Comparative clinical outcomes of home parenteral nutrition in adults with gastrointestinal or gynecologic cancers versus non-cancer patients: a prospective cohort study using propensity score matching from the Canadian HPN registry.

BACKGROUND

Home parenteral nutrition (HPN) is indicated for patients with intestinal failure, but its use in cancer patients requires careful consideration due to the unique challenges and complexities involved.

METHODS

This prospective cohort study analyzed data from cancer patients receiving HPN, recorded in the Canadian HPN Registry from 2003 to 2022. Patients were divided into two groups: those with gastrointestinal or gynecologic cancer and a propensity score-matched cohort of non-cancer patients. The objective was to assess survival rates by performance status and prescription decade in both groups. Secondary objectives were to compare complications between the groups.

RESULTS

A total of 400 HPN patients were enrolled: 200 cancer patients (128 gastrointestinal, 72 gynecologic) and 200 matched non-cancer patients. Median age (interquartile range) was 58 (16) years for cancer and 56 (19) for non-cancer groups, with 71.5% and 66.5% female, respectively. Median survival was 1.71 years (95% confidence interval (CI), 0.81-2.61) for gastrointestinal cancer, 0.99 years (95% CI, 0.36-1.6) for gynecologic cancer, and 3.89 years (95% CI, 2.72-5.06) for non-cancer patients (p-value < 0.001). Survival showed no improvement over two decades. Patients with Karnofsky Performance Scale (KPS) ≤ 50 had shorter survival. Catheter complications and HPN-related hospitalizations were similar, but HPN-related liver disease was more common in non-cancer patients (16.5% vs. 9%, p-value = 0.025).

CONCLUSION

Survival for patients with gastrointestinal and gynecologic cancer and co-existing intestinal failure has not improved over the past two decades, with poorer outcomes observed in those with low KPS. Complication rates were similar in both groups. Graphical abstract: Created in BioRender. Unhapipatpong, C. (2025) https://BioRender.com/l25d998 .