Adult cancer patients on home parenteral nutrition in Slovenia, data analysis by the Clinical Nutrition Unit of the Institute of Oncology in Ljubljana, in the period 2008–2012.
Abstract
Introduction: Home parenteral nutrition (HPN) represents a kind of therapy for intestinal failure. The system of HPN for adult patients was established in Slovenia by the Clinical Nutrition Unit of the Institute of Oncology, Ljubljana in 2008. The aim of the article is to analyse Slovenian data on HPN in cancer patients in the four-year period from 2008 to 2012.
Patients and Methods: In the time period from 2008 to 2012, 53 cancer patients were included in the HPN system in Slovenia–19 males and 34 females.
Results: The average age of the patients at enrollment into the HPN system was 53 years. This represents 74.6 % of all patients on HPN who were registered in our unit in this period. Forty-four patients had advanced cancer and 9 patients had no recurrence of cancer during the observation period. In patients with advanced cancer, tumors of the gastrointestinal tract (15 patients stomach and esophagus, 11 patients colon and rectum) and gynecological cancers (10 patients) were represented most frequently.. Gastrointestinal obstruction (74 %) was the major indication for long-term parenteral nutrition in cancer patients. Thirty-seven patients died during the observation period. Median survival time of patients with advanced cancer was 8 months (95 % CI, 3.61 to 12.39 months). Twenty-seven patients received HPN during anti-cancer therapy (chemotherapy, radiotherapy, surgery). Medians for survival time of patients receiving an anticancer therapy and patients without any therapy were 11 months (95 % CI, 3.72 to 18.28 months) and 2 months (95 % CI, 1.26 to 2.74 months), respectively. The survival of patients with anticancer therapy was significantly longer (p < 0.001). The majority of patients (90 %) had HPN each day, 7 times per week. Twenty-eight patients (52 %) had venous access complications . The most common cause of complication was infection in 16 patients (30 %), which did not shorten the survival time of patients with advanced cancer. The number of VAP complications was time-independent and did not affect the survival of the observed patients. The significance value was 0.44 (95 % CI, 0.153–2.275).
Conclusion: The results of the retrospective study represent the first Slovenian data on the survival time of cancer patients on HPN treatment for intestinal failure. The results are comparable to the results from European surveys, which are a direct indicator that inclusion criteria for HPN in cancer patients used in Slovenia are good. Introduction of HPN as a therapeutic option also offers a possibility to continue with anticancer therapy and improve the survival rate of patients with advanced cancer. They are also an indirect sign that the quality of HPN service is good and serves as a platform for further development of HPN in cancer patients in Slovenia, and at the same time for other patients who would need a replacement therapy in the form of HPN owing to intestinal failure.
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