Supplementary parenteral nutrition in patients with malignant disease

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Much of the morbidity and mortality of malignant disease is due to the profound nutritional depletion caused by the disease. This is particularly true of gastrointestinal related malignancies. Recently Dudrick1 described weight gain, increase in strength and activity, and positive nitrogen balance in patients with malignancies treated with supplementary parenteral nutrition. Schwartz et al2 have also shown parenteral nutrition to be of significant value when combined simultaneously with chemotherapy in the treatment of patients with disseminated carcinoma. However, serious complications can occur which preclude indiscriminate application of parenteral nutrition, especially in patients weakened by malignant disease. This paper reports results of a prospective clinical study undertaken specifically to establish guidelines for the use of total or supplemental parenteral nutrition as an adjunct to the treatment of cancer patients.

Clinical material and methods

Twenty-three patients are included in the study. All patients had malignant disease and received either supplemental or total parenteral nutrition during hospitalization at the Cleveland Clinic or at St. Vincent Charity Hospital, Cleveland, Ohio. Table 1 lists the patients according to site of tumor. As indications for parenteral nutrition all patients had (1) a 20% weight loss from predisease weight, with marked weakness or significant hypoalbuminemia; or (2) a prolonged postoperative course complicated by poor wound healing, wound dehiscence, or fistula formation (Table 2). An operative procedure confirmed the diagnosis of malignancy in all 23 patients. The seven patients selected for treatment preoperatively were given supplemental parenteral nutrition in addition to oral feedings. The 16 patients treated in . . .



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