Clinical practice guidelines, edited by oncology societies, for the management of cancer cachexia and nutritional care suggest that the provision of parenteral nutrition (PN) to manage cachexia in patients with advanced cancer is not recommended, should not be initiated in the last weeks of life, and is appropriate to discontinue if near the end of life.
However, a multicenter study conducted in palliative care units implied that there are beneficial effects of parenteral nutrition and hydration (PNH) on survival and quality of dying among cancer patients with a mean survival of five weeks.
The following are results of a survey of patients with advanced cancer and their families to clarify their beliefs and perceptions about PN, parenteral hydration (PH), and PNH.
Approximately 60% of respondents said that PNH were beneficial. Approximately 70% said that PNH is standard medical practice. However, more than 70-80% said that the information they received in advance, and the knowledge they had about the treatment, was insufficient.
60-80% of respondents said that PNH were beneficial, and 80-90% expressed a need for PNH when the patient was unable to intake a sufficient amount of food. More than 70% said the information they received about PNH was insufficient, and more than 50% said that they did not receive a full explanation about PNH.
While both groups had similar preferences regarding PNH, families were reluctant to withhold PNH for their loved one even if the patient explicitly chose to forgo PNH. Furthermore, the majority of patients considered their families’ opinions to be crucial for making decisions regarding PNH.
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Adapted from: Akiko A, et al. Beliefs and perceptions about parenteral nutrition and hydration by advanced cancer patients. Palliative Medicine Reports 2022; 3(1): 132-139.