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Review Finds Few Benefit From Parenteral Nutrition

Kate Traynor

A review of data from more than 100 studies suggests that few people benefit from parenteral nutrition therapy.

The review, which was conducted by the American Gastroenterological Association (AGA), found that long-term parenteral nutrition is advisable for some home care patients. In particular, the therapy is indicated for people who are unable to absorb sufficient nutrients through the gastrointestinal tract and would otherwise starve to death. Although none of the studies in the review involved patients who had prolonged failure of the gastrointestinal tract while receiving curative cancer treatments, AGA concluded that such patients are candidates for home parenteral nutrition.

But AGA concluded that home parenteral nutrition is not beneficial for people who are thought to have less than three months to live. Three months, noted AGA, is the minimum life expectancy required for Medicare reimbursement of home-based parenteral nutrition therapy.

AGA’s recommendations appeared in a technical review (PDF) and a position statement (PDF) published in the October issue of the association’s journal, Gastroenterology.

The review involved 82 controlled studies of parenteral nutrition and 27 that addressed "protein-sparing therapy," in which nitrogen is infused along with a lower-than-needed number of calories. Most of the studies in the analysis took place in hospitals, but four dealt with patients receiving parenteral nutrition at home.

In all, the studies provided data from more than 4,000 patients with cancer, liver disease, pancreatitis, or another illness. About half of the studies focused on perioperative treatment with parenteral nutrition. Nearly all of the studies chosen for the analysis excluded patients who were "severely malnourished."

Overall, "the large majority" of clinical trials under study "failed to identify any benefit attributable to parenteral nutrition," and some found that the therapy was harmful, according to the review.

AGA recommended against the routine use of parenteral nutrition in patients receiving radiation therapy or chemotherapy for the treatment of cancer. According to the review, hospital-based studies have shown that parenteral nutrition "increases the risk of complications and impairs the response to treatment" in such patients.

In home care settings, long-term parenteral nutrition therapy did not reduce deaths or infections among patients undergoing chemotherapy for testicular cancer or recovering from bone-marrow transplantation, the review showed. Likewise, patients with cystic fibrosis and people infected with the human immunodeficiency virus did not benefit from long-term parenteral nutrition administered in the home.

The review likened the quality of life among patients receiving home-based parenteral nutrition as comparable to that of patients who require hemodialysis. People who receive parenteral nutrition are at increased risk for thrombosis, blood-glucose abnormalities, and liver and bone disease and must be carefully monitored, noted the review.