Availability of palliative parenteral nutrition to patients with advanced cancer: A national survey of service provision

• Published in: Journal of human nutrition and dietetics 2023-08, Vol.36 (4), p.1225-1233
• Main Authors: Baker, James, Smith, Philip J., White, Simon J., Gifford, Alison J.
• Format: Article
• Language: English
• Subjects: Advance directives; advanced cancer; advanced malignancy; Cancer; Clinical medicine; Decision making; Humans; Interest groups; Intestinal Obstruction; Intestine; Malignancy; Neoplasms - complications; Neoplasms - therapy; Nutrition; nutrition support; Nutritional requirements; Ostomy; Palliation; palliative; Parenteral nutrition; Parenteral Nutrition, Home; Patients; Polls & surveys; Prognosis; State Medicine; Surveys
• ISSN: 0952-3871; 1365-277X
• DOI: 10.1111/jhn.13174

Background Patients with advanced malignancy who are unable to meet their nutritional requirements orally or enterally as a result of intestinal failure may be considered for parenteral nutrition support. Current UK guidance recommends that patients with a 3‐month prognosis and good performance status (i.e., Karnofsky performance status >50) should be considered for this intervention at home (termed Home Parenteral Nutrition; HPN). However, HPN is a nationally commissioned service by National Health Service (NHS) England and Improvement that can only be initiated at specific NHS centres and so may not be easily accessed by patients outside of these centres. This survey aimed to identify current clinical practice across UK hospitals about how palliative parenteral nutrition is initiated. Methods Clinical staff associated with Nutrition Support Teams at NHS Organisations within the UK were invited to complete an electronically administered survey of national clinical practice through advertisements posted on relevant professional interest groups. Results Sixty clinicians responded to the survey administered between September and November 2020. The majority of respondents responded positively that decisions made to initiate palliative parenteral nutrition were conducted in alignment with current national guidance in relation to decision‐making and formulation of parenteral nutrition. Variation was observed in relation to the provision of advance care planning in relation to nutrition support prior to discharge, as well as the consideration of venting gastrostomy placement in patients with malignant bowel obstruction unsuitable for surgical intervention. Conclusions Adherence to current national guidance in relation to the provision of palliative parenteral nutrition is variable for some aspects of care. Further work is required particularly in relation to maximising the opportunity for the provision of advance care planning prior to discharge in this patient cohort. Key points The provision of home parenteral nutrition to patients diagnosed with intestinal failure secondary to advanced cancer is recommended for patients with ≥3 months prognosis and good performance status. Home parenteral nutrition in the UK requires the patient to be registered for a home parenteral nutrition service that can only be performed by specialist centres. This survey of UK clinical practice identified that the provision of home parenteral nutrition to this cohort of patients is va