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Survival of the starving cancer patient: a food for thought for oncologists

      Highlights

      • Survival of healthy people undergoing total macronutrient starvation does not exceed 2 months
      • ●Patients with untreated malignant bowel obstruction usually survive 1 month
      • ●Patients with malignant bowel obstruction and TPN usually survive >3 months

      Abstract

      Patients with untreated malignant bowel obstruction usually survive less than 1 month and death is accounted by 3 components: the tumour, the obstruction and the starvation. The potential benefit of total parenteral nutrition cannot be investigated, for ethical reasons, through RCT which would include a non-fed control arm. We hypothesized that if literature would consistently confirm that untreated malignant small bowel obstruction patients survive less than 1 month, there would be no need of randomised clinical trial to study the effect of total parenteral nutrition in these patients and such approach could potentially become part of the armamentarium of the oncologist.
      We reviewed the last 40 years of the literature on patients with malignant small bowel obstruction receiving a palliative care and distinguished 3 groups: Group I (20 studies), patients with untreated tumour, obstruction and starvation; Group II (27 studies), patients with treatment of the obstruction only, and Group III (25 studies), patients with total parenteral nutrition and some control of the obstruction.
      Median survivals were about 1, 1.5 and > 3 months in the 3 groups, respectively. Data suggest that total parenteral nutrition might benefit these patients being associated with a longer survival and sometimes allowing for further oncologic therapies.
      In conclusion, a timely intervention through parenteral nutrition should have a priority indication in a selected group of patients with malignant bowel obstruction before the occurrence of an irreversible nutritional deterioration, This would allow patients with spontaneous remission to survive longer or to be occasionally candidate for further oncologic therapies.

      Keywords

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      References

        • Dudrick S.J.
        • Wilmore D.W.
        • Vars H.M.
        • Rhoads J.E.
        Can intravenous feeding as the sole means of nutrition support growth in the child and restore weight loss in an adult? An affirmative answer.
        Ann Surg. 1969 Jun; 169 (PMID: 4976960; PMCID: PMC1387591): 974-984https://doi.org/10.1097/00000658-196906000-00018
        • Klek S.
        • Forbes A.
        • Gabe S.
        • Holst M.
        • Wanten G.
        • Irtun Ø.
        • et al.
        Management of acute intestinal failure: a position paper from the European society for clinical nutrition and metabolism (ESPEN) special interest group.
        Clin Nutr. 2016 Dec; 35 (Epub 2016 Apr 19. PMID: 27126711): 1209-1218https://doi.org/10.1016/j.clnu.2016.04.009
        • Freedman B.
        Equipoise and the ethics of clinical research.
        N Engl J Med. 1987 Jul 16; 317 (PMID: 3600702): 141-145https://doi.org/10.1056/NEJM198707163170304
        • Bozzetti F.
        • Forbes A.
        The ESPEN clinical practice Guidelines on Parenteral Nutrition: present status and perspectives for future research.
        Clin Nutr. 2009 Aug; 28 (Epub 2009 Jun 12. PMID: 19523723): 359-364https://doi.org/10.1016/j.clnu.2009.05.010
        • Abu-Rustum N.R.
        • Barakat R.R.
        • Venkatraman E.
        • Spriggs D.
        Chemotherapy and total parenteral nutrition for advanced ovarian cancer with bowel obstruction.
        Gynecol Oncol. 1997 Mar; 64 (PMID: 9062158): 493-495https://doi.org/10.1006/gyno.1996.4605
        • Arakawa S.
        • Amano K.
        • Oyamada S.
        • Maeda I.
        • Ishiki H.
        • Miura T.
        • et al.
        East-Asian Collaborative Cross-Cultural Study to Elucidate the Dying Process (EASED) Investigators. Effects of parenteral nutrition and hydration on survival in advanced cancer patients with malignant bowel obstruction: secondary analysis of a multicenter prospective cohort study.
        Support Care Cancer. 2021 Dec; 29 (Epub 2021 Jun 10. PMID: 34114097): 7541-7549https://doi.org/10.1007/s00520-021-06293-8
        • August D.A.
        • Thorn D.
        • Fisher R.L.
        • Welchek C.M.
        Home parenteral nutrition for patients with inoperable malignant bowel obstruction.
        JPEN - J Parenter Enter Nutr. 1991 May-Jun; 15 (PMID: 1907683): 323-327https://doi.org/10.1177/0148607191015003323
        • Baines M.
        • Oliver D.J.
        • Carter R.L.
        Medical management of intestinal obstruction in patients with advanced malignant disease. A clinical and pathological study.
        Lancet. 1985 Nov 2; 2: 990-993
        • Bais J.M.J.
        • Schilthuis M.S.
        • Slors J.F.M.
        • Lammes F.B.
        Intestinal obstruction in patients with advanced ovarian cancer.
        Int J Gynecol Cancer. 1995; 5: 346-350
        • Bateni S.B.
        • Gingrich A.A.
        • Kirane A.R.
        • Sauder C.A.M.
        • Gholami S.
        • Bold R.J.
        • et al.
        Chemotherapy after diagnosis of malignant bowel obstruction is associated with superior survival for medicare patients with advanced malignancy.
        Ann Surg Oncol. 2021 Nov; 28 (Epub 2021 Apr 7. PMID: 33829359; PMCID: PMC8519893): 7555-7563https://doi.org/10.1245/s10434-021-09831-0
        • Bozzetti F.
        • Cozzaglio L.
        • Biganzoli E.
        • Chiavenna G.
        • De Cicco M.
        • Donati D.
        • et al.
        Quality of life and length of survival in advanced cancer patients on home parenteral nutrition.
        Clin Nutr. 2002 Aug; 21 (PMID: 12135587): 281-288https://doi.org/10.1054/clnu.2002.0560
        • Bozzetti F.
        • Santarpia L.
        • Pironi L.
        • Thul P.
        • Klek S.
        • Gavazzi C.
        • et al.
        The prognosis of incurable cachectic cancer patients on home parenteral nutrition: a multi-centre observational study with prospective follow-up of 414 patients.
        Ann Oncol. 2014 Feb; 25 (Epub 2014 Jan 9. PMID: 24406425): 487-493https://doi.org/10.1093/annonc/mdt549
        • Brard L.
        • Weitzen S.
        • Strubel-Lagan S.L.
        • Swamy N.
        • Gordinier M.E.
        • Moore R.G.
        • et al.
        The effect of total parenteral nutrition on the survival of terminally ill ovarian cancer patients.
        Gynecol Oncol. 2006 Oct; 103 (Epub 2006 Mar 27. PMID: 16564074): 176-180https://doi.org/10.1016/j.ygyno.2006.02.013
        • Brooksbank M.A.
        • Game P.A.
        • Ashby M.A.
        Palliative venting gastrostomy in malignant intestinal obstruction.
        Palliat Med. 2002 Nov; 16 (PMID: 12465700): 520-526https://doi.org/10.1191/0269216302pm590oa
        • Cannizzaro R.
        • Bortoluzzi F.
        • Valentini M.
        • Scarabelli C.
        • Campagnutta E.
        • Sozzi M.
        • et al.
        Percutaneous endoscopic gastronomy as a decompressive technique in bowel obstruction due to abdominal carcinomatosis.
        Endoscopy. 1995; 27: 317-320
        • Cato L.D.
        • Evans T.
        • Ward S.T.
        A single-centre ten-year retrospective cohort study of malignant small bowel obstruction.
        Ann R Coll Surg Engl. 2021 Nov; 103 (Epub 2021 Aug 26. PMID: 34436951): 738-744https://doi.org/10.1308/rcsann.2021.0044
        • Chermesh I.
        • Mashiach T.
        • Amit A.
        • Haim N.
        • Papier I.
        • Efergan R.
        • et al.
        Home parenteral nutrition (HTPN) for incurable patients with cancer with gastrointestinal obstruction: do the benefits outweigh the risks?.
        Med Oncol. 2011 Mar; 28 (Epub 2010 Jan 27. PMID: 20107935): 83-88https://doi.org/10.1007/s12032-010-9426-2
        • Chouhan J.
        • Gupta R.
        • Ensor J.
        • Raghav K.
        • Fogelman D.
        • Wolff R.A.
        • et al.
        Retrospective analysis of systemic chemotherapy and total parenteral nutrition for the treatment of malignant small bowel obstruction.
        Cancer Med. 2016 Feb; 5 (Epub 2015 Dec 29. PMID: 26714799; PMCID: PMC4735773): 239-247https://doi.org/10.1002/cam4.587
        • Cotogni P.
        • Monge T.
        • Passera R.
        • Brossa L.
        • De Francesco A.
        Clinical characteristics and predictive factors of survival of 761 cancer patients on home parenteral nutrition: a prospective, cohort study.
        Cancer Med. 2020 Jul; 9 (Epub 2020 May 15. PMID: 32412178; PMCID: PMC7333857): 4686-4698https://doi.org/10.1002/cam4.3064
        • Cozzaglio L.
        • Balzola F.
        • Cosentino F.
        • DeCicco M.
        • Fellagara P.
        • Gaggiotti G.
        • et al.
        Outcome of cancer patients receiving home parenteral nutrition. Italian Society of Parenteral and Enteral Nutrition (S.I.N.P.E.).
        JPEN - J Parenter Enter Nutr. 1997 Nov-Dec; 21 (PMID: 9406131): 339-342https://doi.org/10.1177/0148607197021006339
        • Cunningham M.J.
        • Bromberg C.
        • Kredentser D.C.
        • Malfetano J.H.
        • Collins M.B.
        Percutaneous gastrostomy for decompression in patients with advanced gynecologic malignancies.
        Gynecol Oncol. 1995; 59: 273-276
        • Daniele A.
        • Ferrero A.
        • Fuso L.
        • Mineccia M.
        • Porcellana V.
        • Vassallo
        • et al.
        Palliative care in patients with ovarian cancer and bowel obstruction.
        Support Care Cancer. 2015 Nov; 23 (Epub 2015 Mar 25. PMID: 25805450): 3157-3163https://doi.org/10.1007/s00520-015-2694-9
        • Dean E.
        • Khoja L.
        • Clamp A.
        • Jayson G.C.
        • Goonetilleke D.
        • Conway A.M.
        • et al.
        Malignant bowel obstruction in advanced ovarian cancer.
        Future Oncol. 2017 Mar; 13 (Epub 2017 Jan 18. PMID: 28095701): 513-521https://doi.org/10.2217/fon-2016-0431
        • DeEulis T.G.
        • Yennurajalingam S.
        Venting gastrostomy at home for symptomatic management of bowel obstruction in advanced/recurrent ovarian malignancy: a case series.
        J Palliat Med. 2015 Aug; 18 (Epub 2015 Jun 4. PMID: 262185): 722-728https://doi.org/10.1089/jpm.2014.0355
        • Dittrich A.
        • Schubert B.
        • Kramer M.
        • Lenz F.
        • Kast K.
        • Schuler U.
        • et al.
        Benefits and risks of a percutaneous endoscopic gastrostomy (PEG) for decompression in patients with malignant gastrointestinal obstruction.
        Support Care Cancer. 2017 Sep; 25 (Epub 2017 Apr 22. PMID: 28434096): 2849-2856https://doi.org/10.1007/s00520-017-3700-1
        • Drinkwater B.
        • Clarke B.K.
        • Jones J.
        • Ratcliffe J.
        • Deel-Smith P.
        • Cooper S.C.
        Palliative home parenteral nutrition: clinical service evaluation and identifying potential prognostic factors to assist with patient selection.
        Clin Nutr ESPEN. 2017 Dec; 22 (Epub 2017 Aug 23. PMID: 29415840): 81-84https://doi.org/10.1016/j.clnesp.2017.08.004
        • Duerksen D.R.
        • Ting E.
        • Thomson P.
        • McCurdy K.
        • Linscer J.
        • Larsen-Celhar S.
        • et al.
        Is there a role for TPN in terminally ill patients with bowel obstruction?.
        Nutrition. 2004 Sep; 20 (PMID: 15325683): 760-763https://doi.org/10.1016/j.nut.2004.05.010
        • Dzierżanowski T.
        • Sobocki J.
        Survival of patients with multi-level malignant bowel obstruction on total parenteral nutrition at home.
        Nutrients. 2021 Mar 10; 13 (PMID: 33801869; PMCID: PMC8000265): 889https://doi.org/10.3390/nu13030889
        • Fan B.G.
        Parenteral nutrition prolongs the survival of patients associated with malignant gastrointestinal obstruction.
        JPEN - J Parenter Enter Nutr. 2007 Nov-Dec; 31 (PMID: 17947608): 508-510https://doi.org/10.1177/0148607107031006508
        • Fletcher J.
        • Woodham D.
        • Dera M.
        • Cooper S.C.
        Home parenteral nutrition during palliative care: little benefit.
        BMJ Support Palliat Care. 2019 Dec; 9 (Epub 2019 Apr 11. PMID: 30975714): e38https://doi.org/10.1136/bmjspcare-2018-001736
        • Gauvin G.
        • Do-Nguyen C.C.
        • Lou J.
        • O'Halloran E.A.
        • Selesner L.T.
        • Handorf E.
        • et al.
        Gastrostomy tube for nutrition and malignant bowel obstruction in patients with cancer.
        J Natl Compr Cancer Netw. 2021 Jan 6; 19 (PMID: 33406493): 48-56https://doi.org/10.6004/jnccn.2020.7604
        • Gemlo B.
        • Rayner A.A.
        • Lewis B.
        • Wong A.
        • Viele C.S.
        • Ungaretti J.R.
        • et al.
        Home support of patients with end-stage malignant bowel obstruction using hydration and venting gastrostomy.
        Am J Surg. 1988; 152: 100-104
        • Gleeson N.C.
        • Hoffman M.S.
        • Fiorica J.V.
        • Roberts W.S.
        • Cavanagh D.
        Gastrostomy tubes after gynecologic oncologic surgery.
        Gynecol Oncol. 1994 Jul; 54 (PMID: 8020833): 19-22https://doi.org/10.1006/gyno.1994.1159
        • Goldberg J.I.
        • Goldman D.A.
        • McCaskey S.
        • Koo D.J.
        • Epstein A.S.
        Illness understanding, prognostic awareness, and end-of-life care in patients with GI cancer and malignant bowel obstruction with drainage percutaneous endoscopic gastrostomy.
        JCO Oncol Pract. 2021 Feb; 17 (Epub 2020 Aug 6. PMID: 32758086; PMCID: PMC8189623): e186-e193https://doi.org/10.1200/OP.20.00035
        • Guerra E.M.
        • Cortés-Salgado A.
        • Mateo-Lobo R.
        • Nattero L.
        • Riveiro A.
        • Vega-Piñero B.
        • et al.
        Role of parenteral nutrition in oncologic patients with intestinal occlusion and peritoneal carcinomatosis.
        Nutr Hosp. 2015; 32: 1222-1227
        • Hardy J.
        • Ling J.
        • Mansi J.
        • Isaacs R.
        • Bliss J.
        • A'Hern R.
        • et al.
        Pitfalls in placebo-controlled trials in palliative care: dexamethasone for the palliation of malignant bowel obstruction.
        Palliat Med. 1998 Nov; 12 (PMID: 10621863): 437-442https://doi.org/10.1191/026921698666334766
        • Herman L.L.
        • Hoskins W.J.
        • Shike M.
        Percutaneous endoscopic gastrostomy for decompression of the stomach and small bowel.
        Gastrointest Endosc. 1992 May-Jun; 38 (PMID: 1607082): 314-318https://doi.org/10.1016/s0016-5107(92)70423-4
        • Hisanaga T.
        • Shinjo T.
        • Morita T.
        • Nakajima N.
        • Ikenaga M.
        • Tanimizu M.
        • et al.
        Multicenter prospective study on efficacy and safety of octreotide for inoperable malignant bowel obstruction.
        Jpn J Clin Oncol. 2010 Aug; 40 (Epub 2010 Apr 21. PMID: 20410056): 739-745https://doi.org/10.1093/jjco/hyq048
        • Keane N.
        • Fragkos K.C.
        • Patel P.S.
        • Bertsch F.
        • Mehta S.J.
        • Di Caro S.
        • et al.
        Performance status, prognostic scoring, and parenteral nutrition requirements predict survival in patients with advanced cancer receiving home parenteral nutrition.
        Nutr Cancer. 2018 Jan; 70 (Epub 2017 Nov 7. PMID: 29111787): 73-82https://doi.org/10.1080/01635581.2018.1380206
        • King L.A.
        • Carson L.F.
        • Konstantinides N.
        • House M.S.
        • Adcock L.L.
        • Prem K.A.
        • et al.
        Outcome assessment of home parenteral nutrition in patients with gynecologic malignancies: what have we learned in a decade of experience?.
        Gynecol Oncol. 1993 Dec; 51 (PMID: 8112649. Krebs HB, Goplerud DR. Surgical management of bowel obstruction in advanced ovarian cancer. Obstet Gynecol 1983;61: 327-382): 377-382https://doi.org/10.1006/gyno.1993.1307
        • Lau P.W.
        • Lorentz T.G.
        Results of surgery for malignant bowel obstruction in advanced, unresectable, recurrent colorectal cancer.
        Dis Colon Rectum. 1993; 36: 61-64
        • Laval G.
        • Arvieux C.
        • Stefani L.
        • Villard M.L.
        • Mestrallet J.P.
        • Cardin N.
        Protocol for the treatment of malignant inoperable bowel obstruction: a prospective study of 80 cases at Grenoble University Hospital Center.
        J Pain Symptom Manag. 2006 Jun; 31 (PMID: 16793490): 502-512https://doi.org/10.1016/j.jpainsymman.2005.10.009
        • Lilley E.J.
        • Scott J.W.
        • Goldberg J.E.
        • Cauley C.E.
        • Temel J.S.
        • Epstein A.S.
        • et al.
        Survival, healthcare utilization, and end-of-life care among older adults with malignancy-associated bowel obstruction: comparative study of surgery, venting gastrostomy, or medical management.
        Ann Surg. 2018 Apr; 267 (PMID: 28151799; PMCID: PMC7509894): 692-699https://doi.org/10.1097/SLA.0000000000002164
        • Lund B.
        • Hansen M.
        • Lundvall F.
        • Nielsen N.C.
        • Sørensen B.L.
        • Hansen H.H.
        Intestinal obstruction in patients with advanced carcinoma of the ovaries treated with combination chemotherapy.
        Surg Gynecol Obstet. 1989; 169: 213-218
        • Madhok B.M.
        • Yeluri S.
        • Haigh K.
        • Burton A.
        • Broadhead T.
        • Jayne D.G.
        Parenteral nutrition for patients with advanced ovarian malignancy.
        J Hum Nutr Diet. 2011 Apr; 24 (PMID: 21843153): 187-191https://doi.org/10.1111/j.1365-277X.2010.01127.x
        • Malone Jr., J.M.
        • Koonce T.
        • Larson D.M.
        • Freedman R.S.
        • Carrasco C.H.
        • Saul P.B.
        Palliation of small bowel obstruction by percutaneous gastrostomy in patients with progressive ovarian carcinoma.
        Obstet Gynecol. 1986 Sep; 68 (PMID: 2426641): 431-433https://doi.org/10.1097/00006250-198609000-00030
        • Mangili G.
        • Franchi M.
        • Mariani A.
        • Zanaboni F.
        • Rabaiotti E.
        • Frigerio L.
        • et al.
        Octreotide in the management of bowel obstruction in terminal ovarian cancer.
        Gynecol Oncol. 1996 Jun; 61 (PMID: 8641613): 345-348https://doi.org/10.1006/gyno.1996.0154
        • Martinez Castro P.
        • Vargas L.
        • Mancheño A.
        • Martín Utrilla S.
        • Pascual F.
        • Romero I.
        • et al.
        Malignant bowel obstruction in relapsed ovarian cancer with peritoneal carcinomatosis: an occlusive state.
        Int J Gynecol Cancer. 2017 Sep; 27 (PMID: 28704322): 1367-1372https://doi.org/10.1097/IGC.0000000000001049
        • Mercadante S.
        Bowel obstruction in home-care cancer patients: 4 years experience.
        Support Care Cancer. 1995 May; 3 (PMID: 7544674): 190-193https://doi.org/10.1007/BF00368889
        • Mercadante S.
        • Ripamonti C.
        • Casuccio A.
        • Zecca E.
        • Groff L.
        Comparison of octreotide and hyoscine butylbromide in controlling gastrointestinal symptoms due to malignant inoperable bowel obstruction.
        Support Care Cancer. 2000 May; 8 (PMID: 10789958): 188-191https://doi.org/10.1007/s005200050283
        • Moley J.F.
        • August D.
        • Norton J.A.
        • Sugarbaker P.H.
        Home parenteral nutrition for patients with advanced intraperitoneal cancers and gastrointestinal dysfunction.
        J Surg Oncol. 1986 Nov; 33 (PMID: 3095593): 186-189https://doi.org/10.1002/jso.2930330308
        • Mystakidou K.
        • Tsilika E.
        • Kalaidopoulou O.
        • Chondros K.
        • Georgaki S.
        • Papadimitriou L.
        Comparison of octreotide administration vs conservative treatment in the management of inoperable bowel obstruction in patients with far advanced cancer: a randomized, double- blind, controlled clinical trial.
        Anticancer Res. 2002 Mar-Apr; 22 (PMID: 12168923): 1187-1192
        • Patel P.S.
        • Fragkos K.C.
        • Keane N.
        • Cauldwell K.
        • O'Hanlon F.
        • Rogers J.
        • et al.
        Clinical and nutritional care pathways of patients with malignant bowel obstruction: a retrospective analysis in a tertiary UK center.
        Nutr Cancer. 2021; 73 (Epub 2020 May 21. PMID: 32434435): 572-587https://doi.org/10.1080/01635581.2020.1767165
        • Pinard K.A.
        • Goring T.N.
        • Egan B.C.
        • Koo D.J.
        Drainage percutaneous endoscopic gastrostomy for malignant bowel obstruction in gastrointestinal cancers: prognosis and implications for timing of palliative intervention.
        J Palliat Med. 2017 Jul; 20 (Epub 2017 Feb 16. PMID: 28437204; PMCID: PMC8349727): 774-778https://doi.org/10.1089/jpm.2016.0465
        • Piver M.S.
        • Barlow J.J.
        • Lele S.B.
        • et al.
        The management of ovarian cancer induced by intestinal obstruction.
        Gynecol Oncol. 1982; 13: 44-49
        • Philip J.
        • Depczynski B.
        The role of total parenteral nutrition for patients with irreversible bowel obstruction secondary to gynecological malignancy.
        J Pain Symptom Manag. 1997 Feb; 13 (PMID: 9095568): 104-111https://doi.org/10.1016/s0885-3924(96)00269-2
        • Porzio G.
        • Aielli F.
        • Verna L.
        • Galletti B.
        • Shoja E.
        • Razavi G.
        • et al.
        Can malignant bowel obstruction in advanced cancer patients be treated at home?.
        Support Care Cancer. 2011 Mar; 19: 431-433
        • Pothuri B.
        • Vaidya A.
        • Aghajanian C.
        • Venkatraman Ennapadam
        • Barakat Richard R.
        • Dennis S.
        Chi . Palliative surgery for bowel obstruction in recurrent ovarian cancer: an updated series.
        Gynecol Oncol. 2003; 89: 306-313
        • Prost À la Denise J.
        • Douard R.
        • Malamut G.
        • Mecheri F.
        • Wind P.
        Small bowel obstruction in patients with a prior history of cancer: predictive findings of malignant origins.
        World J Surg. 2014 Feb; 38 (PMID: 24142334): 363-369https://doi.org/10.1007/s00268-013-2303-3
        • Rath K.S.
        • Loseth D.
        • Muscarella P.
        • Phillips G.S.
        • Fowler J.M.
        • O'Malley D.M.
        • et al.
        Outcomes following percutaneous upper gastrointestinal decompressive tube placement for malignant bowel obstruction in ovarian cancer.
        Gynecol Oncol. 2013 Apr; 129 (Epub 2013 Jan 29. PMID: 23369942; PMCID: PMC4098040): 103-106https://doi.org/10.1016/j.ygyno.2013.01.021
        • Romeo M.
        • de Los LLanos Gil M.
        • Cuadra Urteaga J.L.
        • Vilà L.
        • Ahlal S.
        • Indacochea A.
        • et al.
        Outcome prognostic factors in inoperable malignant bowel obstruction.
        Support Care Cancer. 2016 Nov; 24 (Epub 2016 Jun 10. PMID: 27286874): 4577-4586https://doi.org/10.1007/s00520-016-3299-7
        • Rubin S.C.
        • Hoskins W.J.
        • Benjamin I.
        • Lewis J.L.
        Palliative surgery for intestinal obstruction in advanced ovarian cancer.
        Gynecol Oncol. 1989; 34: 16-19
        • Santarpia L.
        • Alfonsi L.
        • Pasanisi F.
        • De Caprio C.
        • Scalfi L.
        • Contaldo F.
        Predictive factors of survival in patients with peritoneal carcinomatosis on home parenteral nutrition.
        Nutrition. 2006 Apr; 22 (Epub 2006 Jan 18. PMID: 16413750): 355-360https://doi.org/10.1016/j.nut.2005.06.011
        • Scheidbach H.
        • Horbach T.
        • Groitl H.
        • Hohenberger W.
        Percutaneous endoscopic gastrostomy/jejunostomy (PEG/PEJ) for decompression in the upper gastrointestinal tract. Initial experience with palliative treatment of gastrointestinal obstruction in terminally ill patients with advanced carcinomas.
        Surg Endosc. 1999 Nov; 13 (PMID: 10556447): 1103-1105https://doi.org/10.1007/s004649901182
        • Shaw C.
        • Bassett R.L.
        • Fox P.S.
        • Schmeler K.M.
        • Overman M.J.
        • Wallace M.J.
        • et al.
        Palliative venting gastrostomy in patients with malignant bowel obstruction and ascites.
        Ann Surg Oncol. 2013 Feb; 20 (Epub 2012 Sep 11. PMID: 22965572; PMCID: PMC4262403): 497-505https://doi.org/10.1245/s10434-012-2643-5
        • Shinoda M.
        • Kojima M.
        • Fukase T.
        • Ueno H.
        • Ogihara T.
        Percutaneous transgastric intestinal decompression: the management of malignant bowel obstruction without nasal intubation.
        Surg Today. 1994; 24 (PMID: 7894197): 937-939https://doi.org/10.1007/BF01651015
        • Singh Curry R.
        • Evans E.
        • Raftery A.M.
        • Hiscock J.
        • Poolman M.
        Percutaneous venting gastrostomy/gastrojejunostomy for malignant bowel obstruction: a qualitative study.
        BMJ Support Palliat Care. 2019 Dec; 9 (Epub 2019 Oct 9. PMID: 31597626): 381-388https://doi.org/10.1136/bmjspcare-2019-001866
        • Soo I.
        • Gramlich L.
        Use of parenteral nutrition in patients with advanced cancer.
        Appl Physiol Nutr Metabol. 2008 Feb; 33 (PMID: 18347659): 102-106https://doi.org/10.1139/H07-152
        • Soo K.C.
        • Davidson T.
        • Parker M.
        • Paterson I.
        • Paterson A.
        Intestinal obstruction in patients with gynaecological malignancies.
        Ann Acad Med Singapore. 1988 Jan; 17 (PMID: 2461141): 72-75
        • Suidan R.S.
        • He W.
        • Sun C.C.
        • Zhao H.
        • Ramondetta L.M.
        • Badgwell B.D.
        • et al.
        Treatment patterns, outcomes, and costs for bowel obstruction in ovarian cancer.
        Int J Gynecol Cancer. 2017 Sep; 27 (PMID: 28574929; PMCID: PMC5862427): 1350-1359https://doi.org/10.1097/IGC.0000000000000998
        • Teriaky A.
        • Gregor J.
        • Chande N.
        Percutaneous endoscopic gastrostomy tube placement for end-stage palliation of malignant gastrointestinal obstructions.
        Saudi J Gastroenterol. 2012 Mar-Apr; 18 (PMID: 22421713; PMCID: PMC3326983): 95-98https://doi.org/10.4103/1319-3767.93808
        • Tsahalina E.
        • Woolas R.P.
        • Carter P.G.
        • Chan F.
        • Gore M.E.
        • Blake P.M.
        • et al.
        Gastrostomy tubes in patients with recurrent gynaecological cancer and intestinal obstruction.
        Br J Obstet Gynaecol. 1999 Sep; 106 (PMID: 10492110): 964-968https://doi.org/10.1111/j.1471-0528.1999.tb08438.x
        • Tuca A.
        • Guell E.
        • Martinez-Losada E.
        • Codorniu N.
        Malignant bowel obstruction in advanced cancer patients: epidemiology, management, and factors influencing spontaneous resolution.
        Cancer Manag Res. 2012; 4 (Epub 2012 Jun 13. PMID: 22904637; PMCID: PMC3421464): 159-169https://doi.org/10.2147/CMAR.S29297
        • Tunca J.C.
        • Buchler D.A.
        • Mack F.F.
        • Ruzicka J J Crowley
        • Carr W.F.
        The management of ovarian-cancer caused bowel obstruction.
        Gynecol Oncol. 1981; 12: 186-192
        • Turnbull A.D.
        • Guerra J.
        • Starnes H.F.
        Results of surgery for obstructing carcinomatosis of gastrointestinal, pancreatic, or biliary origin.
        J Clin Oncol. 1989; 7: 381-386
        • van Ooijen B.
        • van der Burg M.E.L.
        • ASTh Planting
        • Siersema P.D.
        • Wiggers T.
        Surgical treatment or gastric drainage only for intestinal obstruction in patients with carcinoma of the ovary or peritoneal carcinomatosis of other origin.
        Surg Gynecol Obstet. 1993; 176: 469-474
        • Weber C.
        • Zulian G.B.
        Malignant irreversible intestinal obstruction: the powerful association of octreotide to corticosteroids, antiemetics, and analgesics.
        Am J Hosp Palliat Care. 2009 Apr-May; 26 (Epub 2008 Dec 16. PMID: 19088264): 84-88https://doi.org/10.1177/1049909108327967
        • Zucchi E.
        • Fornasarig M.
        • Martella L.
        • Maiero S.
        • Lucia E.
        • Borsatti E.
        • et al.
        Decompressive percutaneous endoscopic gastrostomy in advanced cancer patients with small-bowel obstruction is feasible and effective: a large prospective study.
        Support Care Cancer. 2016 Jul; 24 (Epub 2016 Feb 2): 2877-2882https://doi.org/10.1007/s00520-016-3102-9
        • Kerndt P.R.
        • Naughton J.L.
        • Driscoll C.E.
        • Loxterkamp D.A.
        Fasting: the history, pathophysiology and complications.
        West J Med. 1982 Nov; 137 (PMID: 6758355; PMCID: PMC1274154): 379-399
        • Elia M.
        Hunger disease.
        Clin Nutr. 2000 Dec; 19 (PMID: 1110458726838026): 379-386https://doi.org/10.1054/clnu.2000.0157
        • Altun G.
        • Akansu B.
        • Altun B.U.
        • Azmak D.
        • Yilmaz A.
        Deaths due to hunger strike: post-mortem findings.
        Forensic Sci Int. 2004 Nov 10; 146 (PMID: 15485719): 35-38https://doi.org/10.1016/j.forsciint.2004.03.022
        • Ganzini L.
        • Goy E.R.
        • Miller L.L.
        • Harvath T.A.
        • Jackson A.
        • Delorit M.A.
        Nurses' experiences with hospice patients who refuse food and fluids to hasten death.
        N Engl J Med. 2003 Jul 24; 349 (PMID: 12878744): 359-365https://doi.org/10.1056/NEJMsa035086
        • Bolt E.E.
        • Hagens M.
        • Willems D.
        • Onwuteaka-Philipsen B.D.
        Primary care patients hastening death by voluntarily stopping eating and drinking.
        Ann Fam Med. 2015 Sep; 13 (PMID: 26371262; PMCID: PMC4569449): 421-428https://doi.org/10.1370/afm.1814
        • Stewart W.K.
        • Fleming L.W.
        Features cf a successful therapeutic fast of 382 days' duration.
        Postgrad Med. 1973 Mar; 49: 203-209
        • Cotogni P.
        • Ossola M.
        • Passera R.
        • Monge T.
        • Fadda M.
        • De Francesco A.
        • et al.
        Home parenteral nutrition versus artificial hydration in malnourished patients with cancer in palliative care: a prospective, cohort survival study.
        BMJ Support Palliat Care. 2020 Aug; 21 (bmjspcare-2020-002343) (Epub ahead of print. PMID: 32826263)https://doi.org/10.1136/bmjspcare-2020-002343
        • Bozzetti F.
        • Caccialanza R.
        • Cotogni P.
        • Finocchiaro C.
        • Pironi L.
        • Santarpia L.
        • et al.
        SINPE position paper on home parenteral nutrition in cancer patients. Support care cancer.
        Support Care Cancer. 2022 Apr; 30 (PMID: 35037119. Nutrition. 2022 Mar;95:111578. doi: 10.1016/j.nut.2021.111578. Epub 2022 Jan 10. PMID: 35058116): 2909-2914https://doi.org/10.1007/s00520-021-06785-7
        • Cotogni P.
        • De Carli L.
        • Passera R.
        • Amerio M.L.
        • Agnello E.
        • Fadda M.
        • et al.
        Longitudinal study of quality of life in advanced cancer patients on home parenteral nutrition.
        Cancer Med. 2017 Jul; 6 (Epub 2017 May 29. PMID 1): 1799-1806https://doi.org/10.1002/cam4.1111
        • Cotogni P.
        • Monge T.
        • Fadda M.
        • De Francesco A.
        Bioelectrical impedance analysis for monitoring cancer patients receiving chemotherapy and home parenteral nutrition.
        BMC Cancer. 2018 Oct 17; 18 (PMID: 30332998; PMCID: PMC6192128): 990https://doi.org/10.1186/s12885-018-4904-6
        • Larson J.E.
        • Podczaski E.S.
        • Manetta A.
        • Whitney C.W.
        • Mortel R.
        Bowel obstruction in patients with ovarian carcinoma: analysis of prognostic factors.
        Gynecol Oncol. 1989 Oct; 35 (PMID: 2477316): 61-65https://doi.org/10.1016/0090-8258(89)90012-7
        • Lee M.J.
        • Sayers A.E.
        • Drake T.M.
        • Singh P.
        • Bradburn M.
        • Wilson T.R.
        • et al.
        NASBO Steering Group and NASBO Collaborators. Malnutrition, nutritional interventions and clinical outcomes of patients with acute small bowel obstruction: results from a national, multicentre, prospective audit.
        BMJ Open. 2019 Jul 27; 9 (PMID: 31352419; PMCID: PMC6661661)e029235https://doi.org/10.1136/bmjopen-2019-029235
        • Bozzetti F.
        • Cotogni P.
        • Lo Vullo S.
        • Pironi L.
        • Giardiello D.
        • Mariani L.
        Development and validation of a nomogram to predict survival in incurable cachectic cancer patients on home parenteral nutrition.
        Ann Oncol. 2015 Nov; 26 (Epub 2015 Sep 7. PMID: 26347103): 2335-2340https://doi.org/10.1093/annonc/mdv365
        • Feuer D.J.
        • Broadley K.E.
        Corticosteroids for the resolution of malignant bowel obstruction in advanced gynaecological and gastrointestinal cancer.
        Cochrane Database Syst Rev. 2000; 2000 (PMID: 10796761; PMCID: PMC6481479: 28557362; PMCID: PMC5504329): CD001219https://doi.org/10.1002/14651858.CD001219
        • Martin L.
        • Muscaritoli M.
        • Bourdel-Marchasson I.
        • Kubrak C.
        • Laird B.
        • Gagnon B.
        • et al.
        Diagnostic criteria for cancer cachexia: reduced food intake and inflammation predict weight loss and survival in an international, multi-cohort analysis.
        J Cachexia Sarcopenia Muscle. 2021 Oct; 12 (Epub 2021 Aug 27. PMID: 34448539; PMCID: PMC8517347): 1189-1202https://doi.org/10.1002/jcsm.12756
        • Naghibi M.
        • Smith T.R.
        • Elia M.
        A systematic review with meta-analysis of survival, quality of life and cost-effectiveness of home parenteral nutrition in patients with inoperable malignant bowel obstruction.
        Clin Nutr. 2015 Oct; 34 (Epub 2014 Sep 27. PMID: 25288565): 825-837https://doi.org/10.1016/j.clnu.2014.09.010
        • Sowerbutts A.M.
        • Lal S.
        • Sremanakova J.
        • Clamp A.
        • Todd C.
        • Jayson G. C e al
        Home parenteral nutrition for people with inoperable malignant bowel obstruction.
        Cochrane Database Syst Rev. 2018; 8 (CD012812)https://doi.org/10.1002/14651858.CD012812.pub2
        • Solassol C.
        • Dubois J.B.
        Total parenteral nutrition (TPN) with complete nutritive mixtures: an artificial gut in cancer patients.
        Nutr Cancer. 1979; 1: 13-18
        • Oh S.Y.
        • Jun H.J.
        • Park S.J.
        • Park I.K.
        • Lim G.J.
        • Yu Y.
        • et al.
        A randomized phase II study to assess the effectiveness of fluid therapy or intensive nutritional support on survival in patients with advanced cancer who cannot be nourished via enteral route.
        J Palliat Med. 2014 Nov; 17 (Epub 2014 Jul 1. PMID: 24984081): 1266-1270https://doi.org/10.1089/jpm.2014.0082
        • Altman D.G.
        • Bland J.M.
        • et al.
        Absence of evidence is not evidence of absence.
        BMJ. 1995; 311 (Aug 19, PMID: 7647644; PMCID: PMC2550545): 485https://doi.org/10.1136/bmj.311.7003.485
        • Cheng A.L.
        • Kang Y.K.
        • Chen Z.
        • Tsao C.J.
        • Qin S.
        • Kim J.S.
        • et al.
        Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma: a phase III randomised, double-blind, placebo-controlled trial.
        Lancet Oncol. 2009; 10: 25-34
        • O’Hanlon F.J.
        • Fragkos R.
        • Fini K.C.
        • Patel P.S.
        • Mehta S.J.
        • Rahman F.
        • et al.
        Home parenteral nutrition in patients with advanced cancer: a systematic review and meta-analysis.
        Nutr Cancer. 2021; 73 (Epub 2020 Jun 25. PMID: 32586120): 943-955https://doi.org/10.1080/01635581.2020.1784441
      1. Ong X.S., Sultana R., Tan J.W., Tan Q.X., Wong J.S.M., Chia C.S., et al. The role of total parenteral nutrition in patients with peritoneal carcinomatosis: a systematic review and meta-analysis. Cancers 2021 Aug 18;13(16):4156. doi:10.3390/cancers13164156. PMID: 34439309; PMCID: PMC8393754.