Quality of life in patients receiving home parenteral nutrition

Abstract

Background/aims: Quality of life is an important determinant of the effectiveness of health technologies, but it has rarely been assessed in patients receiving home parenteral nutrition (HPN).

Patients/methods: The non-disease specific sickness impact profile (SIP) and the disease specific inflammatory bowel disease questionnaire (IBDQ) were used on a cohort of 49 patients receiving HPN, and the results compared with those for 36 non-HPN patients with either anatomical (<200 cm) or functional (faecal energy excretion >2.0 MJ/day (approximately 488 kcal/day)) short bowel.

Results: In the HPN patients the SIP scores were worse (higher) overall (17 (13)% v 8 (9)%) and with regard to physical (13 (15)% v 5 (8)%) and psychosocial (14 (12)% v 9 (11)%) dimensions and independent categories (20 (12)% v 9 (8)%) compared with the non-HPN patients (means (SD); all p<0.001). The IBDQ scores were worse (lower) in the HPN patients overall (5.0 (4.3-5.7) v 5.6 (4.8-6.2)) and with regard to systemic symptoms (3.8 (2.8-5.4) v 5.2 (3.9-5.9)) and emotional (5.3 (4.4-6.2) v 5.8 (5.4-6.4)) and social (4.3 (3.4-5. 5) v 4.8 (4.5-5.8)) function (median (25-75%); all p<0.05), but only tended to be worse with regard to bowel symptoms (5.2 (4.8-6.1) v 5.7 (4.9-6.4), p = 0.08). HPN also reduced quality of life in patients with a stoma, whereas a stoma did not reduce quality of life among the non-HPN patients. Female HPN patients and HPN patients older than 45 scored worse.

Conclusion: Quality of life is reduced in patients on HPN compared with those with anatomical or functional short bowel not receiving HPN, and compares with that reported for patients with chronic renal failure treated by dialysis.

Figure 1

Comparison of SIP scores between patients receiving home parenteral nutrition (HPN) and those who did not. Results are expressed as mean (SD). Frequencies of confirmatory answers in the SIP questionnaire were compared between groups using the χ² test or alternatively Fisher's exact test. The VAS scores were compared using a Mann-Whitney rank sum test. The values in parentheses in the category column give the numbers of items in each category. Zero per cent indicates the best possible function (absence of dysfunction), whereas 100% indicates presence of all possible dysfunctional behaviour.

Figure 2

Mean sickness impact profile (SIP) scores and median inflammatory bowel disease questionnaire (IBDQ) scores according to sex (A and B) and age (C and D) in the patients on home parenteral nutrition (HPN). χ² or Fisher exact test: *p<0.05; **p<0.01, ***p<0.001. Mann-Whitney rank sum test: †p<0.05.

Figure 3

Mean sickness impact profile (SIP) scores and median inflammatory bowel disease questionnaire (IBDQ) scores according to the presence or absence of a stoma in patients not on home parenteral nutrition (HPN) (A and B) and those on HPN (C and D). χ² or Fisher exact test: *p<0.05; **p<0.01; ***p<0.001. Mann-Whitney rank sum test: †p<0.01.

Figure 4

Mean sickness impact profile (SIP) scores and median inflammatory bowel disease questionnaire (IBDQ) scores according to diagnosis (A and B) and duration of home parenteral nutrition (HPN) (C and D). IBD, patients with inflammatory bowel disease; MD+OP, patients with intestinal resection because of mesenteric vascular disease or complications of intra-abdominal surgery; dysmotility, patients with intestinal dysmotility. *, † and ‡ denote significant difference (p<0.05) by the χ² or Fisher exact test.