Palliative home parenteral nutrition in patients with ovarian cancer and malignant bowel obstruction: experiences of women and family caregivers.
Clamp, Andrew R
Jayson, Gordon C
Morgan, Robert D
Vickers, Alexander J
AffiliationFaculty of Biology, Medicine and Health and Manchester Academic Health Science Centre, University of Manchester, Manchester,
MetadataShow full item record
AbstractBACKGROUND: Malnutrition is a problem in advanced cancer, particularly ovarian cancer where malignant bowel obstruction (MBO) is a frequent complication. Parenteral nutrition is the only way these patients can received adequate nutrition and is a principal indication for palliative home parenteral nutrition (HPN). Giving HPN is contentious as it may increase the burden on patients. This study investigates patients' and family caregivers' experiences of HPN, alongside nutritional status and survival in patients with ovarian cancer and MBO. METHODS: This mixed methods study collected data on participant characteristics, clinical details and body composition using computed tomography (CT) combined with longitudinal in-depth interviews underpinned by phenomenological principles. The cohort comprised 38 women with ovarian cancer and inoperable MBO admitted (10/2016 to 12/ 2017) to a tertiary referral hospital. Longitudinal interviews (n?=?57) were carried out with 20 women considered for HPN and 13 of their family caregivers. RESULTS: Of the 38 women, 32 received parenteral nutrition (PN) in hospital and 17 were discharged on HPN. Nutritional status was poor with 31 of 33 women who had a CT scan having low muscle mass, although 10 were obese. Median overall survival from admission with MBO for all 38 women was 70?days (range 8-506) and for those 17 on HPN was 156?days (range 46-506). Women experienced HPN as one facet of their illness, but viewed it as a "lifeline" that allowed them to live outside hospital. Nevertheless, HPN treatment came with losses including erosion of normality through an impact on activities of daily living and dealing with the bureaucracy surrounding the process. Family caregivers coped but were often left in an emotionally vulnerable state. CONCLUSIONS: Women and family caregivers reported that the inconvenience and disruption caused by HPN was worth the extended time they had at home.
CitationSowerbutts AM, Lal S, Sremanakova J, Clamp AR, Jayson GC, Teubner A, et al. Palliative home parenteral nutrition in patients with ovarian cancer and malignant bowel obstruction: experiences of women and family caregivers. BMC Palliat Care. 2019;18(1):120.
JournalBMC Palliative Care
- Home parenteral nutrition for people with inoperable malignant bowel obstruction.
- Authors: Sowerbutts AM, Lal S, Sremanakova J, Clamp A, Todd C, Jayson GC, Teubner A, Raftery AM, Sutton EJ, Hardy L, Burden S
- Issue date: 2018 Aug 10
- Home parenteral nutrition for patients with inoperable malignant bowel obstruction.
- Authors: August DA, Thorn D, Fisher RL, Welchek CM
- Issue date: 1991 May-Jun
- The path from oral nutrition to home parenteral nutrition: a qualitative interview study of the experiences of advanced cancer patients and their families.
- Authors: Orrevall Y, Tishelman C, Herrington MK, Permert J
- Issue date: 2004 Dec
- Use of parenteral nutrition in patients with advanced cancer.
- Authors: Soo I, Gramlich L
- Issue date: 2008 Feb
- Home parenteral nutrition: a qualitative interview study of the experiences of advanced cancer patients and their families.
- Authors: Orrevall Y, Tishelman C, Permert J
- Issue date: 2005 Dec