Performance Status, Prognostic Scoring, and Parenteral Nutrition Requirements Predict Survival in Patients with Advanced Cancer Receiving Home Parenteral Nutrition

ABSTRACT

We describe a cohort of Home Parenteral Nutrition (HPN) patients with advanced cancer in order to identify factors affecting prognosis. Demographic, anthropometric, biochemical and medical factors, Karnofsky Performance Status (KPS), Glasgow Prognostic Score (GPS), and PN requirements were recorded. Univariate and multivariate analyses were performed including Kaplan–Meier curves, Cox Regression, and correlation analyses. In total, 107 HPN patients (68 women, 39 men, mean age 57 yr) with advanced cancer were identified. The main indications for HPN were bowel obstruction (74.3%) and high output ostomies (14.3%). Cancer cachexia was present in 87.1% of patients. The hazard ratio (HR) for upper gastrointestinal and “other” cancers vs. gynaecological malignancy was 1.75 (p = 0.077) and 2.11 (p = 0.05), respectively. KPS score, GPS, PN volume, and PN potassium levels significantly predicted survival (HR_{KPS ≥50 vs <50} = 0.47; HR_{GPS = 2 vs. GPS = 0} = 3.19). In multivariate analysis, KPS and GPS remained significant predictors (p < 0.05), whilst PN volume reached borderline significance (p = 0.094). Survival was not significantly affected by the presence of metastatic disease, previous or concurrent surgery, chemo-radiotherapy, or indication for HPN (p > 0.05). Most patients passed away in their homes or hospice (77.9%). Performance status, prognostic scoring, and PN requirements may predict survival in patients with advanced cancer receiving HPN.

Acknowledgments and notes

This study did not receive any funding. The authors would like to acknowledge the assistance of the following individuals during this research: Alastair Forbes, Shola Ajibodu, Simon O'Callaghan, Mark Samaan, Dariush Sadigh, Ivana Barnova, Sarah Obbard, Krista Murray, Lisa Smith, Michelle Babington, Emma Paulon, Klaartje (Bel) Kok. The authors also acknowledge the constructive feedback received from the reviewers which improved greatly the present paper. Financial Disclosure: The authors have no financial disclosure or conflict of interest to declare.

Statement

This manuscript has not been published elsewhere and has not been submitted simultaneously for publication elsewhere.