Prediction of survival time in advanced intra-abdominal cancer patients receiving total parenteral nutrition or home parenteral nutrition

Abstract

Background: Home parenteral nutrition (HPN) remains controversial for endstage cancer patients incapable of oral or enteral food intake. We retrospectively reviewed data from patients treated for such conditions in our hospital or at home, paying particular attention to life expectancy. Methods: Of 124 patients who were incapable of oral intake and were treated by total parenteral nutrition for advanced abdominal malignancies, 76 patients were discharged so as to receive HPN (HPN group) after completing education in the management. The remaining 48 patients died in the hospital (non-HPN group). Patients' data were compared between the two groups, and their survival time was estimated using multiple regression analysis. Results: The median durations of HPN and TPN were 33.5 and 108.5 days in the HPN group, compared with a median of 32.0 days in the non-HPN group. In 71% of the HPN group, nutrition was managed by the patient alone or with a single family member, posing a problem about nutritional support at home. In the majority of the non-HPN group, the shift to HPN was hindered by aggravated disease. The observed survival time was significantly correlated with the Onodera nutritional prognostic index, and with the survival time estimated by our multiple regression analysis using serum albumin and the lymphcite count. Individual prediction of life expectancy was not successful, however. Conclusion: Retrospective analysis of patients receiving TPN for endstage intra-abdominal malignancies shows that prediction of survival time of individuals has yet to be refined requiring multiple regression analysis with additional predictors.