Consideraciones éticas sobre el papel de la nutrición parenteral domiciliaria. Tratamiento conservador de la obstrucción intestinal en pacientes con cáncer avanzado

Abstract

The use of artificial feeding in patients with advanced cancer with no curative treatment continues to be a controversial matter with strong emotional implications. However, this group of patients constitutes the first indication relating to programs of parenteral feeding or hyperalimentation at home(*) (NPD inin most series of cases*, at both sides of the Atlantic. Objective: showing the characteristics of a series of patients included in a program of Parenteral Feeding or Hyperalimentation at home named “NPD” (*) in the past ten years and, from the standpoint of clinical bioethics, gain insight of the convenience of its use in this type of patients. Method: Carrying out retrospective study of the clinical history of the eleven patients that received parenteral home nutrition during this period. Demographical and clinical data, together with information on complications and evolution, were collected and compared against those of the group of patients with benign disease conditions who got parenteral home nutrition in the same period. The literature relating to the use of this technique in these patients was extensively reviewed. Results: Eleven patients received parenteral home nutrition, nine of them due to an irresoluble intestinal obstruction and two for a high debit fistula. The mean age at the initiation of the program was 50,8 ± 12,7 years, against 37,3 ± 17,2 of the benign disease group. The mean duration of the parental feeding process at home was significantly lower in the group of patients with cancer. None of the ones included in the program is still alive. The quality of life, as measured by an activity scales was similar, at initiation, in both groups. The program was suspended in only one of the patients prior to the 5 days preceding death by clinical deterioration. Data from the bibliographical review show similar results to those reported in this series. Conclusions: This Parenteral Feeding program offers patients with advanced cancer and severe intestinal malfunction the opportunity of getting treatment at home, with a low complication rate. If we consider the short average duration of parenteral feeding at home, the inclusion in the program should be assessed individually and revised on a periodic basis.