200x Filetype PPTX File size 1.00 MB Source: nwpgmd.nhs.uk
Aims • Discuss parenteral nutrition (PN) in intestinal failure related to advanced abdominal cancer • Christie referral pathway for HPN • Review some of the practicalities involved for patients receiving HPN • Not covering PN in cancer cachexia Background • Home Parenteral Nutrition (HPN) in advanced malignancy is becoming increasingly common 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Total n= n= n= n= n= n= n= n= n= n= n= 112 101 138 157 148 228 262 351 472 400 420 Malignancy 13 17 16 24 14 32 43 66 116 102 115 New adult HPN registrations, 2005 and 2015 • Lack of consensus throughout the world, with the proportion of HPN patients with cancer as the indication up to 60% in some parts of Europe (Naghibi et al, 2014) BANS report on Adult Home Parenteral Nutrition & Home Intravenous Fluids, 2016 IFU SRFT - referrals Year Total referrals to IFU Total referrals for remote D 2009 – 10 147 2010 – 11 121 2011 – 12 126 2012 – 13 152 13 2013 – 14 156 7 2014 - 15 146 16 15 - 16 171 15 16 - 17 180 32 17 - 18 195 43 18 - 19 198 57 Primary malignancy Gastro-intestinal n=16 Gynaecology n=29 other n=13 pseudomyxoma n=5 Others: - Lymphoma - Carcinoid - Mesothelioma - Urology - Pancreatic Background • Failure to maintain weight and nutrition is common in patients with cancer • In those with a functioning and accessible GI tract, use oral/enteral route of nutrition • In those with intestinal failure secondary to advanced abdominal malignancy (e.g. inoperable malignant bowel obstruction) consider parenteral nutrition
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