Abstract
Rationale: Malignant bowel obstruction is a complication of certain advanced cancers and patients may require home parenteral nutrition (HPN). This systematic review assessed the effectiveness and safety of HPN in these patients.
Methods: Registered with Cochrane Collaboration. Electronic searches of Ovid MEDLINE, Embase, BNI, CINAHL, Web of Science, NHS Economic Evaluation and Health Technology Assessment, Central Register of Controlled Trials, ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry, and hand-searching of references and similar articles on PubMed were carried out in May 2017.
Studies with 5 or more participants, over 16 years, receiving HPN with inoperable malignant bowel obstruction were included. Quality of the evidence was assessed using GRADEpro.
Results: 13 studies with 721 participants were identified. Studies were observational, 12 studies had only 1 relevant treatment arm and no control. Data were synthesised narratively due to heterogeneity, and quality of the evidence was very low and the risk of bias high.
The evidence for benefit from HPN was uncertain; all the studies measured survival, but defined it differently. Reported survival varied widely with median survival between 15 to 155 days (range 3 to 1278 days). Quality of life (QoL) was measured in 3 studies using 3 different validated measures; results were equivocal. One study reported improvements in QoL up to 3 months after HPN initiation and 2 studies reported similar numbers of patients with QoL improvements and deterioration. Adverse events were measured by 9 studies, with 8 having individual participant data; 11% patients developed a central venous catheter infection or were hospitalised with PN complications.
Conclusions: Due to the low quality of evidence, it is uncertain whether HPN improves survival or QoL, further high quality prospective studies are required.
Methods: Registered with Cochrane Collaboration. Electronic searches of Ovid MEDLINE, Embase, BNI, CINAHL, Web of Science, NHS Economic Evaluation and Health Technology Assessment, Central Register of Controlled Trials, ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry, and hand-searching of references and similar articles on PubMed were carried out in May 2017.
Studies with 5 or more participants, over 16 years, receiving HPN with inoperable malignant bowel obstruction were included. Quality of the evidence was assessed using GRADEpro.
Results: 13 studies with 721 participants were identified. Studies were observational, 12 studies had only 1 relevant treatment arm and no control. Data were synthesised narratively due to heterogeneity, and quality of the evidence was very low and the risk of bias high.
The evidence for benefit from HPN was uncertain; all the studies measured survival, but defined it differently. Reported survival varied widely with median survival between 15 to 155 days (range 3 to 1278 days). Quality of life (QoL) was measured in 3 studies using 3 different validated measures; results were equivocal. One study reported improvements in QoL up to 3 months after HPN initiation and 2 studies reported similar numbers of patients with QoL improvements and deterioration. Adverse events were measured by 9 studies, with 8 having individual participant data; 11% patients developed a central venous catheter infection or were hospitalised with PN complications.
Conclusions: Due to the low quality of evidence, it is uncertain whether HPN improves survival or QoL, further high quality prospective studies are required.
| Original language | English |
|---|---|
| Title of host publication | Clinical Nutrition |
| Pages | s74-s75 |
| Volume | 37 |
| Publication status | Published - Sept 2018 |