The Role of Parenteral Nutrition in Cancer in Indian Settings
Kumar Prabhash
Tata Memorial Hospital, Mumbai, India.
Arvind Krishnamurthy *
Surgical Oncology, Cancer Institute (WIA), India.
Chandra Sekhar Puli
London Gastro Care, Hyderabad, India.
Saurabh Bhave
Tieten Medicity and Sunrise Oncology Center, Thane and Mumbai, India.
Shirish Alurkar
HCG Cancer Hospital, Ahmedabad, India.
Shivshankar Timmanpyati
Tata Memorial Hospital, Mumbai, India.
Shisir Shetty
Dr DY Patil School of Medicine, Fortis Hospital Vashi, Navi Mumbai, India.
Suvadip Chakrabarti
Department of Surgical Oncology, Apollo Multi-Specialty Hospital Kolkata, India.
Tejinder Singh
Apollo Hospitals, Navi Mumbai, India.
Nandini Mefnon
Tata Memorial Hospital, Mumbai, India.
Vanita Noronha
Tata Memorial Hospital, Mumbai, India.
*Author to whom correspondence should be addressed.
Abstract
Background: Almost 50% of patients with cancer suffer from malnutrition during their first hospital visit. However, it is often overlooked and undiagnosed and is associated with morbidity, mortality, poor tolerance to treatment, and treatment outcomes. Guidelines recommend supportive nutrition from the early stages of cancer treatment. However, in clinical practice, nutritional support is often prescribed only as an end-of-life intervention or is not prescribed at all; moreover, the use of parenteral nutrition (PN) is not well-defined. There are limited practical guidelines on the use of PN in patients with cancer.
Methods: A multidisciplinary group of specialists in India formulated this consensus to guide oncologists on the judicious use of PN in Indian settings. It includes general and cancer-specific recommendations on the use of PN, supplemental PN (SPN), composition of PN, and monitoring patients to prevent adverse events associated with PN.
Recommendations: The risk of malnutrition should be assessed at the very first presentation of a patient with cancer. These patients’ nutritional requirements are largely like those of the healthy population. Nutritional assessment of all cancer patients should begin at diagnosis and repeated regularly to initiate and monitor early nutritional intervention, before the general status is severely compromised. Oncologists and nutritionists need to be educated about using the appropriate nutrition support options according to the guidelines. While EN should be the preferred form of nutritional support, in specific circumstances PN might be a better option. Early PN in specific settings provides additional benefits, and is particularly important in some types of cancers. SPN as an additional nutritional support to EN can improve treatment tolerability and quality-of-life of patients with cancer. Education is also necessary for awareness about preventing and managing adverse effects of PN, which is the major reason for poor adoption of PN.
Keywords: Parenteral nutrition, total parenteral nutrition, supplemental parenteral nutrition, cancer