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Comparative clinical outcomes of home parenteral nutrition in adults with gastrointestinal or gynecologic cancers versus non-cancer patients: a prospective cohort study using propensity score matching from the Canadian HPN registry

European Journal of Clinical Nutrition volume 79, pages 1036–1045 (2025) Cite this article

Subjects

Abstract

Background

Home parenteral nutrition (HPN) is indicated for patients with intestinal failure, but its use in cancer patients requires careful consideration due to the unique challenges and complexities involved.

Methods

This prospective cohort study analyzed data from cancer patients receiving HPN, recorded in the Canadian HPN Registry from 2003 to 2022. Patients were divided into two groups: those with gastrointestinal or gynecologic cancer and a propensity score-matched cohort of non-cancer patients. The objective was to assess survival rates by performance status and prescription decade in both groups. Secondary objectives were to compare complications between the groups.

Results

A total of 400 HPN patients were enrolled: 200 cancer patients (128 gastrointestinal, 72 gynecologic) and 200 matched non-cancer patients. Median age (interquartile range) was 58 (16) years for cancer and 56 (19) for non-cancer groups, with 71.5% and 66.5% female, respectively. Median survival was 1.71 years (95% confidence interval (CI), 0.81–2.61) for gastrointestinal cancer, 0.99 years (95% CI, 0.36–1.6) for gynecologic cancer, and 3.89 years (95% CI, 2.72–5.06) for non-cancer patients (p-value < 0.001). Survival showed no improvement over two decades. Patients with Karnofsky Performance Scale (KPS) ≤ 50 had shorter survival. Catheter complications and HPN-related hospitalizations were similar, but HPN-related liver disease was more common in non-cancer patients (16.5% vs. 9%, p-value = 0.025).

Conclusion

Survival for patients with gastrointestinal and gynecologic cancer and co-existing intestinal failure has not improved over the past two decades, with poorer outcomes observed in those with low KPS. Complication rates were similar in both groups.

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Data availability

Data described in the manuscript, code book, and analytic code will be made available upon request pending application and approval. Supplementary files are available online.

References

  1. Pironi L, Boeykens K, Bozzetti F, Joly F, Klek S, Lal S, et al. ESPEN guideline on home parenteral nutrition. Clin Nutr. 2020;39:1645–66. https://doi.org/10.1016/j.clnu.2020.03.005.

    Article  PubMed  Google Scholar 

  2. Pironi L, Boeykens K, Bozzetti F, Joly F, Klek S, Lal S, et al. ESPEN practical guideline: Home parenteral nutrition. Clin Nutr. 2023;42:411–30. https://doi.org/10.1016/j.clnu.2022.12.003.

    Article  PubMed  Google Scholar 

  3. O’Hanlon FJ, Fragkos KC, Fini L, Patel PS, Mehta SJ, Rahman F, et al. Home parenteral nutrition in patients with advanced cancer: a systematic review and meta-analysis. Nutr Cancer. 2021;73:943–55. https://doi.org/10.1080/01635581.2020.1784441.

    Article  CAS  PubMed  Google Scholar 

  4. Silva FR, de Oliveira MG, Souza AS, Figueroa JN, Santos CS. Factors associated with malnutrition in hospitalized cancer patients: a croos-sectional study. Nutr J. 2015;14:123. https://doi.org/10.1186/s12937-015-0113-1.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Mariean CR, Tiucă OM, Mariean A, Cotoi OS. Cancer cachexia: new insights and future directions. Cancers 2023;15. e-pub ahead of print 20231126; https://doi.org/10.3390/cancers15235590

  6. Altun G, Akansu B, Ugur Altun B, Azmak D, Yilmaz A. Deaths due to hunger strike: post-mortem findings. Forensic Sci Int. 2004;146:35–38. https://doi.org/10.1016/j.forsciint.2004.03.022.

    Article  PubMed  Google Scholar 

  7. Naghibi M, Smith TR, Elia M. A systematic review with meta-analysis of survival, quality of life and cost-effectiveness of home parenteral nutrition in patients with inoperable malignant bowel obstruction. Clin Nutr. 2015;34:825–37. https://doi.org/10.1016/j.clnu.2014.09.010.

    Article  CAS  PubMed  Google Scholar 

  8. Vashi PG, Dahlk S, Popiel B, Lammersfeld CA, Ireton-Jones C, Gupta D. A longitudinal study investigating quality of life and nutritional outcomes in advanced cancer patients receiving home parenteral nutrition. BMC Cancer. 2014;14:593. https://doi.org/10.1186/1471-2407-14-593.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Bouleuc C, Anota A, Cornet C, Grodard G, Thiery-Vuillemin A, Dubroeucq O, et al. Impact on health-related quality of life of parenteral nutrition for patients with advanced cancer cachexia: results from a randomized controlled trial. Oncologist. 2020;25:e843–e851. https://doi.org/10.1634/theoncologist.2019-0856.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Fearon KC. The 2011 ESPEN Arvid Wretlind lecture: cancer cachexia: the potential impact of translational research on patient-focused outcomes. Clin Nutr. 2012;31:577–82. https://doi.org/10.1016/j.clnu.2012.06.012.

    Article  CAS  PubMed  Google Scholar 

  11. Bozzetti F, Mori V. Nutritional support and tumour growth in humans: a narrative review of the literature. Clin Nutr. 2009;28:226–30. https://doi.org/10.1016/j.clnu.2009.02.006.

    Article  CAS  PubMed  Google Scholar 

  12. Deshayes E, de Forges H, Fraisse J, Eberlé M-C, Guillemard S, Fallières A, et al. Artificial nutrition in patients with cancer has no impact on tumour glucose metabolism: Results of the PETANC study. Clin Nutr. 2019;38:2121–6. https://doi.org/10.1016/j.clnu.2018.08.033.

    Article  CAS  PubMed  Google Scholar 

  13. Crosby D, Bhatia S, Brindle KM, Coussens LM, Dive C, Emberton M, et al. Early detection of cancer. Science. 2022;375:eaay9040. https://doi.org/10.1126/science.aay9040.

    Article  CAS  PubMed  Google Scholar 

  14. Hortencio TDR, Arendt BM, Teterina A, Jeejeebhoy KN, Gramlich LM, Whittaker JS, et al. Changes in home parenteral nutrition practice based on the canadian home parenteral nutrition patient registry. JPEN J Parenter Enter Nutr. 2017;41:830–6. https://doi.org/10.1177/0148607115609289.

    Article  Google Scholar 

  15. Dreesen M, Foulon V, Spriet I, Goossens GA, Hiele M, De Pourcq L, et al. Epidemiology of catheter-related infections in adult patients receiving home parenteral nutrition: a systematic review. Clin Nutr. 2013;32:16–26. https://doi.org/10.1016/j.clnu.2012.08.004.

    Article  PubMed  Google Scholar 

  16. Kopczynska M, Teubner A, Taylor M, Abraham A, Bond A, Clamp A, et al. Home parenteral nutrition in patients with advanced cancer. Clin Nutr ESPEN. 2023;54:590. https://doi.org/10.1016/j.clnesp.2022.09.385.

    Article  Google Scholar 

  17. Vashi PG, Virginkar N, Popiel B, Edwin P, Gupta D. Incidence of and factors associated with catheter-related bloodstream infection in patients with advanced solid tumors on home parenteral nutrition managed using a standardized catheter care protocol. BMC Infect Dis. 2017;17:372. https://doi.org/10.1186/s12879-017-2469-7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Cotogni P, Pittiruti M, Barbero C, Monge T, Palmo A, Boggio Bertinet D. Catheter-related complications in cancer patients on home parenteral nutrition: a prospective study of over 51,000 catheter days. JPEN J Parenter Enter Nutr. 2013;37:375–83. https://doi.org/10.1177/0148607112460552.

    Article  Google Scholar 

  19. Clement D, Brown SE, Naghibi M, Cooper SC, Tesselaar MET, van Leerdam ME et al. Feasibility of home parenteral nutrition in patients with intestinal failure due to neuroendocrine tumours: a systematic review. Nutrients 2023;15. e-pub ahead of print 20230830; https://doi.org/10.3390/nu15173787.

  20. Tran V, Bielawska B, Jeejeebhoy KN, Gramlich LM, Raman M, Whittaker JS, et al. Variations in practice patterns for adult cancer patients on home parenteral nutrition in Canada. Nutrition. 2019;65:27–32. https://doi.org/10.1016/j.nut.2019.01.021.

    Article  PubMed  Google Scholar 

  21. Scolapio JS, Fleming CR, Kelly DG, Wick DM, Zinsmeister AR. Survival of home parenteral nutrition-treated patients: 20 years of experience at the Mayo Clinic. Mayo Clin Proc. 1999;74:217–22. https://doi.org/10.4065/74.3.217.

    Article  CAS  PubMed  Google Scholar 

  22. Freedman LS. Tables of the number of patients required in clinical trials using the logrank test. Stat Med. 1982;1:121–9. https://doi.org/10.1002/sim.4780010204.

    Article  CAS  PubMed  Google Scholar 

  23. IBM Corp IBM SPSS Statistics for Windows. Armonk, NY: IBM Corp; 2023. Version 29.0.2.0.

    Google Scholar 

  24. Bossi P, De Luca R, Ciani O, D’Angelo E, Caccialanza R. Malnutrition management in oncology: An expert view on controversial issues and future perspectives. Front Oncol. 2022;12:910770. https://doi.org/10.3389/fonc.2022.910770.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Aoyagi T, Terracina KP, Raza A, Matsubara H, Takabe K. Cancer cachexia, mechanism and treatment. World J Gastrointest Oncol. 2015;7:17–29. https://doi.org/10.4251/wjgo.v7.i4.17.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Bosaeus I. Nutritional support in multimodal therapy for cancer cachexia. Support Care Cancer. 2008;16:447–51. https://doi.org/10.1007/s00520-007-0388-7.

    Article  PubMed  Google Scholar 

  27. Fletcher J, Woodham D, Dera M, Cooper SC. Home parenteral nutrition in patients receiving palliative care: a curriculum-based review. Frontline Gastroenterol. 2019;10:421–6. https://doi.org/10.1136/flgastro-2018-101113.

    Article  PubMed  Google Scholar 

  28. Wright JD, Chen L, Tergas AI, Patankar S, Burke WM, Hou JY, et al. Trends in relative survival for ovarian cancer from 1975 to 2011. Obstet Gynecol. 2015;125:1345–52. https://doi.org/10.1097/aog.0000000000000854.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Maharjan U, Kauppila JH. Survival trends in gastric cancer patients between 1987 and 2016: a population-based cohort study in Finland. Gastric Cancer. 2022;25:989–1001. https://doi.org/10.1007/s10120-022-01326-5.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Cotogni P, Stragliotto S, Ossola M, Collo A, Riso S, On behalf of the Intersociety Italian Working Group for Nutritional Support in Cancer. The role of nutritional support for cancer patients in palliative care. Nutrients 2021;13. e-pub ahead of print 20210122; https://doi.org/10.3390/nu13020306.

  31. Theilla M, Cohen J, Kagan I, Attal-Singer J, Lev S, Singer P. Home parenteral nutrition for advanced cancer patients: contributes to survival?. Nutrition. 2018;54:197–200. https://doi.org/10.1016/j.nut.2017.03.005.

    Article  PubMed  Google Scholar 

  32. Cotogni P, Monge T, Passera R, Brossa L, De Francesco A. Clinical characteristics and predictive factors of survival of 761 cancer patients on home parenteral nutrition: a prospective, cohort study. Cancer Med. 2020;9:4686–98. https://doi.org/10.1002/cam4.3064.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Kopczynska M, Teubner A, Abraham A, Taylor M, Bond A, Clamp A et al. Home parenteral nutrition in patients with advanced cancer: quality outcomes from a centralized model of care delivery. Nutrients 2022;14. e-pub ahead of print 20220817; https://doi.org/10.3390/nu14163379.

  34. Bond A, Chadwick P, Smith TR, Nightingale JMD, Lal S. Diagnosis and management of catheter-related bloodstream infections in patients on home parenteral nutrition. Frontline Gastroenterol. 2020;11:48–54. https://doi.org/10.1136/flgastro-2018-101094.

    Article  PubMed  Google Scholar 

  35. Lafuente Cabrero E, Terradas Robledo R, Civit Cuñado A, García Sardelli D, Hidalgo López C, Giro Formatger D, et al. Risk factors of catheter-associated bloodstream infection: Systematic review and meta-analysis. PLoS One. 2023;18:e0282290 https://doi.org/10.1371/journal.pone.0282290.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Hon K, Bihari S, Holt A, Bersten A, Kulkarni H. Rate of catheter-related bloodstream infections between tunneled central venous catheters versus peripherally inserted central catheters in adult home parenteral nutrition: a meta-analysis. JPEN J Parenter Enter Nutr. 2019;43:41–53. https://doi.org/10.1002/jpen.1421.

    Article  Google Scholar 

  37. Daoud DC, Cartagena EMS, Schwenger KJP, Somlaw N, Gramlich L, Whittaker S, et al. Home parenteral nutrition in older vs younger patients: clinical characteristics and outcomes. JPEN J Parenter Enter Nutr. 2022;46:348–56. https://doi.org/10.1002/jpen.2117.

    Article  Google Scholar 

  38. O’Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, et al. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis. 2011;52:e162–193. https://doi.org/10.1093/cid/cir257.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Kelly DA. Intestinal failure–associated liver disease: What do we know today?. Gastroenterology. 2006;130:S70–S77. https://doi.org/10.1053/j.gastro.2005.10.066.

    Article  CAS  PubMed  Google Scholar 

  40. Nowak K. Parenteral nutrition-associated liver disease. Clin Liver Dis. 2020;15:59–62. https://doi.org/10.1002/cld.888.

    Article  Google Scholar 

  41. Zametkin E, Guyer D, Tarshish Y, Bash K, Almhanna K. Total parenteral nutrition for patients with gastrointestinal cancers: a clinical practice review. Ann Palliat Med. 2023;12:1072–80.

    Article  PubMed  Google Scholar 

  42. Klek S, Szczepanek K, Scislo L, Walewska E, Pietka M, Pisarska M, et al. Intravenous lipid emulsions and liver function in adult chronic intestinal failure patients: results after 5 y of home parenteral nutrition. Nutrition. 2021;82:111029. https://doi.org/10.1016/j.nut.2020.111029.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

Participating programs of the Canadian Home Parenteral Nutrition Registry: 1. Toronto General Hospital, University of Toronto, Toronto, ON, Canada, PI: Johane P. Allard,MD; Celeste Arca, RN; Patricia Kim, PharmD; Ann MacGillvray, RD; Katherine Schwenger RD, MAN, PhD. 2. Northern Alberta Health Services, University of Alberta, Edmonton, AB, Canada, PI: Leah Gramlich, MD; Jennifer Jin, MD; Adela Delgado, RD, Nicole Anderson RN, Kimberly Johnston RN, Bianca Spark RN, Loretta Vogt RN. 3. University of British Columbia, Vancouver, BC, Canada, PI: Dr Scott Whittaker, MD; Andree Richardson, RD; Greg Rosenfeld, MD; Hin Ko, MD; Nicole Beauregard, RD; Jennifer Lazuna, RN. 4. Division of Gastroenterology and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada, PI: David Armstrong, MD; Carol Lynn Godin, RN; Anne Childs, RN; Michelle Dawson, RN; Suzanne Hansen, RD. 5. St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada: Brian Jurewitsch, PharmD; Camille Sagun, RN; Tracey Pignatiello, RN. 6. Hotel-Dieu de Quebec, Quebec, QC, Canada, PI: Anabelle Cloutier, MD. 7. Southern Alberta Health Services, Calgary, AB, Canada, Maitreyi Raman, MD; Cathy Berry, RN; Kelly Cochran, RD; Melanie Stapleton, MD;Sari Czink, RD. 8. University of Manitoba, Winnipeg, MB, Canada, PI: Donald Duerksen, MD. 9. Regina Saskatchewan Health Authority, Regina, SK, Canada, PI: J.D McHattie, MD; Danielle Stevenson, RN. 10. The Ottawa Hospital, Ottawa, Ontario, Canada (PI: Barbara Bielawska, MD; Jennifer Okhrimtchouk, RD; Rita Johnston, RN). 11. Centre Hospitalier de l’Université de Montréal, Montreal, Quebec,Canada (PI : Dane Christina Daoud, MD; Esther Lalonde : RD; Alejandro Contreras : RN). 12. McGill University Health Center, Montreal, Quebec, Canada (PI: Yidan Lu, MD).

Financial disclosures

Ontario Medical Supply is a pharmaceutical company providing unrestricted funding for the maintenance of the HPN registry. It is not a study sponsor and had no influence on study design.

Author information

Authors and Affiliations

  1. Division of Nutrition, Department of Medicine, Khon Kaen Hospital, Khon Kaen, Thailand

    Chanita Unhapipatpong

  2. Division of Gastroenterology, Department of Medicine, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada; Toronto General Hospital, University Health Networko, Toronto, ON, Canada

    Chanita Unhapipatpong, Katherine J. P. Schwenger & Johane P. Allard

  3. Division of Gastroenterology & Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada

    David Armstrong

  4. Department of Medicine, University of Ottawa, Ottawa, ON, Canada

    Barbara Bielawska

  5. St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada

    Brian Jurewitsch

  6. Regina Saskatchewan Health Authority, Regina, SK, Canada

    J. D. McHattie

  7. Department of Medicine, University of Manitoba, Winnipeg, MB, Canada

    Donald R. Duerksen

  8. McGill University Health Center, Montreal, QC, Canada

    Yidan Lu

  9. Department of Medicine, Division of Gastroenterology, Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC, Canada

    Dane Christina Daoud

  10. Hotel-Dieu de Quebec, Quebec, QC, Canada

    Anabelle Cloutier

  11. Division of Gastroenterology and Hepatology, University of Calgary, Alberta, Canada, AB

    Matreyi Raman

  12. Department of Medicine, University of Alberta, Edmonton, AB, Canada

    Leah Gramlich

  13. Department of Medicine, University of British Columbia, Vancouver, BC, Canada

    George Ou

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  1. Chanita Unhapipatpong
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Contributions

CU, KJPS, DA, BB, BJ, JM, DRD, YL, DCD, AC, MR, LG, GO, and JA contributed to the study conception and design. Material preparation, data collection, and analysis were performed by CU, KJPS, and JA. The first draft of the manuscript was written by CU and KJPS, and DA, BB, BJ, JM, DRD, YL, DCD, AC, MR, LG, GO, and JA commented on previous versions of the manuscript. CU, KJPS, DA, BB, BJ, JM, DRD, YL, DCD, AC, MR, LG, GO, and JA read and approved the final manuscript.

Corresponding author

Correspondence to Johane P. Allard.

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Each program obtained approval from its Research Ethics Board, and all patients provided written informed consent.

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Unhapipatpong, C., Schwenger, K.J.P., Armstrong, D. et al. Comparative clinical outcomes of home parenteral nutrition in adults with gastrointestinal or gynecologic cancers versus non-cancer patients: a prospective cohort study using propensity score matching from the Canadian HPN registry. Eur J Clin Nutr 79, 1036–1045 (2025). https://doi.org/10.1038/s41430-025-01640-y

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