Total parenteral nutrition in the cancer patient Review uri icon

Overview

MeSH Major

  • Neoplasms
  • Parenteral Nutrition
  • Parenteral Nutrition, Total

abstract

  • Total parenteral nutrition (TPN), although very expensive, is widely used as a life saving method of nutritional support for patients who are unable to ingest, digest, or absorb sufficient nutrient to prevent death from starvation. TPN allows total control of all exogeneous nutrients and it should be used to explore alternative therapies in oncological medicine. There is a challange for i.v. nutrition to reverse increased energy demand and restore the failure to adapt energy expenditure to available intake and to maintain the host without stimulating the tumour. TPN can evoke a positive nitrogen balance in association with weight gain. Total-body potassium level can be also improved. The formation of glucose from alanine - a process present in any form of starvation - can be almost suppressed by TPN. The more simple indexes of nutritional benefit, such as serum albumin, are poor indicators of nutritional response and they usually do not increase with TPN. An over-all improvement by TPN was observed in ca 50% of cancer patients. Human data are lacking on the effect of TPN on tumour growth. Experimental data indicate that short-term and incomplete i.v. dietary regimens, such as using amino acids only, impair the host and either stimulate tumour growth or have no effect on it. Prolonged TPN, however, preserves the host but with a larger tumour than that of the anorexic control. Alterations in different indexes of malnutrition and a 10-15% loss in the pre-illness bodyweight are indications to TPN. It is most often accomplished through percutaneous central venous catheter in the subclavian vein. Clinically detected risk of thrombosis is 5%. At present, no solution with an amino acid composition defined specifically for cancer patients is available. The widespread 3-bottle system ensures the daily requirement of calorie, electrolytes, vitamins, etc. Tolerance to fluid load is usually the limiting factor. Consequent abnormality: elevated results of liver function test. TPN reduced surgical complications of the gastrointestinal tract, but had no effect during radiotherapy. TPN is unjustified in patients undergoing aggressive therapy; however, when response rates and nutritional morbidity are high, it is recommended to mitigate the side effects of antineoplastic therapy. (Sugar-Budapest-Country)

publication date

  • December 1981

Research

keywords

  • Review

Identity

Language

  • eng

PubMed ID

  • 6789202

Additional Document Info

start page

  • 375

end page

  • 82

volume

  • 305

number

  • 7