Home parenteral nutrition in advanced cancer: where are we?

Patients with advanced and incurable cancer are a compelling group. Questions and comments that these individuals and their families have may include: "My daughter is expecting our first grandchild in 3 months--can I hope to see our new family member?"; "I can't keep any food down--is there anything I can do?"; "I am worried about losing so much weight, and feeling tired and weak--is there anything that may help?"; "Will I suffer a lot?". Indeed, the most pressing concerns of the patient relate to predictions about survival and control of symptoms. The clinician taking care of the patient may wonder what is the utility or futility of home parenteral nutrition (HPN) in both the individual with advanced cancer and in this population of patients at large, whether there is potential for harm such as increasing the burden of care or prolonging suffering, and how to optimize care and communication with the patient and their families. The nutrition scientist may want to know what the implications of advanced cancer are on nutrient requirements and utilization, whether there are markers that would differentiate between cachexia and simple starvation, and whether it is possible to use specific nutrients to modify the disease process. This review will provide insights into the understanding of the role of HPN in advanced cancer and opportunities for further investigation.