Parenteral Nutrition for treating ovarian cancer

Saakshi Bangera, DY Patil School of Biotechnology and Bioinformatics

Ovarian cancer causes a higher mortality rate in women, as compared to other gynaecological cancers. It is characterized by a late presentation and the absence of obvious symptoms. The late diagnosis of ovarian cancer leads to reduced calorie intake and eventually malnutrition. Malnutrition is presumed to increase the frequency of complications in the advanced stages of cancer. This results in the subsided quality of life and decreased rate of survival. 

Total parenteral nutrition (TPN) is an intravenous method of feeding nutrients that bypass the digestive tract. It displays the potential to improve malnutrition in cancer patients. Despite its debatable role in other advanced-stage cancers, it can successfully help last-stage ovarian cancer patients. According to current guidelines, Total parenteral nutritionshould be commenced when malnourished cancer patients become unable to derive nutrients through the gastrointestinal tract. 

This study comprises of two main purposes:

• Identification of risk factors that associate malnutrition status with patient survival. 
• Comparison of outcomes of such patients treated with TPN after bowel resection and debulking surgery. 

Progression-free survival (PFS) and Overall Survival (OS) were also measured

Progression-free survival is described as the time from initiation of treatment to the onset of disease progression.

Findings of the study

Characteristics of the patient

In this study, 415 patients were included. These patients had undergone surgery incorporating bowel resection for advanced ovarian cancer. 

Based on the Nutritional Risk Index (NRI) score, the patients were separated into  

• Nourished
• Mildly malnourished
• Moderately malnourished
• Severely malnourished

A substantial difference was observed for PFS and OS among the patient sets. A large number of patients were suffering from stage 3 cancer displayed optimal cytoreduction. Nutrition status was observed to worsen with the fall in serum albumin level and body mass index. Mildly and severely malnourished patients were observed to be younger than moderately nourished and nourished patients. 

Prediction of survival outcome of the patient

In the Univariate analysis, patients’ age, Nutritional Risk Index, and serum albumin level were considerably associated with progression-free survival of patients. In multivariate analysis, these factors independently predicted poor survival. 

The impact of TPN on malnutrition

28.9% of patients received TPN and 140 patients received conservative nutritional management post-surgery. Any significant differences in the terms of age, BMI and NRI at admission, type of bowel resection, and several complications were not observed. Post-operative complications were observed by 4 patients in the Total parenteral nutrition group and 11 patients in the management group. 2 patients in the TPN group experienced bowel obstruction and the other two patients experienced entero-cutaneous fistula. They were treated accordingly. In the conservative management group, 8 people suffered from surgical site infection and were readmitted for treatment. Upon regression analysis, it was concluded that lower serum albumin, number of complications, and the use of TPN were closely related to the duration of stay at the hospital. 

Discussion and conclusion

Using the Nutritional Risk Index (NRI) scoring system, nearly half of the total patients were diagnosed to be moderately or severely malnourished. BMI values that were measured at admission and after surgery were found to lack relation with overall survival of patients. Among the nutritional groups, these values were different. This differential value was probable due to postoperative fluid gain. Additionally, this might explain the decreased level of serum albumin in malnourished patients. The use of TPN in the treatment of patients in this study proved to reduce the time of hospitalization. However, it failed to influence the time required to restore bowel function and the number of postoperative difficulties. 

To summarize,

• Half the patient population suffering from ovarian cancer at an advanced stage suffered from moderate or severe malnutrition. 
• Serum albumin level and NRI score at admission were correlated with poor survival
• Lower serum albumin level, use of total parenteral nutrition, and numbers of complications were strongly related to the length of hospital stay.

These suggest that TPN should be considered to treat patients suffering from ovarian cancer of late.

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Source:

Yan, X., Zhang, S., Jia, J. et al. Exploring the malnutrition status and impact of total parenteral nutrition on the outcome of patients with advanced stage ovarian cancer. BMC Cancer 21, 799 (2021). https://doi.org/10.1186/s12885-021-08537-6 

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About the author: Saakshi is currently pursuing MSc in Biotechnology from DY Patil School of Biotechnology and Bioinformatics. She believes that she doesn’t have a specific area of interest yet. She wishes to explore toxicology and food biotechnology. She’s quite passionate about Biotechnology and aims to grab every opportunity she comes across.