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Review
. 2020 Jun;5(3):e000709.
doi: 10.1136/esmoopen-2020-000709.

The clinical and cost-effectiveness of supplemental parenteral nutrition in oncology

Neil Webb  1 , Julie Fricke  2 , Elizabeth Hancock  3 , David Trueman  3 , Srobana Ghosh  3 , Julie Winstone  4 , Alec Miners  5 , Julian Shepelev  6 , Juan W Valle  7
Affiliations
Review

The clinical and cost-effectiveness of supplemental parenteral nutrition in oncology

Neil Webb et al. ESMO Open. 2020 Jun.

Abstract

Background: Clinical guidelines recommend that parenteral nutrition (PN) is added to enteral nutrition (EN; supplemental parenteral nutrition (SPN)) in order to meet energy and protein needs in patients with cancer when EN alone is insufficient. However, although cancer-related malnutrition is common, there is poor awareness of the value of nutritional care, resulting in SPN being chronically underused.

Methods: We performed a targeted literature review and exploratory cost-utility analysis to gather evidence on the clinical effectiveness of SPN, and to estimate the potential cost-effectiveness of SPN versus EN alone in an example cancer setting.

Results: The literature review identified studies linking SPN with malnutrition markers, and studies linking malnutrition markers with clinical outcomes. SPN was linked to improvements in body mass index (BMI), fat-free mass, phase angle (PhA) and prealbumin. Of these markers, BMI and PhA were strong predictors of survival. By combining published data, we generated indirect estimates of the overall survival HR associated with SPN; these ranged from 0.80 to 0.99 (mode 0.87). In patients with Stage IV inoperable pancreatic cancer, the incremental cost-effectiveness ratio versus EN alone was estimated to be £41 350 or £91 501 depending on whether nursing and home delivery costs for EN and SPN were combined or provided separately.

Conclusion: Despite a lack of direct evidence, the results of the literature review demonstrate that SPN may provide important clinical and quality of life benefits to patients with cancer. The potential for any improvement in outcomes in the modelled patient population is very limited, so cost-effectiveness may be greater in patients with less severe disease and other types of cancer.

Keywords: cancer; cost-effectiveness; malnutrition; supplemental parenteral nutrition; targeted literature review.

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Conflict of interest statement

Competing interests: NW, JF, EH, DT and SG are employees of Source Health Economics which received consultancy fees from Baxter Healthcare SA for performing literature reviews, model construction and analysis, and manuscript development. JW and AM report personal fees from Baxter Healthcare SA. JS is an employee of Baxter Healthcare. JWV declares a consulting and advisory board role for Baxter Healthcare. Outside the submitted work JWV reports personal fees from AstraZeneca, Debiopharm, Delcath Systems, Genoscience Pharma, Imaging Equipment Limited, Incyte, Ipsen, Keocyt, Merck, Mundipharma EDO, Novartis, PCI Biotech, Pieris Pharmaceuticals, QED, Wren Laboratories and Agios, grants, personal fees and non-financial support from NuCana, personal fees and non-financial support from Pfizer and grants and personal fees from Servier.

Figures

Figure 1
Figure 1
Flow of studies through TLR2. BMI, body mass index; FFM, fat-free mass; PAB, prealbumin; PhA, phase angle; SPN, supplemental parenteral nutrition; TLR, targeted literature review.
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References

    1. Evans WJ, Morley JE, Argilés J, et al. . Cachexia: a new definition. Clin Nutr 2008;27:793–9. 10.1016/j.clnu.2008.06.013 - DOI - PubMed
    1. Muscaritoli M, Anker SD, Argilés J, et al. . Consensus definition of sarcopenia, cachexia and pre-cachexia: joint document elaborated by Special Interest Groups (SIG) "cachexia-anorexia in chronic wasting diseases" and "nutrition in geriatrics". Clin Nutr 2010;29:154–9. 10.1016/j.clnu.2009.12.004 - DOI - PubMed
    1. Andreyev HJ, Norman AR, Oates J, et al. . Why do patients with weight loss have a worse outcome when undergoing chemotherapy for gastrointestinal malignancies? Eur J Cancer 1998;34:503–9. 10.1016/S0959-8049(97)10090-9 - DOI - PubMed
    1. Stratton RJ, Green CJ, Elia M. Disease-Related malnutrition: an evidence-based approach to treatment, 2003.
    1. Dewys WD, Begg C, Lavin PT, et al. . Prognostic effect of weight loss prior to chemotherapy in cancer patients. eastern cooperative Oncology Group. Am J Med 1980;69:491–7. 10.1016/s0149-2918(05)80001-3 - DOI - PubMed

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