This lecture will address topics about Home Parenteral Nutrition (HPN) in palliative oncological patients, often hypo-
aphagic or in whom oral nutrition is contraindicated because mechanical intestinal obstruction. In fact, in patients with
cancer, parenteral nutrition is controversial, although many studies have shown it is able to slow the loss of weight, restore the
heritage protein, enhance and prolong survival. According to the main guidelines and evidences, in incurable malnourished
cancer patients, palliative home parenteral nutrition should be start if the probability to die from starvation is superior to that
of dying from tumor spread, if expected survival is longer than two/three months, if Karnofsky Performance score is more than
50 (patients capable of self-care), if the intake of nutrients by mouth drops to about 60% for a period equal to or more than 10
days and if enteral nutrition is not feasible. The aim is not the rehabilitation, but to guarantee the functionality of vital organs
and to improve the quality of life, by reducing physical, psychological and spiritual distress, even thanks to a performance status
recovery. The decision to utilize parenteral nutrition in patients with advanced cancer is difficult not only because it assumes
the existence of clinical requirements, but also the availability of its management by the patient and family. Data about a study
conducted in my clinical nutrition unit on HPN duration in oncological patients will be presented and some consideration on
indications of starting or stopping, if already started, an oncological HPN will be done.
Michela Zanardi is a Physician specialist in clinical nutrition, working in an hospital of Turin, Professor of Oncology and Nutrition Science at the
degree of Dietetics, Pediatric Nursing and Midwives, in the Working Group of Italian Dieticians Association (ADI) on hospital artificial nutrition.
Participation as a speaker at numerous conferences and training courses on various aspects of nutrition (artificial nutrition, role of food on prevention
of cardiovascular and oncological diseases, malnutrition, waste food) author of publications (abstracts, books, original articles).
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