Scientific publications
Home parenteral nutrition in patients with malignant bowel obstruction. Ethical considerations
José Manuel Moreno Villares 1 , María Nuria Virgili-Casas 2 , Rosana Ashbaugh Enguídanos 3 , Carmina Wanden-Berghe 4 , Ana Cantón Blanco 5 , Julia Álvarez Hernández 3 , Irene Bretón 6 , Dolores Del Olmo 7 , Isabel Ferrero López 8 , Francisca Margarita Lozano Fuster 9 , Juan B Molina Soria 10
Background: patients with cancer are one of the main group of patients on home parenteral nutrition (HPN). Patients with malignant bowel obstruction (MBO) represent a challenging group when considering HPN. At the Ethics Working Group of SENPE ethical considerations on this subject were reviewed and a guidelines proposal was made.
Methods: a literature search was done and a full set of questions arose: When, if ever, is HPN indicated for patients with MBO? How should the training program be? When withdrawal of HPN should be considered?
Results: HPN in MBO has better outcomes when patients have a good functional status (Karnofsky ≥ 50 or ECOG ≤ 2), expected survival > 2-3 months, and low inflammatory markers. Very few data have been reported on quality of life, but HPN allows a valuable time at home albeit with a considerable burden for both patients and their families.
Proposal: once a patient is considered for HPN, there is a need for a deep talk on the benefits, complications and risks. In this initial talk, when HNP should be stopped needs to be included. The palliative care team with the help of the nutrition support team should follow the patient, whose clinical status must be assessed regularly. HPN should be withdrawn when no additional benefits are achieved.
Conclusion: HPN may be considered an option in patients with MBO when they have a fair or good functional status and a desire to spend their last days at home.
CITATION Nutr Hosp. 2023 Dec 4. doi: 10.20960/nh.05042
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