Difficulty with maintaining nutritional intake is common in patients with cancer. European guidance suggests that wherever possible nutritional support should first be provided by the oral or enteral route. Where this is not possible, for example, in malignant small bowel obstruction, parenteral nutrition (PN) may be considered. In palliative care, it is generally accepted that the significant risks and burdens of PN outweigh the potential benefits in patients with an expected survival <2 months. Determining prognosis is crucial when helping patients to make decisions regarding appropriate care pathways; however, this remains challenging. An overview of clinical issues and prognostic indicators related to selecting patients appropriately for palliative PN is given to cover the relevant advanced competencies of the 2010 Gastroenterology Curriculum. The organisation of Home Parenteral Nutrition (HPN) services in England is described including the associated risks and burdens of HPN in the palliative patient.
- clinical decision making
- gastric cancer
- parenteral nutrition
- quality of life
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Contributors JF made substantial contributions to the article in the conception and design of the content, drafting the article and revising it critically for important intellectual content. DW, MD and SCC made substantial contributions in the conception and design of the article content. All authors have reviewed and approved the final version of the article to be submitted.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests JF: participated in a BD Medical Expert Advisory Board and received an honorarium. DW: received educational sponsorship from Calea/Fresenius-Kabi. MD: none declared. SCC: received honoraria and participated in advisory boards for Eli Lilly, honoraria from Baxter and educational sponsorship from Shire and Calea/Fresenius-Kabi.
Provenance and peer review Not commissioned; externally peer reviewed.
Patient consent for publication Not required.