全靜脈營養於晚期癌症病人現有文獻結果之整理與介紹

Total Parenteral Nutrition in the Advanced Cancer Patients- Review of Current Articles

10.6537/TJHPC.202211_26(3).03

莊子瑩(Tzu-Ying Chuang)；楊久嫻(Chiu-Hsien Yang)；李純瑩(Chun-Ying Lee)；吳建誼(Chien-Yi Wu)

全靜脈營養 ； 晚期癌症 ； 安寧緩和療護 ； 醫病共享決策 ； total parenteral nutrition ； advanced cancer ； palliative care ； shared decision making

安寧療護雜誌

26卷3期（2022 / 11 / 01）

239 - 250

繁體中文

晚期癌症病人常面臨營養不良與惡病質的問題，營養支持對於這類病人以及醫療人員始終是一大課題，歷年國際組織嘗試對於經口飲食困難病人的營養介入提出臨床指引，不過相關研究及證據力仍是缺乏，而本文章目的在於整合近年關於全靜脈營養（total parenteral nutrition, TPN）使用於晚期癌症病人之較新的研究結果，以提供臨床應用之參考。總結相關文獻結果，目前晚期癌症病人使用TPN對於其存活期並無影響，對提升生活品質和身體功能亦無一致的結果，且有文獻提出TPN於惡性疾病使用所需帶來的巨大花費更提醒臨床上需要更強力的理由來支持使用，基於安寧緩和療護以提升病人的舒適度、生活品質的原則，為了減少不必要的TPN營養使用，同時消弭病人和家屬對於無法進食、日漸消瘦的焦慮與恐懼，需透過完善的醫病共享決策過程，提供病人及家屬足夠的醫療臨床證據，並了解病人與家屬的想法與價值觀，經由充分溝通後整合出最適宜的照護方針。

Patients with advanced cancer often face the problems of malnutrition and cachexia. Nutritional support is always a challenging issue for these patients and medical professionals. Over the years, international organizations have strived to provide relevant clinical guidelines for the nutritional intervention of patients with oral intake difficulties. However, relevant research and evidence are still lacking. Thus, the purpose of this article is to integrate recent relevant research findings on total parenteral nutrition (TPN) in improving the survival rate, quality of life, and possible side effects of advanced cancer patients to provide a clinical reference. Summarizing the systematic reviews and the results of the meta-analysis suggest that the use of TPN for patients with advanced cancer has no effect on their survival, and there is no consistent result in improving the quality of life and physical function. Some literature proposes that the considerable cost of using TPN for malignant diseases reminds the need for stronger reasons to support the use of TPN. Based on the principle of palliative care is to improve the patient's comfort and quality of life, it is necessary to provide patients and their families with sufficient medical clinical evidence and understand their thoughts and values through a comprehensive shared decision-making process and thus propose an appropriate care plan.

1. Arhip, L,Serrano-Moreno, C,Romero, I,Camblor, M,Cuerda, C(2021).The economic costs of home parenteral nutrition: Systematic review of partial and full economic evaluations.Clin Nutr,40,339-349.
2. Aría Guerra, E,Cortés-Salgado, A,Mateo-Lobo, R(2015).ROLE OF PARENTERAL NUTRITION IN ONCOLOGIC PATIENTS WITH INTESTINAL OCCLUSION AND PERITONEAL CARCINOMATOSIS.Nutr Hos,32,1222-1227.
3. August, DA,Huhmann, MB,Parenteral, ASf,Directors ENBo(2009).A.S.P.E.N. Clinical Guidelines: Nutrition Support Therapy During Adult Anticancer Treatment and in Hematopoietic Cell Transplantation.JPEN J Parenter Enteral Nutr,33,472-500.
4. Bozzetti, F,Arends, J,Lundholm, K,Micklewright, A,Zurcher, G,Muscaritoli, M(2009).ESPEN Guidelines on Parenteral Nutrition: non-surgical oncology.Clin Nutr,28,445-454.
5. Bozzetti, F,Cozzaglio, L,Biganzoli, E(2002).Quality of life and length of survival in advanced cancer patients on home parenteral nutrition.Clinical Nutrition,21,281-288.
6. Cozzaglio, L,Balzola, F,Cosentino, F(1997).Outcome of cancer patients receiving home parenteral nutrition. Italian Society of Parenteral and Enteral Nutrition (S.I.N.P.E.).JPEN J Parenter Enteral Nutr,21,339-342.
7. De Cicco, M,Panarello, G,Fantin, D(1993).Parenteral nutrition in cancer patients receiving chemotherapy: effects on toxicity and nutritional status.JPEN J Parenter Enteral Nutr,17,513-518.
8. Ditto, PH,Hawkins, NA(2005).Advance directives and cancer decision making near the end of life.Health Psychol,24,S63-S70.
9. Dy, SM(2006).Enteral and parenteral nutrition in terminally ill cancer patients: a review of the literature.Am J Hosp Palliat Care,23,369-377.
10. Fearon, KC(2008).Cancer cachexia: developing multimodal therapy for a multidimensional problem.Eur J Cancer,44,1124-1132.
11. Huang, HL,Tsai, JS,Yao, CA,Cheng, SY,Hu, WY,Chiu, TY(2020).Shared decision making with oncologists and palliative care specialists effectively increases the documentation of the preferences for do not resuscitate and artificial nutrition and hydration in patients with advanced cancer: a model testing study.BMC palliative care,19,17.
12. Koretz, RL,Lipman, TO,Klein, S(2001).AGA technical review on parenteral nutrition.Gastroenterology,121,970-1001.
13. Morita, T,Bito, S,Koyama, H,Uchitomi, Y,Adachi, I(2007).Development of a national clinical guideline for artificial hydration therapy for terminally ill patients with cancer.J Palliat Med,10,770-780.
14. Muscaritoli, M,Molfino, A,Laviano, A,Rasio, D,Rossi Fanelli, F(2012).Parenteral nutrition in advanced cancer patients.Crit Rev Oncol Hematol,84(1),26-36.
15. Naghibi, M,Smith, TR,Elia, M(2015).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,34,825-837.
16. Ozcelik, H,Gozum, S,Ozer, Z(2019).Is home parenteral nutrition safe for cancer patients? Positive effects and potential catheter-related complications: A systematic review.Eur J Cancer Care,28,e13003.
17. Tobberup, R,Thoresen, L,Falkmer, UG,Yilmaz, MK,Solheim, TS,Balstad, TR(2019).Effects of current parenteral nutrition treatment on health-related quality of life, physical function, nutritional status, survival and adverse events exclusively in patients with advanced cancer: A systematic literature review.Crit Rev Oncol Hematol,139,96-107.
18. Vigano, A,Donaldson, N,Higginson, IJ,Bruera, E,Mahmud, S,Suarez-Almazor, M(2004).Quality of life and survival prediction in terminal cancer patients: a multicenter study.Cancer,101,1090-1098.
19. 李貞慧,林宜芬,金惠民(2015)。癌末病人安寧療護之營養照護。北市醫學雜誌，12，27-34。
20. 邱泰源(2004)。安寧緩和醫療常見倫理困境及解決之道。台灣醫學，8，672-683。
21. 翁慈羚,鄭博仁,林明慧(2021)。末期癌症病人人工營養補充議題之探討。家庭醫學與基層醫療，36，108-113。
22. 衛生福利部。病人自主權利法施行細則。2018。