Variations in practice patterns for adult cancer patients on home parenteral nutrition in Canada

OBJECTIVES: Cancer has become a major indication for home parenteral nutrition (HPN). However, the use of HPN in adult cancer patients is highly variable between countries and may also differ within each country. The aim of the present study was to characterize regional variations in practice patterns for cancer patients on HPN using data from the Canadian HPN Registry. METHODS: This retrospective analysis included all cancer patients (n = 164) enrolled in the registry from 2005 to 2016. Patient demographic and clinical characteristics were described. Differences in baseline characteristics were evaluated by province and duration of HPN therapy. Survival was estimated with the Kaplan-Meier method and compared among different tumor types and provinces using the log-rank test. RESULTS: The most common tumors were gastrointestinal (54.2%) and gynecologic (31.8%). Most patients were from the provinces of Ontario (54.3%) and Alberta (41.5%). Patients who received HPN for ≥3 mo (64.6%) had a higher baseline Karnofsky Performance Status (80 versus 50) and albumin (35 versus 26 mmol/L) compared with those on HPN for <3 mo. There were no differences in survival based on tumor category. Patients in Ontario programs had a longer median survival (11.3 versus 7.1 mo) and higher proportion of secondary indications for HPN relative to patients in Alberta programs. CONCLUSIONS: Most cancer patients on HPN have gastrointestinal or gynecologic cancers. Those surviving for ≥3 mo have better baseline characteristics. Regional variability in the prevalence, selection, and survival of cancer patients receiving HPN suggests the need for consensus on the use of HPN in this population.