To what extent can improvement of nutritional status through parenteral nutrition affect the results of oncological treatment?

Risks of malnutrition in cancer patients

Approximately half of cancer patients are malnourished.^{1, 2} Malnutrition can adversely affect the condition of the patient and the results of the treatment. Compared to well-nourished patients, malnutrition can reduce the response to systemic treatment, shorten survival, worsen quality of life, limit performance, increase the number of hospitalizations, risk of infection, postoperative complications, and occurrence of anxiety.¹⁻⁵

Recommended protein intake

The ESPEN recommendations for the nutrition of cancer patients highlight the need to maintain or increase muscle mass as one of the goals of nutritional therapy.⁵ Protein intake should be higher than 1 g/kg of body weight per day, and where possible, should reach up to 1.5 g/kg/day. A cancer patient weighing 80 kg should thus consume more than 80 g of protein daily.⁵

Home parenteral nutrition

Home parenteral nutrition can be used to improve the nutrition of cancer patients. This method demonstrably improves the effectiveness of chemotherapy by reducing the risk of toxicity⁶, alleviates fatigue and loss of appetite^{7, 8}, increases the quality of life⁷⁻¹⁰, prolongs survival⁶, and prevents the loss of lean tissue¹¹. For example, the parenteral nutrition preparation Olimel N12(E) combines a high protein content with a low glucose level and is available in standard three-chamber bags.¹² Significant improvements in the quality of life⁹ and prolonged survival⁶ have been observed with home administration of this parenteral nutrition.

Improvement in quality of life

A prospective multicenter study evaluating the impact of parenteral nutrition on the quality of life of patients with malignancies, as assessed by the patients themselves, their families, and physicians, included 767 patients. Their average age was 63 years, 50% had a primary GIT tumor, 65% had metastases, and 98% were malnourished. After 28 days of home parenteral nutrition, physical well-being improved significantly by 13%. Social, emotional, and functional well-being, respectively, also improved (well-being; p < 0.0001). According to self-assessment, the overall quality of life improved in 60% of patients.⁹

Prolongation of survival

A prospective cohort study examined the impact of 90-day home parenteral nutrition on anthropometric and clinical parameters in patients with advanced solid tumors undergoing systemic anticancer treatment. Nutritional status was assessed using the PG-SGA (Patient-Generated Subjective Global Assessment) scale, which combines qualitative and quantitative data to show a resulting nutrition score (categorized as: A = good nutrition, B = suspected or moderate malnutrition, C = severe malnutrition). Sixty-five patients who were evaluated as moderately or severely malnourished at the study's start were included. Their average age was 64 years, 58% had a primary GIT tumor, and 75% were stage IV. Home parenteral nutrition significantly improved the nutritional status. Nutritional status A was associated with a significant prolongation of overall survival compared to patients with severe malnutrition (hazard ratio [HR] 0.15; 95% confidence interval [CI] 0.06–0.37) and moderate malnutrition (HR 0.39; 95% CI 0.17–0.90). Significantly longer survival was also found in patients with moderate/suspected malnutrition compared to those with severe malnutrition (HR 0.41; 95% CI 0.20–0.72).⁶

Conclusion

Home parenteral nutrition helps meet the high protein needs of cancer patients. It can improve their quality of life and even prolong survival.

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Sources: 
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2. La Torre M., Ziparo V., Nigri G. et al. Malnutrition and pancreatic surgery: prevalence and outcomes. J Surg Oncol 2013; 107 (7): 702−708, doi: 10.1002/jso.23304.
3. Bozzetti F., Arends J., Lundholm K. et al.; ESPEN. ESPEN Guidelines on Parenteral Nutrition: non-surgical oncology. Clin Nutr 2009; 28 (4): 445−454, 10.1016/j.clnu.2009.04.011.
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10. Bozzetti F., Cozzaglio L., Biganzoli E. et al. Quality of life and length of survival in advanced cancer patients on home parenteral nutrition. Clin Nutr 2002; 21 (4): 281−288, doi: 10.1054/clnu.2002.0560.
11. Obling S. R., Wilson B. V., Pfeiffer P., Kjeldsen J. Home parenteral nutrition increases fat free mass in patients with incurable gastrointestinal cancer. Results of a randomized controlled trial. Clin Nutr 2019; 38 (1): 182−190, doi: 10.1016/j.clnu.2017.12.011.
12. SPC Olimel N12E. Available at: www.sukl.cz/modules/medication/download.php?file=SPC164457.pdf&type=spc&as=olimel-n12e-spc