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. 2020 Jul;9(13):4686-4698.
doi: 10.1002/cam4.3064. Epub 2020 May 15.

Clinical characteristics and predictive factors of survival of 761 cancer patients on home parenteral nutrition: A prospective, cohort study

Paolo Cotogni  1 , Taira Monge  1   2 , Roberto Passera  3 , Laura Brossa  1   2 , Antonella De Francesco  2
Affiliations

Clinical characteristics and predictive factors of survival of 761 cancer patients on home parenteral nutrition: A prospective, cohort study

Paolo Cotogni et al. Cancer Med. 2020 Jul.

Abstract

Background: Robust data reporting the survival of cancer patients on home parenteral nutrition (HPN) are lacking. The aim of this prospective, cohort study was to investigate clinical characteristics, predictive factors, and overall survival (OS) of adult-malnourished cancer patients eligible for HPN according to the European guideline recommendations.

Methods: During the study period, 1658 cancer patients were consecutively evaluated in a tertiary university hospital. Of these, 761 who received HPN were grouped into four cohorts according to the provision of supplemental PN (SPN) or total (TPN) and whether they received chemotherapy (CT+ or CT- ): SPN/CT+ (n = 376), TPN/CT+ (n = 99), SPN/CT- (n = 191), and TPN/CT- (n = 95). Patient demographics, nutritional status, cancer-related characteristics, and prognostic scores assessed at HPN start. The primary outcome was OS.

Results: Median OS was 8.9, 4.3, 5.7, and 2.2 months for the SPN/CT+ , TPN/CT+ , SPN/CT- , and TPN/CT- cohorts, respectively. In multivariable analysis, predictors showing significant association with decreased survival were patient cohorts, modified Glasgow Prognostic Score (1 and 2 scores), weight loss (>15%) in the 3 months before HPN start, and TNM IV stage while protective factors of survival were Karnofsky Performance Status (>50), albumin level (>3.5 g/dL), oral protein intake, BMI (>20.5), and weight at HPN start.

Conclusion: For the first time, in four different cohorts of cancer patients on HPN, clinical characteristics and survival were compared. This large study showed that survival is significantly correlated with patient characteristics at HPN start and that the presence of favorable factors may determine even a fourfold increase in survival. These data are expected to assist physicians in the appropriate prescription of HPN.

Keywords: cancer survival; cohort study; home care; medical nutrition therapy; oncologic treatment; supportive care.

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Conflict of interest statement

PC reported honoraria for speaking and teaching from Baxter. The other authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Study flow chart. HPN: home parenteral nutrition; ONS: oral nutritional supplements; HEN: home enteral nutrition; SPN: supplemental parenteral nutrition; TPN: total parenteral nutrition; CT+: chemotherapy received; CT‐: no chemotherapy received
Figure 2
Figure 2
Differences in patient distribution (%) for the four groups identified (by the type of parenteral nutrition and whether they received chemotherapy during the study period). Differences are according to (a) BMI‐adjusted weight loss categories, (b) Patient‐Generated Subjective Global Assessment (PG‐SGA) score, (c) Karnofsky Performance Status, and (d) modified Glasgow Prognostic Score. ** P < .01 (SPN/CT + was the reference group when compared with TPN/CT+; SPN/CT‐; TPN/CT‐).SPN: supplemental parenteral nutrition; TPN: total parenteral nutrition; CT+: chemotherapy received; CT‐: no chemotherapy received; BMI: body mass index
Figure 3
Figure 3
Overall survival. Overall survival (in months) since home parenteral nutrition start reported as Kaplan‐Meier curves that identify the different cohorts; percent of patients alive at different time‐points; median survival and 95% CI. * Reference group for the log‐rank test. SPN: supplemental parenteral nutrition; TPN: total parenteral nutrition; CT+: chemotherapy received; CT‐: no chemotherapy received; CI: confidence interval
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