Role of Home Parenteral Nutrition in Cancer Patients
Keywords:
home parenteral nutrition, chronic intestinal failure, cancer, malignant bowel obstruction, cancer cachexiaAbstract
Currently, the proportion of patients with cancer receiving home parenteral nutrition (HPN) is steadily increasing, with a broad spectrum of indications ranging from cancer treatment–related intestinal failure and malignant bowel obstruction to cancer cachexia. HPN has been shown to maintain and improve nutritional status in this population. Nevertheless, other clinically relevant outcomes, including survival, quality of life, risk of complications, and health economic cost-effectiveness, remain highly heterogeneous and are strongly influenced by patient characteristics, disease stage, and the healthcare system context across different countries. Notably, in patients with advanced-stage cancer, robust evidence demonstrating a clear survival or quality-of-life benefit of HPN over palliative care alone remains lacking.
Therefore, the initiation of HPN in patients with cancer should be made with careful consideration, based on a thorough assessment of indications, contraindications, and safety, grounded in the fundamental principles of medical ethics, and guided by a shared decision-making process among physicians, patients, and their families. In addition, HPN should be appropriately implemented in accordance with established clinical practice guidelines, with the European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines serving as an important framework for patient management.
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