Total parenteral nutrition in cancer patients

To report on how the parenteral nutrition of patients with advanced cancer has evolved and on the current status of research and clinical practice in this field.

Clinical research has shown that parenteral nutrition may play a role in incurable cancer if patients are expected to die earlier from starvation than from tumour progression. A benefit was recently observed in hypophagic patients requiring supplemental on-demand home parenteral nutrition. There is some doubt that parenteral nutrition plays a palliative role, and data on quality of life are limited. The regimen of parenteral nutrition should be tailored to the needs of the patient, and recent data indicate a reduction in total energy expenditure and water requirements. There is interest in new lipid emulsions enriched with N-3 polyunsaturated fatty acids, which are well utilized by tumour-bearing individuals and may reduce the catabolic drive of cachectic patients.

Future research is addressed at identifying parameters to help in the selection of aphagic/obstructed patients who may benefit from home parenteral nutrition, the early use of supplemental parenteral nutrition in hypophagic patients and developing a better nutritional formulation of lipid emulsions more appropriate for use in advanced cancer patients.