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Supportive Care in Cancer

, Volume 27, Issue 12, pp 4393–4399 | Cite as

The role of parenteral nutrition in patients with malignant bowel obstruction

  • Federico BozzettiEmail author
Review Article

Abstract

Purpose

The role of parenteral nutrition in the treatment of malignant bowel obstruction is underestimated since palliative literature mainly focuses on gastric aspiration, nothing per os and antisecretory therapy. The purpose of this review is the appraisal of the literature with a focus on the potential contribution of parenteral nutrition.

Methods

Literature included in a recent meta-analysis and in a Cochrane review on parenteral nutrition in malignant bowel obstruction and updated through PUBMED until March 2019 has been reviewed.

Results

Prompt withholding of food intake, nasogastric aspiration and then the use of antisecretory agents represent the milestones of treatment which are applied to all patients with malignant bowel obstruction. After this initial approach, excluding few surgical patients and those defined as imminently dying, there is a heterogeneous group of patients achieving a benefit in a few days but with a prompt recurrence of symptoms as they attempt to reassume some food intake. Parenteral nutrition in hospital or at home addresses to these patients provided their life expectancy is likely to depend on progressive nutritional deterioration due to the prolonged starvation more than on the tumour spread. These patients on home parenteral nutrition can survive a few months with some indefinite benefit on quality of life whereas untreated patients have a survival of few weeks.

Conclusion

Parenteral nutrition should be considered in selected patients who benefit from standard palliative treatment of malignant obstruction and are obliged to maintain a total bowel rest for weeks or months.

Keywords

Home parenteral nutrition Malignant bowel obstruction Intravenous nutrition Palliative therapy in cancer 

Notes

References

  1. 1.
    Anthony T, Baron T, Mercadante S, Green S, Chi D, Cunningham J, Herbst A, Smart E, Krouse RS (2007) Report of the clinical protocol committee: development of randomized trials for malignant bowel obstruction. J Pain Symptom Manag 34:S49–S59Google Scholar
  2. 2.
    Ripamonti C, Bruera E (2002) Palliative management of malignant bowel obstruction. Int J Gynecol Cancer 12:135–143PubMedGoogle Scholar
  3. 3.
    Ripamonti C, Easson AM, Gerdes H (2008) Management of malignant bowel obstruction. Eur J Cancer 44(8):1105–1015PubMedGoogle Scholar
  4. 4.
    Ripamonti C, Twycross R, Baines M, Bozzetti F, Capri S, de Conno F, Gemlo B, Hunt T, Hans-B. K, Mercadante S, Schaerer R, Wilkinson P, Working Group of the European Association for Palliative Care (2001) Clinical-practice recommendations for the management of bowel obstruction in patients with end-stage cancer. Support Care Cancer 9:223–233PubMedGoogle Scholar
  5. 5.
    Henry JC, Pouly S, Sullivan R, Sharif S, Klemanski D, Abdel-Misih S, Arradaza N, Jarjoura D, Schmidt C, Bloomston M (2012) A scoring system for the prognosis and treatment of malignant bowel obstruction. Surgery 152(4):747–756PubMedPubMedCentralGoogle Scholar
  6. 6.
    Laval G, Marcelin-Benazech B, Guirimand F et al (2014) French Society for Palliative Care; French Society for Digestive Surgery; French Society for Gastroenterology; French Association for Supportive Care in oncology; French Society for Digestive Cancer. Recommendations for bowel obstruction with peritoneal carcinomatosis. J Pain Symptom Manag 48(1):75–91Google Scholar
  7. 7.
    Martinez Castro P, Vargas L, Mancheño A et al (2017) Malignant bowel obstruction in relapsed ovarian cancer with peritoneal carcinomatosis: an occlusive state. Int J Gynecol Cancer 27(7):1367–1372PubMedGoogle Scholar
  8. 8.
    Paul Olson TJ, Pinkerton C, Brasel KJ, Schwarze ML (2014) Palliative surgery for malignant bowel obstruction from carcinomatosis: a systematic review. JAMA Surg 149(4):383–392PubMedPubMedCentralGoogle Scholar
  9. 9.
    Ferguson HJ, Ferguson CI, Speakman J et al (2015) Management of intestinal obstruction in advanced malignancy. Ann Med Surg (Lond) 4(3):264–270Google Scholar
  10. 10.
    Naghibi M, Smith TR, Elia M (2015) A systematic review with meta-analysis of survival, quality of life and cost-effectiveness of home parenteral nutrition in patients with inoperable malignant bowel obstruction. Clin Nutr 34(5):825–837PubMedGoogle Scholar
  11. 11.
    Sowerbutts AM, Lal S, Sremanakova J et al (2018) Home parenteral nutrition for people with inoperable malignant bowel obstruction. Cochrane Database Syst Rev 8:CD012812.  https://doi.org/10.1002/14651858.CD012812 CrossRefPubMedGoogle Scholar
  12. 12.
    Tuca A, Guell E, Martinez-Losada E et al (2012) Malignant bowel obstruction in advanced cancer patients: epidemiology, management, and factors influencing spontaneous resolution. Cancer Manag Res 4:159–169PubMedPubMedCentralGoogle Scholar
  13. 13.
    Ketcham AS, Hoye RC, Pilch YH, Morton DL (1970) Delayed intestinal obstruction following treatment for cancer. Cancer 25(2):406–410PubMedGoogle Scholar
  14. 14.
    Osteen RT, Guyton S, Steele G Jr, Wilson RE (1980) Malignant intestinal obstruction. Surgery 87(6):611–615PubMedGoogle Scholar
  15. 15.
    Legendre H, Vahhuyse F, Caroli-Bose FX et al (2001) Survival and quality of life after palliative surgery for neoplastic gastrointestinal obstruction. Eur J Surg Oncol 27:364–367PubMedGoogle Scholar
  16. 16.
    Kim DH, Kim B, Choi JH, Park SJ, Hong SP, Cheon JH, Kim WH, Kim TI (2016) Tumor characteristics associated with malignant large bowel obstruction in stage IV colorectal cancer patients undergoing chemotherapy. Int J Color Dis 31:1767–1774Google Scholar
  17. 17.
    Cousins SE, Tempest E, Feuer DJ (2016) Surgery for the resolution of symptoms in malignant bowel obstruction in advanced gynaecological and gastrointestinal cancer. Cochrane Database Syst Rev 1:CD002764Google Scholar
  18. 18.
    Chakraborty A, Selby D, Gardiner K, Myers J, Moravan V, Wright F (2011) Malignant bowel obstruction: natural history of a heterogeneous patient population followed prospectively over two years. J Pain Symptom Manag 41(2):412–420Google Scholar
  19. 19.
    Mooney SJ, Winner M, Hershman DL, Wright JD, Feingold DL, Allendorf JD, Neugut AI (2013) Bowel obstruction in elderly ovarian cancer patients: a population based study. Gynecol Oncol 129(1):107–112PubMedGoogle Scholar
  20. 20.
    Lilley EJ, Scott JW, Goldberg JE et al (2017) Survival, healthcare utilization, and end-of-life care among older adults with malignancy-associated bowel obstruction: comparative study of surgery, venting gastrostomy, or medical management. Ann Surg 267(4):692–699Google Scholar
  21. 21.
    Winner M, Mooney SJ, Hershman DL, Feingold DL, Allendorf JD, Wright JD, Neugut AI (2013) Management and outcomes of bowel obstruction in patients with stage IV colon cancer: a population-based cohort study. Dis Colon Rectum 56(7):834–843PubMedPubMedCentralGoogle Scholar
  22. 22.
    Woolfson RG, Jennings K, Whalen GF (1997) Management of bowel obstruction in patients with abdominal cancer. Arch Surg 132:1093–1097PubMedGoogle Scholar
  23. 23.
    Diver E, O’Connor O, Garrett L et al (2013) Modest benefit of total parenteral nutrition and chemotherapy after venting gastrostomy tube placement. Gynecol Oncol 129(2):332–335PubMedGoogle Scholar
  24. 24.
    Chouhan J, Gupta R, Ensor J et al (2016) Retrospective analysis of systemic chemotherapy and total parenteral nutrition for the treatment of malignant small bowel obstruction. Cancer Med 5(2):239–247PubMedGoogle Scholar
  25. 25.
    Brard L, Weitzen S, Strubel-Lagan SL et al (2006) The effect of total parenteral nutrition on the survival of terminally ill ovarian cancer patients. Gynecol Oncol 103(1):176–180PubMedGoogle Scholar
  26. 26.
    Glare P, Pereira G, Kristjanson LJ, Tattersall M, Stockler M (2004) Systematic review of the efficacy of antiemetics in the treatment of nausea in patients with far-advanced cancer. Support Care Cancer 12(6):432–440PubMedGoogle Scholar
  27. 27.
    Baines M, Oliver DJ, Carter RL (1985) Medical management of intestinal obstruction in patients with advanced malignant disease. A clinical and pathological study. Lancet. 2(8462):990–993PubMedGoogle Scholar
  28. 28.
    Ripamonti C, Mercadante S, Groff L, Zecca E, de Conno F, Casuccio A (2000) Role of octreotide, scopolamine butylbromide and hydration in symptom control of patients with inoperable bowel obstruction and nasogastric tubes: a prospective randomized trial. J Pain Symptom Manag 19:23–34Google Scholar
  29. 29.
    Mercadante S, Ripamonti C, Casuccio A, Zecca E, Groff L (2000) Comparison of octreotide and hyoscine butylbromide in controlling gastrointestinal symptoms due to malignant inoperable bowel obstruction. Support Care Cancer 8:188–191PubMedGoogle Scholar
  30. 30.
    Mystakidou K, Tsilika E, Kalaidopoulou O, Chondros K, Georgaki S, Papadimitriou L (2002) Comparison of octreotide administration vs. conservative treatment in the management of inoperable bowel obstruction in patients with far advanced cancer: a randomized, double-blind, controlled clinical trial. Anticancer Res 22(2B):1187–1192PubMedGoogle Scholar
  31. 31.
    Tunca JC, Buchler DA, Mack EA, Ruzicka FF, Crowley JJ, Carr WF (1981) The management of ovarian-cancer caused bowel obstruction. Gynecol Oncol 12:186–192PubMedGoogle Scholar
  32. 32.
    Lund B, Hansen M, Lundvall F et al (1989) Intestinal obstruction in patients with advanced carcinoma of the ovaries treated with combination chemotherapy. Surg Gynecol Obstet 169(3):213–218PubMedGoogle Scholar
  33. 33.
    Bais JMJ, Schilthuis MS, Slors JFM, Lammes FB (1995) Intestinal obstruction in patients with advanced ovarian cancer. Int J Gynecol Cancer 5(5):346–350PubMedGoogle Scholar
  34. 34.
    Jong P, Sturgeon J, Jamieson CG (1995) Benefit of palliative surgery for bowel obstruction in advanced ovarian cancer. Can J Surg 38(5):454–457PubMedGoogle Scholar
  35. 35.
    Pothuri B, Vaidya A, Aghajanian C, Venkatraman E, Barakat RR, Chi DS (2003) Palliative surgery for bowel obstruction in recurrent ovarian cancer: an updated series. Gynecol Oncol 89(2):306–313PubMedGoogle Scholar
  36. 36.
    Chi DS, Phaëton R, Miner TJ et al (2009) A prospective outcomes analysis of palliative procedures performed for malignant intestinal obstruction due to recurrent ovarian cancer. Oncologist 14(8):835–839PubMedGoogle Scholar
  37. 37.
    Kim K, Kang SB, Kim MJ et al (2009) Factors associated with successful palliation and improved survival in patients with malignant bowel obstruction caused by ovarian cancer. J Am Med Wom Assoc 2(2):54–58Google Scholar
  38. 38.
    Kolomainen DF, Daponte A, Barton DPJ, Pennert K, Ind TEJ, Bridges JE, Shepherd JH, Gore ME, Kaye SB, Riley J (2012) Outcomes of surgical management of bowel obstruction in relapsed epithelial ovarian cancer (EOC). Gynecol Oncol 125(1):31–36PubMedGoogle Scholar
  39. 39.
    Krebs HB, Goplerud DR (1983) Surgical management of bowel obstruction in advanced ovarian cancer. Obstet Gynecol 61:327–330PubMedGoogle Scholar
  40. 40.
    Gemlo B, Rayner AA, Lewis B, Wong A, Viele CS, Ungaretti JR et al (1988) Home support of patients with end-stage malignant bowel obstruction using hydration and venting gastrostomy. Am J Surg 152:100–104Google Scholar
  41. 41.
    Rubin SC, Hoskins WJ, Benjamin I, Lewis JL (1989) Palliative surgery for intestinal obstruction inadvanced ovarian cancer. Gynecol Oncol 34:16–19PubMedGoogle Scholar
  42. 42.
    Porzio G, Aielli F, Verna L, Galletti B, Shoja E, Razavi G, Ficorella C (2011) Can malignant bowel obstruction in advanced cancer patients be treated at home? Support Care Cancer 19(3):431–433PubMedGoogle Scholar
  43. 43.
    Mercadante S (1995) Bowel obstruction in home-care cancer patients: 4 years experience. Support Care Cancer 3:190–193PubMedGoogle Scholar
  44. 44.
    Mangili G, Franchi M, Mariani A, Zanaboni F, Rabaiotti E, Frigerio L, Bolis PF, Ferrari A (1996) Octreotide in the management of bowel obstruction in terminal ovarian cancer. Gynecol Oncol 61(3):345–348PubMedGoogle Scholar
  45. 45.
    August DA, Thorn D, Fisher RL, Welchek CM (1991) Home parenteral nutrition for patients with inoperable malignant bowel obstruction. J Parenter Enter Nutr 15:323–327Google Scholar
  46. 46.
    Bozzetti F, Cozzaglio L, Biganzoli E et al (2002) Quality of life and length of survival in advanced cancer patients on home parenteral nutrition. Clin Nutr 21:281–288PubMedGoogle Scholar
  47. 47.
    Chermesh I, Mashiach T, Amit A, Haim N, Papier I, Efergan R, Lachter J, Eliakim R (2011) Home parenteral nutrition (HTPN) for incurable patients with cancer with gastrointestinal obstruction: do the benefits outweigh the risks? Med Oncol 28:83–88PubMedGoogle Scholar
  48. 48.
    Duerksen DR, Ting E, Thomson P, McCurdy K, Linscer J, Larsen-Celhar S, Brennenstuhl E (2004) Is there a role for TPN in terminally ill patients with bowel obstruction? Nutrition 20:760–763PubMedGoogle Scholar
  49. 49.
    Mercadante S (1995) Parenteral nutrition at home in advanced cancer patients. J Pain Symptom Manag 10:476–480Google Scholar
  50. 50.
    Pasanisi F, Orban A, Scalfi L, Alfonsi L, Santarpia L, Zurlo E, Celona A, Potenza A, Contaldo F (2001) Predictors of survival in terminal-cancer patients with irreversible bowel obstruction receiving home parenteral nutrition. Nutrition 17:581–584PubMedGoogle Scholar
  51. 51.
    Pironi L, Ruggeri E, Tanneberger S, Giordani S, Pannuti F, Miglioli M (1997) Home artificial nutrition in advanced cancer. J R Soc Med 90(11):597–603PubMedPubMedCentralGoogle Scholar
  52. 52.
    Soo I, Gramlich L (2008) Use of parenteral nutrition in patients with advanced cancer. Appl Physiol Nutr Metab 33:102–106PubMedGoogle Scholar
  53. 53.
    Cotogni P, De Carli L, Passera R et al (2017) Longitudinal study of quality of life in advanced cancer patients on home parenteral nutrition. Cancer Med 6:1799–1806PubMedPubMedCentralGoogle Scholar
  54. 54.
    Santarpia L, Alfonsi L, Pasanisi F, de Caprio C, Scalfi L, Contaldo F (2006) Predictive factors of survival in patients with peritoneal carcinomatosis on home parenteral nutrition. Nutrition 22:355–360PubMedGoogle Scholar
  55. 55.
    Keane N, Fragkos K, Patel P et al (2018) Performance status, prognostic scoring, and parenteral nutrition requirements predict survival in patients with advanced cancer receiving home parenteral nutrition. Nutr Cancer 70(1):73–82PubMedGoogle Scholar
  56. 56.
    King LA, Carson LF, Konstantinides N, House MS, Adcock LL, Prem KA, Twiggs LB, Cerra FB (1993) Outcome assessment of home parenteral nutrition in patients with gynecologic malignancies: what have we learned in a decade of experience? Gynecol Oncol 51:377–382PubMedGoogle Scholar
  57. 57.
    Oh SY, Jun HJ, Park SJ, Park IK, Lim GJ, Yu Y, Cho SJ, Song A (2014) A randomized phase II study to assess the effectiveness of fluid therapy or intensive nutritional support on survival in patients with advanced cancer who cannot be nourished via enteral route. J Palliat Med 17(11):1266–1270PubMedGoogle Scholar
  58. 58.
    Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F, Fearon K, Hütterer E, Isenring E, Kaasa S, Krznaric Z, Laird B, Larsson M, Laviano A, Mühlebach S, Muscaritoli M, Oldervoll L, Ravasco P, Solheim T, Strasser F, de van der Schueren M, Preiser JC (2017) ESPEN guidelines on nutrition in cancer patients. Clin Nutr 36(1):11–48PubMedGoogle Scholar
  59. 59.
    Bozzetti F, Santarpia L, Pironi L, Thul P, Klek S, Gavazzi C, Tinivella M, Joly F, Jonkers C, Baxter J, Gramlich L, Chicharro L, Staun M, van Gossum A, Lo Vullo S, Mariani L (2014) The prognosis of incurable cachectic cancer patients on home parenteral nutrition: a multi-centre observational study with prospective follow-up of 414 patients. Ann Oncol 25(2):487–493PubMedGoogle Scholar
  60. 60.
    Bozzetti F, Cotogni P, Lo Vullo S, Pironi L, Giardiello D, Mariani L (2015) Development and validation of a nomogram to predict survival in incurable cachectic cancer patients home parenteral nutrition. Ann Oncol 26:2335–2340PubMedGoogle Scholar
  61. 61.
    Selby D, Wright F, Stilos K, Daines P, Moravan V, Gill A, Chakraborty A (2010) Room for improvement? A quality-of-life assessment in patients with malignant bowel obstruction. Palliat Med 24(1):38–45PubMedGoogle Scholar
  62. 62.
    Finocchiaro C, Gervasio S, Agnello E et al (2002) Multicentric study on home parenteral nutrition in advanced cancer patients. Rivista italiana di Nutrizione Parenterale ed Enterale 20:98–107Google Scholar
  63. 63.
    Bozzetti F, Amadori D, Bruera E et al (1996) Guidelines on artificial nutrition versus hydration in terminal cancer patients. Nutrition 12:163–167PubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Faculty of MedicineUniversity of MilanMilanItaly

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