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Home Parenteral Nutrition in Patients with Advanced Cancer: Quality Outcomes from a Centralized Model of Care Delivery

Lack of expertise in home parenteral nutrition (HPN) management has been reported as a barrier to its initiation in patients with advanced cancer (AC), and there are limited data describing hospital readmissions and HPN-related complications. We aimed to assess a centralized approach for managing HP...

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Autores principales: Kopczynska, Maja, Teubner, Antje, Abraham, Arun, Taylor, Michael, Bond, Ashley, Clamp, Andrew, Wight, Rebecca, Salih, Zena, Hasan, Jurjees, Mitchell, Claire, Jayson, Gordon C., Lal, Simon
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9414691/
https://www.ncbi.nlm.nih.gov/pubmed/36014885
http://dx.doi.org/10.3390/nu14163379
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author Kopczynska, Maja
Teubner, Antje
Abraham, Arun
Taylor, Michael
Bond, Ashley
Clamp, Andrew
Wight, Rebecca
Salih, Zena
Hasan, Jurjees
Mitchell, Claire
Jayson, Gordon C.
Lal, Simon
author_facet Kopczynska, Maja
Teubner, Antje
Abraham, Arun
Taylor, Michael
Bond, Ashley
Clamp, Andrew
Wight, Rebecca
Salih, Zena
Hasan, Jurjees
Mitchell, Claire
Jayson, Gordon C.
Lal, Simon
author_sort Kopczynska, Maja
collection PubMed
description Lack of expertise in home parenteral nutrition (HPN) management has been reported as a barrier to its initiation in patients with advanced cancer (AC), and there are limited data describing hospital readmissions and HPN-related complications. We aimed to assess a centralized approach for managing HPN in AC and evaluate associated outcomes, including hospital readmissions and HPN-related complications. This was a cohort study of adults with AC requiring palliative HPN between 2010–2018 at a tertiary intestinal failure (IF) center, primarily utilizing a centralized model of HPN oversight to discharge patients remotely from an oncology center to their homes over a wide geographic area. A total of 126 patients were included, with a median distance between the patient’s home and the IF center of 17.5 km (IQR 10.9–39.1; maximum 317.4 km). A total of 28 (22%) patients experienced at least one HPN-related complication, the most common being a central venous catheter (CVC) occlusion and electrolyte abnormalities. The catheter-related bloodstream infection (CRBSI) rate was 0.49/1000 catheter days. The CVC type, administration of concomitant chemotherapy via a distinct CVC lumen separate from PN, venting gastrostomy and distance between the patient’s home and the IF center were not associated with CRBSI or mechanical CVC complications. A total of 82 (65.1%) patients were readmitted while on HPN, but only 7 (8.5%) of these readmissions were HPN-related. A total of 44 (34.9%) patients died at home, 41 (32.5%) at a hospice and 41 (32.5%) in a hospital. In conclusion, this study demonstrates that a centralized approach to IF care can provide HPN to patients over a large geographical area while maintaining low HPN-related complications that are comparable to patients requiring HPN for benign conditions and low hospital readmission rates.
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spelling pubmed-94146912022-08-27 Home Parenteral Nutrition in Patients with Advanced Cancer: Quality Outcomes from a Centralized Model of Care Delivery Kopczynska, Maja Teubner, Antje Abraham, Arun Taylor, Michael Bond, Ashley Clamp, Andrew Wight, Rebecca Salih, Zena Hasan, Jurjees Mitchell, Claire Jayson, Gordon C. Lal, Simon Nutrients Article Lack of expertise in home parenteral nutrition (HPN) management has been reported as a barrier to its initiation in patients with advanced cancer (AC), and there are limited data describing hospital readmissions and HPN-related complications. We aimed to assess a centralized approach for managing HPN in AC and evaluate associated outcomes, including hospital readmissions and HPN-related complications. This was a cohort study of adults with AC requiring palliative HPN between 2010–2018 at a tertiary intestinal failure (IF) center, primarily utilizing a centralized model of HPN oversight to discharge patients remotely from an oncology center to their homes over a wide geographic area. A total of 126 patients were included, with a median distance between the patient’s home and the IF center of 17.5 km (IQR 10.9–39.1; maximum 317.4 km). A total of 28 (22%) patients experienced at least one HPN-related complication, the most common being a central venous catheter (CVC) occlusion and electrolyte abnormalities. The catheter-related bloodstream infection (CRBSI) rate was 0.49/1000 catheter days. The CVC type, administration of concomitant chemotherapy via a distinct CVC lumen separate from PN, venting gastrostomy and distance between the patient’s home and the IF center were not associated with CRBSI or mechanical CVC complications. A total of 82 (65.1%) patients were readmitted while on HPN, but only 7 (8.5%) of these readmissions were HPN-related. A total of 44 (34.9%) patients died at home, 41 (32.5%) at a hospice and 41 (32.5%) in a hospital. In conclusion, this study demonstrates that a centralized approach to IF care can provide HPN to patients over a large geographical area while maintaining low HPN-related complications that are comparable to patients requiring HPN for benign conditions and low hospital readmission rates. MDPI 2022-08-17 /pmc/articles/PMC9414691/ /pubmed/36014885 http://dx.doi.org/10.3390/nu14163379 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Kopczynska, Maja
Teubner, Antje
Abraham, Arun
Taylor, Michael
Bond, Ashley
Clamp, Andrew
Wight, Rebecca
Salih, Zena
Hasan, Jurjees
Mitchell, Claire
Jayson, Gordon C.
Lal, Simon
Home Parenteral Nutrition in Patients with Advanced Cancer: Quality Outcomes from a Centralized Model of Care Delivery
title Home Parenteral Nutrition in Patients with Advanced Cancer: Quality Outcomes from a Centralized Model of Care Delivery
title_full Home Parenteral Nutrition in Patients with Advanced Cancer: Quality Outcomes from a Centralized Model of Care Delivery
title_fullStr Home Parenteral Nutrition in Patients with Advanced Cancer: Quality Outcomes from a Centralized Model of Care Delivery
title_full_unstemmed Home Parenteral Nutrition in Patients with Advanced Cancer: Quality Outcomes from a Centralized Model of Care Delivery
title_short Home Parenteral Nutrition in Patients with Advanced Cancer: Quality Outcomes from a Centralized Model of Care Delivery
title_sort home parenteral nutrition in patients with advanced cancer: quality outcomes from a centralized model of care delivery
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9414691/
https://www.ncbi.nlm.nih.gov/pubmed/36014885
http://dx.doi.org/10.3390/nu14163379
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