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The number of new instances of cancer is anticipated to dramatically increase, making it one of the main causes of illness and death in the globe [1]. Parallel to this, individuals with severe illness stages may live for longer periods of time, leading to related malnutrition frequently being a key factor in their prognosis. In fact, malnutrition has been found in as many as 80% of cancer patients with advanced disease (AC) [2]. Its emergence has several causes, including reduced nutritional intake, cancer cachexia, chemotherapeutic side effects, intestinal blockage brought on by cancer, and surgical complications [3]. Survival, quality of life, performance status, and the capacity to tolerate systemic anti-cancer medication are all impacted by malnutrition [3,4]. Therefore, it may be logical to infer that providing nutrition to these malnourished individuals may enhance patient outcomes and long-term energy balance. Home parenteral nutrition (HPN) is still debatable in patients with AC, albeit [5-7].

Through use of a central venous catheter, HPN entails the intermittent injection of intravenous solutions including electrolytes, energy, protein, vitamins, and micronutrients (CVC). Different countries have different rates of HPN usage in patients with AC, with the Netherlands and Italy accounting for over 60% of all HPN indications and the UK for less than 25%, while other European nations and the USA have intermediate rates. In a recent international survey of multidisciplinary clinicians, the disparities in global attitudes and experiences regarding the use of HPN in patients with AC were highlighted. The choice to begin HPN in patients with AC requires consideration of both clinical and ethical issues, with an examination of the patients' preferences being a key component. Notably, practical concerns such as a lack of local experience, financing, or community services for HPN administration were mentioned in the international survey as significant impediments to the launch of HPN. Indeed, the way that HPN is delivered might differ between and within nations, with some institutions starting HPN with oncologists while others doing so with bigger, centralised multidisciplinary teams for intestinal failure (IF). Hospital readmission rates and CVC-related complications are examples of quality outcomes connected to the administration of IF and HPN treatment. Notably, it has been found that tertiary centres centralised treatment and delivery of HPN is linked to lower incidence of HPN-related complications. Collaborations between IF centres and cancer units might improve patient treatment, enable remote patient discharge and monitoring, and assist remove logistical obstacles to HPN commencement that might be caused by a lack of service infrastructure or clinical expertise. But according to current literature, it's unclear if HPN helps AC patients live longer or have better quality of life [6,7]. There is also a lack of information on the prevalence of HPN-related complications, the influence of concurrent chemotherapy on their development, readmission rates, or places of death in this patient cohort, all of which can be important factors in determining the quality of life for this group of patients.

Therefore, the purpose of this study was to evaluate the HPN services provided to AC patients by tertiary IF and cancer facilities and to look at patient outcomes such as survival, HPN-related problems, and hospital readmissions.

Maintaining a high quality of life is crucial for people with AC, thus it's crucial to make sure that the risks of the medication outweigh its advantages. The majority of the patients in our sample had no treatment-related problems and a low risk of CRBSI (0.49 episodes per 1000 catheter days), which is comparable to patients who needed HPN for benign illnesses. The use of concurrent systemic anti-cancer medication did not have a detrimental effect on the incidence of either CRBSI or mechanical CVC problems, even if both treatments were provided through the same CVC, according to this study, which is significant because it is the first to show this. This gives patients comfort in knowing that they can benefit from HPN treatment with a minimum load of potential consequences if catheter care is followed and a discrete lumen is used that is separate from the PN.

Conclusion

We provide one of the most extensive single-center experiences regarding the delivery of HPN services to patients with advanced malignancies in our conclusion. According to our analysis, creating centralised care might result in the supply of HPN to a significant number of people. A large geographic region of patients while retaining minimal complication and readmission rates and positive patient outcomes in terms of quality.

Acknowledgement

Not applicable.

Conflict of Interest

None to declare.

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