Introduction: The role of home parenteral nutrition (HPN) for advanced cancer patients is controversial. The therapeutic goal for parenteral nutrition (PN) in cancer patients is improvement of quality of life. International guidelines suggest considering HPN in patients with expected survival of more than 2 months.
Study Objectives: The aim is to examine the demographics and outcomes of advanced cancer patients receiving HPN in South Australia. We also examined factors in patients classified as good survivors (> 6 months) or poor survivors (≤ 2 months) based on survival time on HPN.
Methods: A retrospective study in adult cancer patients with intestinal failure receiving home parenteral nutrition from 1991 to 2022. The clinic notes and electronic medical records were examined. Data on age, sex, outcomes, length on HPN, gastrointestinal intervention, and type of venous access were collected. Karnofsky Performance Status (KPS), Glasgow Prognostic Score, Metastasis score and total score (based on Bozzetti’s Nomogram) were calculated. Independent t test and Mann-Whitney U test were used to compare patients who were classified as good and poor survivors.
Results: Total of 62 patients were examined. Mean age was 60 and female was 72.6%. Median HPN days were 93.5 (IQR 23.5, 330.3). Top three sites of primary cancer were gynaecological (35.5%), gastrointestinal tract (27.4%) and pancreatic (11.3%). The groups are divided into good survivor (N=24, 39%) and poor survivors (N=14, 23%). Factors that were statistically significant different between these groups were metastases score, KPS and total score (P value= 0.021, 0.002 and 0.032 respectively).
Conclusion: More than one third of our advanced cancer patients on HPN were good survivors. The good survivors had lower metastases, KPS and total scores. This suggest that the baseline health of patients, cancer types and metastases may influence outcome.