1. Evaluation of Parenteral Nutrition Utilization in Oncology Patients
CPA-MPS Conference Malaysia 2007
Evaluation of Parenteral Nutrition Utilization in Oncology Patients
Sivakami Janahiraman, SM Yew, Che Ton Saari Pharmacy Division, Hospital Kuala Lumpur (HKL)

2. INTRODUCTION
Parenteral Nutrition (PN) -therapeutic intravenous administration of nutrients
Indicated in cases where oral or enteral feeding is:-
Insufficient
Impossible
Undesirable
(Messing B, 2000; Giovanni F et al, 1999)

3. INTRODUCTION
Malnutrition is a common manifestation of cancer which is often present with loss of appetite and ineffective utilization of nutrients.
Impact of malnutrition:
Higher risk of infection
Poorer tolerance and response to treatment
Lower quality of life
Shorter survival
(Grant et al, 1994; Ottery, 1996; Nitenberg & Raynard, 2000)

4. INTRODUCTION The use of nutritional therapy in cancer
patients is tailored to complement the
primary treatment
PN support in surgery
PN support during chemotherapy
PN in radiation therapy

5. GENERAL OBJECTIVE To elucidate the appropriateness of PN
support in cancer patients using the criteria of nutritional status and ultimate outcome

6. SPECIFIC OBJECTIVES
To identify the demographic characteristics of cancer patients
To obtain the diagnosis or related medical problem of patients
To identify the method of PN delivery
To analyze the quantity of PN preparations and duration of nutritional support provided
To evaluate type of regimen administered to patients

7. METHODOLOGY Setting: Hospital Kuala Lumpur Design: Retrospective study
Subjects: Cancer patients
Study location:
Record Units - Wisma Kayu (K2)
Surgical Out-Patient Dept
Oncology and Radiotherapy Dept
Urology and Nephrology Dept
Study period: January 2005 – December 2005

8. SELECTION CRITERIA INCLUSION CRITERIA EXCLUSION CRITERIA
Adult (>18 years) patients
Paediatric (<18years) patients
Received Total Parenteral Nutrition
Preterm neonates
Patients with complete medical record

9. STUDY FLOW CHART SCREENING OF PATIENTS’ RECORD IN TPN PHARMACY (n=159)
PATIENTS FIT INCLUSION / EXCLUSION CRITERIA
SELECTED AS SUBJECTS (n=69)
DATA COLLECTION
RECORD UNIT

10. (filling up incomplete details)
STUDY FLOW CHART
K 2, SOPD, RT & UN
DATA COMPLETION
(filling up incomplete details)
COMPLETE DATA (n=56)
INSUFFICIENT DATA
DATA ANALYSIS
REJECTED (n=13)
CONCLUSION

11. METHODOLOGY Nutritional status was determined by:
Serum albumin level < 35 g/L
(Jeliffe 1966; Bishop et al 1981, Ireton J & Hasse J 1992)
Total protein < 60g/L
(Jeliffe 1966, Bishop et al 1981, Kotler DP 2000 )
Total lymphocyte count < 1.5 x 10-9/L
(Jeliffe 1966; Bishop et al 1981)
Ultimate outcome were one of the following:
Improved
Declined
Death

12. RESULTS & DISCUSSION

13. Distribution of patients by age and gender
DEMOGRAPHIC
Distribution of patients by age and gender
Mean age : female (23.2%) years
male (76.8%) years
There was no significant association between age and gender (p = 0.424).
Majority of subjects were Malays(28) followed by Chinese(17) and Indians(11).

15. Route of PN administration
Peripheral – 1 to 15 days (mean 5 + 7days)
Central – 1 to 25 days (mean days)

16. Total PN preparations provided to patients

17. 23% of the patients received compounded PN upon initiation (n=13).

19. 93% malnourished
70% malnourished
73% malnourished

20. 55% malnourished
48% malnourished
37% malnourished
Nutritional status correlated positively with albumin, total protein and total lymphocyte count (r=0.312, p<0.01).

21. No significant difference in nutritional status among cancer patients with
regard to duration of PN provided {F(1,54) = 0.238, p>0.05}.

22. No significant difference in outcome and duration of PN supplementation

23. DISCUSSION
Prevalence of malnutrition in this study as identified by using serum albumin, total protein and TLC as indicator was comparable to that found in other studies
Bauer et al 2002 – prevalence of malnutrition in oncology inpatients ~ 76%
Results of nutritional status and outcomes differ from other similar studies
Neither adjunctive therapy nor supportive PN improved quality of life and ultimate outcome in terminally ill cancer patients
(Giovanni et al 1999)

24. CONCLUSION
Most oncology patients are malnourished before nutritional intervention
Early identification of patients at risk of malnutrition is necessary
Carefully targeted parenteral nutrition may benefit patients and improve outcome

25. Thank You….