Home parenteral nutrition in advanced cancer.

The use of home parenteral nutrition (HPN) in advanced cancer evokes ethical problems related to risk/benefit, patient autonomy, justice, medical futility, and cost. Case series have been beneficial for some patients, particularly when survival is expected to be longer than 2 months. A team approach to involving the patient and family in evaluating risk and benefits is preferred. Social workers serve a key role in enabling the patient and family to make end-of-life decisions by helping them clarify the psychosocial and ethical aspects of these decisions. Clinical standards and case law will further define whether HPN in advanced cancer is futile treatment. Broader social issues of rationing, access to HPN, and costs must be addressed. Further research on outcomes and patient/family decision making on HPN are needed.