The clinical outcomes of 2968 patients with active
cancer receiving home nutrition support are described. Of these patients 1672 were receiving
home parenteral nutrition and 1296 were receiving home
enteral nutrition. The outcomes of these active
cancer patients are compared to those of 123 radiation
enteritis ("cured"
cancer) and 480
Crohn's disease patients receiving
home parenteral nutrition and 918 noncancer dysphagic patients receiving home
enteral nutrition. This longitudinal clinical information was reported to the North American Home Parenteral and
Enteral Nutrition Patient Registry between 1985 and 1990. Evidence indicates that the number of home parenteral and
enteral nutrition patients has increased nationally by about 25% each year between 1989 and 1990. In a subsample of 37 home nutrition support programs that have consistently reported their data to the registry since 1985, more than 90% of their program growth was accounted for by new patients with active
cancer. This is now the largest single diagnosis of patients starting home parenteral and
enteral nutrition. The mean survival time of
cancer patients is 6 months after starting home parenteral and
enteral nutrition, but 25% live beyond a year and 20% resume full oral nutrition. Although most active
cancer patients experience only partial rehabilitation, for those patients with longer survival, rehabilitation is more complete. The outcome is relatively better for children and for patients whose
neoplasm is
leukemia,
lymphoma, small bowel, or liver. In comparison, 96% of
home parenteral nutrition Crohn's patients, 80% of
home parenteral nutrition radiation
enteritis patients, and 60% of home
enteral nutrition noncancer dysphagic patients survive at least 1 year. Adult active
cancer home parenteral and
enteral nutrition patients do not have a greater incidence of
therapy-related readmissions than other patient groups, however, their overall
rehospitalization rate is much more frequent. This article discusses factors that may have contributed to this growth in home nutrition support in active
cancer patients. It attempts to clarify where this
therapy is clearly justified and where more information is needed. It emphasizes some of the special issues that need to be addressed in treating these vulnerable patients.