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Velasquez DA, Dhiman A, Brottman C, Eng OS, Fenton E, Herlitz J, Lozano E, McDonald E, Reynolds V, Wall E, Whitridge J, Semrad C, Turaga K, Micic D. Outcomes of parenteral nutrition in patients with advanced cancer and malignant bowel obstruction. Support Care Cancer 2024; 32:206. [PMID: 38433169 DOI: 10.1007/s00520-024-08403-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/21/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Malignant bowel obstruction (MBO) affects 3% to 15% of all cancer patients. In patients with advanced cancer and inoperable MBO, the average survival varies between four to nine weeks. Parenteral nutrition (PN) may improve survival in specific patient populations with malignant bowel obstruction. AIMS This retrospective, single-center cohort study aimed to review individual patient outcomes on PN in the setting of advanced cancer with a diagnosis of MBO and identify clinical and laboratory markers predictive of short- and long-term survival to further highlight patients that would benefit from PN in the setting of an inoperable MBO. RESULTS In a retrospective analysis of 68 patients receiving PN for inoperable MBO, the median survival was 142 (IQR: 63.3-239.5) days. Patients experienced a median number of two hospital readmissions (range: 0-10) and spent a median of 29 days (range: 0-105) in the hospital after starting PN. Eighteen (26.5%) patients developed a catheter-related bloodstream infection (CRBSI). A diagnosis of appendiceal cancer was identified as a predictive marker of improved survival (HR: 0.53, 95% CI: 0.29-0.92, p = 0.023). CONCLUSIONS The use of PN in the context of end-of-life cancer care is a practice that necessitates improvement. Recognizing the outcomes and patient experiences of PN utilization is essential to physicians and patients.
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Affiliation(s)
- David A Velasquez
- University of Chicago, Pritzker School of Medicine, Chicago, IL, USA
| | - Ankit Dhiman
- Section of General Surgery and Surgical Oncology, University of Chicago Medicine, Chicago, IL, USA
| | - Colette Brottman
- Section of General Surgery and Surgical Oncology, University of Chicago Medicine, Chicago, IL, USA
| | - Oliver S Eng
- Section of General Surgery and Surgical Oncology, University of Chicago Medicine, Chicago, IL, USA
| | - Emily Fenton
- Section of General Surgery and Surgical Oncology, University of Chicago Medicine, Chicago, IL, USA
| | - Jean Herlitz
- Department of Internal Medicine, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Medicine, Chicago, IL, USA
| | - Edward Lozano
- Department of Internal Medicine, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Medicine, Chicago, IL, USA
| | - Edwin McDonald
- Department of Internal Medicine, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Medicine, Chicago, IL, USA
| | - Valerie Reynolds
- Department of Internal Medicine, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Medicine, Chicago, IL, USA
| | - Elizabeth Wall
- Department of Internal Medicine, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Medicine, Chicago, IL, USA
| | - Jeffrey Whitridge
- Section of General Surgery and Surgical Oncology, University of Chicago Medicine, Chicago, IL, USA
| | - Carol Semrad
- Department of Internal Medicine, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Medicine, Chicago, IL, USA
| | - Kiran Turaga
- Section of General Surgery and Surgical Oncology, University of Chicago Medicine, Chicago, IL, USA
| | - Dejan Micic
- Department of Internal Medicine, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Medicine, Chicago, IL, USA.
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Velasquez DA, Dhiman A, Brottman C, Eng OS, Fenton E, Herlitz J, Lozano E, McDonald E, Reynolds V, Wall E, Whitridge J, Semrad C, Turaga K, Micic D. Outcomes of parenteral nutrition in patients with advanced cancer and malignant bowel obstruction. RESEARCH SQUARE 2023:rs.3.rs-3455273. [PMID: 38014195 PMCID: PMC10680932 DOI: 10.21203/rs.3.rs-3455273/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Background Malignant bowel obstruction (MBO) affects 3-15% of all cancer patients. In patients with advanced cancer and inoperable MBO, the average survival varies between four to nine weeks. Parenteral nutrition (PN) may improve survival in specific patient populations with malignant bowel obstruction. Aims This retrospective, single-center cohort study aimed to review individual patient outcomes on PN in the setting of advanced cancer with a diagnosis of MBO and identify clinical and laboratory markers predictive of short- and long-term survival to further highlight patients that would benefit from PN in the setting of an inoperable MBO. Results In a retrospective analysis of 68 patients receiving PN for inoperable MBO, the median survival was 142 (IQR: 63.3-239.5) days. Patients experienced a median number of two hospital readmissions (range: 0-10) and spent a median of 29 days (range: 0-105) in the hospital after starting PN. Eighteen (26.5%) patients developed a catheter-related bloodstream infection (CRBSI). A diagnosis of appendiceal cancer was identified as a predictive marker of improved survival (HR: 0.53, 95% CI: 0.29-0.92, p = 0.023). Conclusions The use of PN in the context of end-of-life cancer care is a practice that necessitates improvement. Recognizing the outcomes and patient experiences of PN utilization is essential to physicians and patients.
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