Aims
  • Discuss parenteral nutrition (PN) in intestinal 
   failure related to advanced abdominal cancer
  • Christie referral pathway for HPN
  • Review some of the practicalities involved for 
   patients receiving HPN
  • Not covering PN in cancer cachexia
                            Background
     • Home Parenteral Nutrition (HPN) in advanced malignancy is 
        becoming increasingly common
            2005 2006 2007 2008      2009  2010 2011    2012 2013 2014 2015
 Total      n=    n=    n=    n=     n=    n=    n=     n=    n=    n=    n= 
            112   101   138   157    148   228   262    351   472   400   420
 Malignancy 13    17    16    24     14    32    43     66    116   102   115
                             New adult HPN registrations, 2005 and 2015
     • Lack of consensus throughout the world, with the 
        proportion of HPN patients with cancer as the indication up 
        to 60% in some parts of Europe (Naghibi et al, 2014)
    BANS report on Adult Home Parenteral Nutrition & Home Intravenous Fluids, 2016
                            IFU SRFT - referrals
        Year                              Total referrals to IFU     Total referrals for remote D
        2009 – 10                                  147                               
        2010 – 11                                  121                               
        2011 – 12                                  126                               
        2012 – 13                                  152                             13
        2013 – 14                                  156                             7
        2014 - 15                                  146                             16
        15 - 16                                    171                             15
        16 - 17                                    180                             32
        17 - 18                                    195                             43
        18 - 19                                    198                             57
                Primary malignancy
                                         Gastro-intestinal n=16
                                         Gynaecology n=29
                                         other n=13
                                         pseudomyxoma n=5
        Others:
              - Lymphoma        -  Carcinoid
              - Mesothelioma    -  Urology
              - Pancreatic
         Background
  • Failure to maintain weight and nutrition is 
   common in patients with cancer
  • In those with a functioning and accessible GI 
   tract, use oral/enteral route of nutrition
  • In those with intestinal failure secondary to 
   advanced abdominal malignancy (e.g. 
   inoperable malignant bowel obstruction)  
   consider parenteral nutrition