Choice of access route for artificial nutrition in cancer patients: thirty years of activity in a home palliative care setting

Summary Background and aims Malnutrition negatively affects the quality of life, survival and clinical outcome of cancer patients. Home artificial nutrition (HAN) is an appropriate nutritional therapy to prevent death from cachexia and improve quality of life, and it can be integrated into a home palliative care programme. The choice to start home enteral nutrition (HEN) or home parenteral nutrition (HPN) is based on patient-specific indications and contraindications. This observational study aims to analyse the changes that occurred in the criteria for choosing the access route to artificial nutrition during thirty years of activity of a nutritional service team (NST) in a palliative home care setting, as well as to compare indications, clinical-nutritional outcomes and complications between HEN and HPN. Methods The following parameters were analysed and compared for HEN and HPN: tumour site and metastases; nutritional status (body mass index, weight loss in the past 6 months); basal energy expenditure (BEE) and oral food intake; Karnofsky performance status (KPS); access routes to HEN (feeding tubes) and HPN (central venous catheters); water and protein-calorie support; survival and complications of HAN. Results From 1990 to 2020, HAN was started in 1014 cancer patients (592 men, 422 women; age: 65.6 ± 12.7); HPN was started in 666 patients (66%); and HEN was started in 348 patients (34%). At the end of the study, 921 patients had died, 77 had suspended HAN for oral refeeding and 16 were in the progress of HAN. The oral caloric intake was Conclusions Over thirty years of NST activity, the choice of CVC as an access route to HAN increased progressively and significantly due to personalized patient decision-making choices. Nutritional efficacy was comparable between HEN and HPN. In patients who maintained food oral intake, SPN improved weight, performance status and survival better than other types of HAN.