Criteria to start home parenteral nutrition in advanced cancer

This review will present current practice and criteria for considering and commencing home parenteral nutrition (HPN) among people with advanced cancer.

Despite the use of HPN in advanced cancer historically being considered controversial, there has been an increase in the number of people with advanced cancer receiving HPN in recent years in many countries. Clinical guidelines are highlighted throughout this review which outline key factors that should be considered when commencing HPN. Decisions should align with the ethical concepts of medical decision-making. Quality of life is a key outcome measure for people with advanced cancer; several studies have indicated an improvement in quality of life on HPN.

International guidelines provide evidence-based recommendations around clinical parameters that should be considered when deciding about suitability for HPN, including performance status, prognosis and patient wishes. Patient-centred care is of the utmost importance, taking account of each patient's views and preferences, with an individualized approach. To provide coordinated care and facilitate timely discharge from hospital, all members of the multidisciplinary team must work together, ensuring effective communication.