Home parenteral nutrition for people with bowel obstruction caused by cancer


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What is the issue?
People with advanced cancer within the abdominal cavity can develop blockages of the bowel that cannot be treated surgically. This may cause nausea and vomiting and an inability to absorb enough nutrition via the gut. An alternative to conventional feeding when the gut does not work, is feeding through a vein, known as parenteral nutrition (PN). This is often used in hospital to support patients when return of gut function is expected. However, it can also be considered as part of palliative treatment in advanced cancer when return of gut function is unlikely.

Why is it important?
PN in people with blockage of the bowel due to advanced, inoperable cancer is controversial. Treatments are largely limited to best supportive care and there are arguments for and against artificial feeding in this situation. There is some evidence that it may lengthen survival, but the treatment can be burdensome and risky for individuals where quality of life is a priority.

We asked:
Is PN effective in improving survival and quality of life in people with inoperable blockage of the bowel caused by advanced cancer?

We found:
The benefits of PN are uncertain as the evidence is of very low certainty, provided mainly by studies that only looked at people who received PN rather than comparing patients who received PN with those who did not. As we found no randomised controlled trials, we have included the results from 13 observational studies with a total of 721 participants. For 12 of the studies, there was only one relevant treatment group and no control group. Therefore, the results are only for people receiving PN and we have no information about those not receiving it. The average survival time for people on PN varied from three to 1278 days. Only three studies measured quality of life using a recognised measure. One study found quality of life improved and two studies found similar numbers of people both improved and deteriorated. However, the three studies monitored quality of life at different points in time and measured it in different ways. Side effects occurred in 12% of people in the eight studies that measured them.

This means:
Further research is needed to find out if PN is of benefit to people with an inoperable blockage of the bowel caused by advanced cancer.