

Parenteral nutrition offers the possibility of increasing or ensuring nutrient intake in patients in whom normal food intake is inadequate and enteral nutrition is not feasible, is contraindicated or is not accepted by the patient. These guidelines are intended to provide evidence-based recommendations for the use of parenteral nutrition in cancer patients. They were developed by an interdisciplinary expert group in accordance with accepted standards, are based on the most relevant publications of the last 30 years and share many of the conclusions of the ESPEN guidelines on enteral nutrition in oncology. Under-nutrition and cachexia occur frequently in cancer patients and are indicators of poor prognosis and, per se, responsible for excess morbidity and mortality. Many indications for parenteral nutrition parallel those for enteral nutrition (weight loss or reduction in food intake for more than 7-10 days), but only those who, for whatever reason cannot be fed orally or enterally, are candidates to receive parenteral nutrition. A standard nutritional regimen may be recommended for short-term parenteral nutrition, while in cachectic patients receiving intravenous feeding for several weeks a high fat-to-glucose ratio may be advised because these patients maintain a high capacity to metabolize fats. The limited nutritional response to the parenteral nutrition reflects more the presence of metabolic derangements which are characteristic of the cachexia syndrome (or merely the short duration of the nutritional support) rather than the inadequacy of the nutritional regimen. Perioperative parenteral nutrition is only recommended in malnourished patients if enteral nutrition is not feasible. In non-surgical well-nourished oncologic patients routine parenteral nutrition is not recommended because it has proved to offer no advantage and is associated with increased morbidity. A benefit, however, is reported in patients undergoing hematopoietic stem cell transplantation. Short-term parenteral nutrition is however commonly accepted in patients with acute gastrointestinal complications from chemotherapy and radiotherapy, and long-term (home) parenteral nutrition will sometimes be a life-saving maneuver in patients with sub acute/chronic radiation enteropathy. In incurable cancer patients home parenteral nutrition may be recommended in hypophagic/(sub)obstructed patients (if there is an acceptable performance status) if they are expected to die from starvation/under nutrition prior to tumor spread.

Role of Parenteral Nutrition in Cancer Patients Undergoing High-Dose Chemotherapy Followed by Autologous Peripheral Blood Progenitor Cell Transplantation

High-dose chemotherapy followed by autologous bone marrow or peripheral blood progenitor cell transplantation represents a recognized option in the treatment of solid tumors and hematologic diseases. Patients receiving high-dose chemotherapy are traditionally supported with parenteral nutrition with the aim to prevent malnutrition secondary to gastrointestinal toxicity and metabolic alterations induced by the conditioning regimens. Nevertheless, well-defined guidelines for its use in this clinical setting are lacking and there are several areas of controversy.

[Changing perspectives of parenteral nutrition in cancer patients. Rational and clinical implications].

Drug Prescribing for Patients with Chronic Kidney Disease in General Practice: a Cross-Sectional Study

Adverse Metabolic Consequences of Nutritional Support: Micronutrients

The role of total parenteral nutrition in cancer patients is still a matter of controversy. Over the last decade there has been a heightened interest in the interaction of micronutrients with tumor cells. A review of the literature reveals that the question of feeding or suppressing the tumor by supplementing micronutrients remains unanswered. Prospective studies are needed to define the requirements of vitamins and trace elements in the cancer patient.

Use of total parenteral nutrition in cancer patients

Use of total parenteral nutrition in cancer patients

The role of preoperative parenteral nutrition in cancer patients.

The observations that malnutrition frequently affects cancer patients, that it adversely affects postoperative prognosis, and that it is amenable to intensive nutrition therapy, lead logically to the hypothesis that preoperative parenteral nutrition should have a salutary effect on many patients undergoing oncologic surgery. Available studies evaluating this hypothesis suggest that adequate preoperative intravenous feedings improve the postoperative course of malnourished patients and patients initially well nourished but in whom oral nutrition may be interrupted prior to operation.

Bacteriological monitoring during parenteral nutrition in cancer patients: Usefulness of weekly blood cultures performed through the catheter : [formula omitted], A. Lemaire, A. Pascual-Lopez, J.C. Pector, D. Lauzon, A. Borkowski, F. Meunier-Carpentier (Services de Médecine Interne et de Chirurgie, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles, Bruxelles, Belgium)

Bacteriological monitoring during parenteral nutrition in cancer patients: Usefulness of weekly blood cultures performed through the catheter : [formula omitted], A. Lemaire, A. Pascual-Lopez, J.C. Pector, D. Lauzon, A. Borkowski, F. Meunier-Carpentier (Services de Médecine Interne et de Chirurgie, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles, Bruxelles, Belgium)