The prognosis of incurable cachectic cancer patients on home parenteral nutrition: a multi-centre observational study with prospective follow-up of 414 patients

TY - JOUR

T1 - The prognosis of incurable cachectic cancer patients on home parenteral nutrition

T2 - a multi-centre observational study with prospective follow-up of 414 patients

AU - Bozzetti, F

AU - Santarpia, L

AU - Pironi, L

AU - Thul, P

AU - Klek, S

AU - Gavazzi, C

AU - Tinivella, M

AU - Joly, F

AU - Jonkers, C

AU - Baxter, J

AU - Gramlich, L

AU - Chicharro, L

AU - Staun, M

AU - Van Gossum, A

AU - Lo Vullo, S

AU - Mariani, L

PY - 2014/2

Y1 - 2014/2

N2 - BACKGROUND: The role of home parenteral nutrition (HPN) in incurable cachectic cancer patients unable to eat is extremely controversial. The aim of this study is to analyse which factors can influence the outcome.PATIENTS AND METHODS: We studied prospectively 414 incurable cachectic (sub)obstructed cancer patients receiving HPN and analysed the association between patient or clinical characteristics and surviving status.RESULTS: Median weight loss, versus pre-disease and last 6-month period, was 24% and 16%, respectively. Median body mass index was 19.5, median KPS was 60, median life expectancy was 3 months. Mean/median survival was 4.7/3.0 months; 50.0% and 22.9% of patients survived 3 and 6 months, respectively. At the multivariable analysis, the variables significantly associated with 3- and 6-month survival were Glasgow Prognostic Score (GPS) and KPS, and GPS, KPS and tumour spread, respectively. By the aggregation of the significant variables, it was possible to dissect several classes of patients with different survival probabilities.CONCLUSIONS: The outcome of cachectic incurable cancer patients on HPN is not homogeneous. It is possible to identify groups of patients with a ≥6-month survival (possibly longer than that allowed in starvation). The indications for HPN can be modulated on these clinical/biochemical indices.

AB - BACKGROUND: The role of home parenteral nutrition (HPN) in incurable cachectic cancer patients unable to eat is extremely controversial. The aim of this study is to analyse which factors can influence the outcome.PATIENTS AND METHODS: We studied prospectively 414 incurable cachectic (sub)obstructed cancer patients receiving HPN and analysed the association between patient or clinical characteristics and surviving status.RESULTS: Median weight loss, versus pre-disease and last 6-month period, was 24% and 16%, respectively. Median body mass index was 19.5, median KPS was 60, median life expectancy was 3 months. Mean/median survival was 4.7/3.0 months; 50.0% and 22.9% of patients survived 3 and 6 months, respectively. At the multivariable analysis, the variables significantly associated with 3- and 6-month survival were Glasgow Prognostic Score (GPS) and KPS, and GPS, KPS and tumour spread, respectively. By the aggregation of the significant variables, it was possible to dissect several classes of patients with different survival probabilities.CONCLUSIONS: The outcome of cachectic incurable cancer patients on HPN is not homogeneous. It is possible to identify groups of patients with a ≥6-month survival (possibly longer than that allowed in starvation). The indications for HPN can be modulated on these clinical/biochemical indices.

KW - Adolescent

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Cachexia

KW - Carcinoma

KW - Digestive System Neoplasms

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Kaplan-Meier Estimate

KW - Logistic Models

KW - Male

KW - Middle Aged

KW - Parenteral Nutrition, Home

KW - Prognosis

KW - Prospective Studies

KW - Young Adult

U2 - 10.1093/annonc/mdt549

DO - 10.1093/annonc/mdt549

M3 - Journal article

C2 - 24406425

SN - 0923-7534

VL - 25

SP - 487

EP - 493

JO - Annals of Oncology

JF - Annals of Oncology

IS - 2

ER -