PW08 - COMPARISON OF PROGNOSTIC SCORES AT PREDICTING MORTALITY IN PATIENTS WITH ADVANCED MALIGNANCY IN A PALLIATIVE HOME PARENTERAL NUTRITION POPULATION.

PW08

COMPARISON OF PROGNOSTIC SCORES AT PREDICTING MORTALITY IN PATIENTS WITH ADVANCED MALIGNANCY IN A PALLIATIVE HOME PARENTERAL NUTRITION POPULATION.

E. McGowan^1,*, S. Lal^1,², M. V. Teso³, A. Teubner¹, S. Burden²

¹Salford Royal Intestinal Failure Unit, Northern Care Alliance, Salford, ²University of Manchester, Manchester, United Kingdom, ³Gastroenterology B Unit, Pancreas Centre, University of Verona, Verona, Italy

Rationale: The decision to initiate Home Parenteral Nutrition (HPN) for patients with advanced incurable cancer remains controversial, given the associated limited life expectancy.¹ In the past decade there has been a marked rise in the use of palliative HPN (pHPN) in many countries, prompting an examination of its utility and the factors influencing patient outcomes.² ESPEN guidelines recommend HPN is avoided in patients with a prognosis of less than 2 to 3 months.³ It is proposed that improved prognostic scores to aid clinician selection would help select patients who would derive most benefit from this treatment.

Methods: A review of electronic records was undertaken of all patients commenced on pHPN from a national intestinal failure centre over the last 12 years. Variables including demographics were collected to retrospectively calculate the PiPS-B and the nomogram proposed by Bozzetti. Each tool was compared to actual survival taken from the point home parenteral nutrition was commenced, recorded in days. Descriptive statistics were undertaken and Harrell’s concordance (C) statistic with 95% confidence intervals (CI) calculated from Somers’ D.

Results: There were 283 patients discharged on pHPN between January 2012 and January 2025 with a diagnosis of advanced incurable cancer, all of whom subsequently died. Mean age was 59.4 (SD 11.2) years, with 39 males (14%) and 244 females (86%). Primary tumour site was ovarian in 172 patients (61%), colorectal in 36 patients (13%), small bowel lymphoma in 18 patients (6%), with small numbers across 18 other primary sites. Median overall survival was 80 days, IQR 142. There were 187 (66%) patients who survived >56 days and 132 (46.6%) patients survived >3 months. Harrell’s C was 0.63 (95% CI 0.59, 0.67) for Bozzetti’s nomogram predicting survival at 3 months and C=0.77 (95% CI 0.72, 81) for PIPs-B for survival at 56 days.

Conclusion: PiPs-B gives a better prediction of survival at 56 days compared to Bozzetti’s nomogram predictions at 3 months for patients with advanced cancer commencing pHPN. Predicting survival using PIPs-B shows greater discrimination in distinguishing between patients with different probability levels for survival. Further refinement of prognostic tools is required to help decision making when considering pHPN.

References: 1: Sowerbutts AM, Lal S, Sremanakova J, Clamp A, Todd C, Jayson GC, Teubner A, Raftery AM, Sutton EJ, Hardy L, Burden S. Home parenteral nutrition for people with inoperable malignant bowel obstruction. Cochrane Database Syst Rev. 2018 Aug 10;8(8):CD012812. doi: 10.1002/14651858.CD012812.pub2. PMID: 30095168; PMCID: PMC6513201.

2.Smith T, Naghibi M. BANS Report 2016 Artificial Nutrition Support in the UK 2005-2015 Adult Home Parenteral Nutrition & Home Intravenous Fluids. A Report By The British Artificial Nutrition Survey (BANS) - A Committee Of BAPEN; 2017. https://www.bapen.org.uk/images/pdfs/reports/bans-report-2016.pdf

3: Arends, J., Bodoky, G., Bozzetti, F., Fearon, K. C., Muscaritoli, M., Selga, G. et al. (2006). ESPEN Guidelines on Enteral Nutrition: Non-surgical oncology. Clinical Nutrition, 25(2), 245-259.

Disclosure of Interest: None declared