Home parenteral support in patients with incurable cancer. Patient characteristics of importance for catheter related complications and overall survival

Sine Roelsgaard Obling, Benedicte Vibjerg Wilson, Jens Kjeldsen

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

Purpose: It is uncertain if home parenteral support (HPS) is of advantage in patients with incurable cancer and intestinal failure, functional obstruction or severe malabsorption. From a single centre cohort we present characteristics of patients with incurable cancer treated with HPS. Methods: Over a ten year period (2005–2015) data were retrospectively collected on patients with incurable cancer discharged on HPS from a Danish tertiary referral centre. Data on socio-demographics, catheters and parenteral nutrition, catheter related complications, re-admissions and mortality were analysed. The inflammation based score; modified Glasgow prognostic score (mGPS) was investigated as a prognostic score by Cox proportional hazard regression analyses adjusted for sex, age, diagnosis, and pathophysiological conditions. Results: Eighty patients with incurable cancer, aged 25.1–83.6 (median 63.8) were identified. Patients with gynaecologic cancer accounted for 25% of the cohort, thus women predominated. Short bowel syndrome was more prevalent in the patients with gynaecologic or lower gastrointestinal cancer compared to the upper gastrointestinal cancer. Catheter related complications occurred in a minority of patients (31%); most frequent was catheter related bloodstream infection (CRBSI). CRBSI rate was overall 0.97 pr 1000 catheter days, depending on diagnosis. Eleven percent had several infections, and 75% did not have any. Patients self-administering the catheter were younger, less frail and had fewer CRBSI events. Re-admissions were prevalent, and only one fifth of the patients had no re-admissions after initiation of HPS. Patients with mGPS 0 or 1 survived significantly longer, median 372 (CI 39–2006) days versus patients scoring 2 in mGPS, median 43 (CI 6–578) (p < 0.01). In patients with mGPS 0 or 1 survival at six months was 75% and in patients with mGPS 2, 20%. In multivariate cox regression analyses mGPS 2 was a significant predictor of mortality (HR 4.66, 95% CI 2.65–8.20, p < 0.01). Conclusions: It is feasible to offer HPS to patients with incurable cancer. Frequency of catheter related infections is acceptable but most patients will be re-readmitted after initiation of HPS. Predictors of survival in patients with incurable cancer on HPS may include mGPS. However, our study does not give a clear answer; when to prescribe HPS and who might possible benefit from the treatment in patients with incurable cancer.

Original languageEnglish
Article number88-95
JournalClinical Nutrition ESPEN
Volume28
Pages (from-to)88-95
ISSN2405-4577
DOIs
Publication statusPublished - 1. Dec 2018

Fingerprint

Catheters
Neoplasms
Gastrointestinal Neoplasms
Regression Analysis
Intestinal Neoplasms
Short Bowel Syndrome
Tertiary Care Centers

Keywords

  • CRBSI
  • Cancer
  • Catheter related bloodstream infections
  • Home parenteral support
  • Overall survival
  • Parenteral nutrition
  • mGPS
  • Demography
  • Prognosis
  • Humans
  • Middle Aged
  • Male
  • Socioeconomic Factors
  • Aged, 80 and over
  • Adult
  • Female
  • Retrospective Studies
  • Neoplasms/diet therapy
  • Tertiary Care Centers
  • Catheter-Related Infections/mortality
  • Proportional Hazards Models
  • Glasgow Outcome Scale
  • Parenteral Nutrition, Home
  • Survival Analysis
  • Denmark
  • Aged
  • Cohort Studies

Cite this

@article{b34bc798fb6c4ee0ab9dd53a3e220723,
title = "Home parenteral support in patients with incurable cancer. Patient characteristics of importance for catheter related complications and overall survival",
abstract = "Purpose: It is uncertain if home parenteral support (HPS) is of advantage in patients with incurable cancer and intestinal failure, functional obstruction or severe malabsorption. From a single centre cohort we present characteristics of patients with incurable cancer treated with HPS. Methods: Over a ten year period (2005–2015) data were retrospectively collected on patients with incurable cancer discharged on HPS from a Danish tertiary referral centre. Data on socio-demographics, catheters and parenteral nutrition, catheter related complications, re-admissions and mortality were analysed. The inflammation based score; modified Glasgow prognostic score (mGPS) was investigated as a prognostic score by Cox proportional hazard regression analyses adjusted for sex, age, diagnosis, and pathophysiological conditions. Results: Eighty patients with incurable cancer, aged 25.1–83.6 (median 63.8) were identified. Patients with gynaecologic cancer accounted for 25{\%} of the cohort, thus women predominated. Short bowel syndrome was more prevalent in the patients with gynaecologic or lower gastrointestinal cancer compared to the upper gastrointestinal cancer. Catheter related complications occurred in a minority of patients (31{\%}); most frequent was catheter related bloodstream infection (CRBSI). CRBSI rate was overall 0.97 pr 1000 catheter days, depending on diagnosis. Eleven percent had several infections, and 75{\%} did not have any. Patients self-administering the catheter were younger, less frail and had fewer CRBSI events. Re-admissions were prevalent, and only one fifth of the patients had no re-admissions after initiation of HPS. Patients with mGPS 0 or 1 survived significantly longer, median 372 (CI 39–2006) days versus patients scoring 2 in mGPS, median 43 (CI 6–578) (p < 0.01). In patients with mGPS 0 or 1 survival at six months was 75{\%} and in patients with mGPS 2, 20{\%}. In multivariate cox regression analyses mGPS 2 was a significant predictor of mortality (HR 4.66, 95{\%} CI 2.65–8.20, p < 0.01). Conclusions: It is feasible to offer HPS to patients with incurable cancer. Frequency of catheter related infections is acceptable but most patients will be re-readmitted after initiation of HPS. Predictors of survival in patients with incurable cancer on HPS may include mGPS. However, our study does not give a clear answer; when to prescribe HPS and who might possible benefit from the treatment in patients with incurable cancer.",
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author = "Obling, {Sine Roelsgaard} and Wilson, {Benedicte Vibjerg} and Jens Kjeldsen",
year = "2018",
month = "12",
day = "1",
doi = "10.1016/j.clnesp.2018.09.073",
language = "English",
volume = "28",
pages = "88--95",
journal = "Clinical Nutrition ESPEN",
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}

Home parenteral support in patients with incurable cancer. Patient characteristics of importance for catheter related complications and overall survival. / Obling, Sine Roelsgaard ; Wilson, Benedicte Vibjerg; Kjeldsen, Jens.

In: Clinical Nutrition ESPEN, Vol. 28, 88-95, 01.12.2018, p. 88-95.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Home parenteral support in patients with incurable cancer. Patient characteristics of importance for catheter related complications and overall survival

AU - Obling, Sine Roelsgaard

AU - Wilson, Benedicte Vibjerg

AU - Kjeldsen, Jens

PY - 2018/12/1

Y1 - 2018/12/1

N2 - Purpose: It is uncertain if home parenteral support (HPS) is of advantage in patients with incurable cancer and intestinal failure, functional obstruction or severe malabsorption. From a single centre cohort we present characteristics of patients with incurable cancer treated with HPS. Methods: Over a ten year period (2005–2015) data were retrospectively collected on patients with incurable cancer discharged on HPS from a Danish tertiary referral centre. Data on socio-demographics, catheters and parenteral nutrition, catheter related complications, re-admissions and mortality were analysed. The inflammation based score; modified Glasgow prognostic score (mGPS) was investigated as a prognostic score by Cox proportional hazard regression analyses adjusted for sex, age, diagnosis, and pathophysiological conditions. Results: Eighty patients with incurable cancer, aged 25.1–83.6 (median 63.8) were identified. Patients with gynaecologic cancer accounted for 25% of the cohort, thus women predominated. Short bowel syndrome was more prevalent in the patients with gynaecologic or lower gastrointestinal cancer compared to the upper gastrointestinal cancer. Catheter related complications occurred in a minority of patients (31%); most frequent was catheter related bloodstream infection (CRBSI). CRBSI rate was overall 0.97 pr 1000 catheter days, depending on diagnosis. Eleven percent had several infections, and 75% did not have any. Patients self-administering the catheter were younger, less frail and had fewer CRBSI events. Re-admissions were prevalent, and only one fifth of the patients had no re-admissions after initiation of HPS. Patients with mGPS 0 or 1 survived significantly longer, median 372 (CI 39–2006) days versus patients scoring 2 in mGPS, median 43 (CI 6–578) (p < 0.01). In patients with mGPS 0 or 1 survival at six months was 75% and in patients with mGPS 2, 20%. In multivariate cox regression analyses mGPS 2 was a significant predictor of mortality (HR 4.66, 95% CI 2.65–8.20, p < 0.01). Conclusions: It is feasible to offer HPS to patients with incurable cancer. Frequency of catheter related infections is acceptable but most patients will be re-readmitted after initiation of HPS. Predictors of survival in patients with incurable cancer on HPS may include mGPS. However, our study does not give a clear answer; when to prescribe HPS and who might possible benefit from the treatment in patients with incurable cancer.

AB - Purpose: It is uncertain if home parenteral support (HPS) is of advantage in patients with incurable cancer and intestinal failure, functional obstruction or severe malabsorption. From a single centre cohort we present characteristics of patients with incurable cancer treated with HPS. Methods: Over a ten year period (2005–2015) data were retrospectively collected on patients with incurable cancer discharged on HPS from a Danish tertiary referral centre. Data on socio-demographics, catheters and parenteral nutrition, catheter related complications, re-admissions and mortality were analysed. The inflammation based score; modified Glasgow prognostic score (mGPS) was investigated as a prognostic score by Cox proportional hazard regression analyses adjusted for sex, age, diagnosis, and pathophysiological conditions. Results: Eighty patients with incurable cancer, aged 25.1–83.6 (median 63.8) were identified. Patients with gynaecologic cancer accounted for 25% of the cohort, thus women predominated. Short bowel syndrome was more prevalent in the patients with gynaecologic or lower gastrointestinal cancer compared to the upper gastrointestinal cancer. Catheter related complications occurred in a minority of patients (31%); most frequent was catheter related bloodstream infection (CRBSI). CRBSI rate was overall 0.97 pr 1000 catheter days, depending on diagnosis. Eleven percent had several infections, and 75% did not have any. Patients self-administering the catheter were younger, less frail and had fewer CRBSI events. Re-admissions were prevalent, and only one fifth of the patients had no re-admissions after initiation of HPS. Patients with mGPS 0 or 1 survived significantly longer, median 372 (CI 39–2006) days versus patients scoring 2 in mGPS, median 43 (CI 6–578) (p < 0.01). In patients with mGPS 0 or 1 survival at six months was 75% and in patients with mGPS 2, 20%. In multivariate cox regression analyses mGPS 2 was a significant predictor of mortality (HR 4.66, 95% CI 2.65–8.20, p < 0.01). Conclusions: It is feasible to offer HPS to patients with incurable cancer. Frequency of catheter related infections is acceptable but most patients will be re-readmitted after initiation of HPS. Predictors of survival in patients with incurable cancer on HPS may include mGPS. However, our study does not give a clear answer; when to prescribe HPS and who might possible benefit from the treatment in patients with incurable cancer.

KW - CRBSI

KW - Cancer

KW - Catheter related bloodstream infections

KW - Home parenteral support

KW - Overall survival

KW - Parenteral nutrition

KW - mGPS

KW - Demography

KW - Prognosis

KW - Humans

KW - Middle Aged

KW - Male

KW - Socioeconomic Factors

KW - Aged, 80 and over

KW - Adult

KW - Female

KW - Retrospective Studies

KW - Neoplasms/diet therapy

KW - Tertiary Care Centers

KW - Catheter-Related Infections/mortality

KW - Proportional Hazards Models

KW - Glasgow Outcome Scale

KW - Parenteral Nutrition, Home

KW - Survival Analysis

KW - Denmark

KW - Aged

KW - Cohort Studies

U2 - 10.1016/j.clnesp.2018.09.073

DO - 10.1016/j.clnesp.2018.09.073

M3 - Journal article

VL - 28

SP - 88

EP - 95

JO - Clinical Nutrition ESPEN

JF - Clinical Nutrition ESPEN

SN - 2405-4577

M1 - 88-95

ER -