ABSTRACT
An array of clinical ambiguities, many with signišcant ethical and moral charge, plagues end-of-life care. The benešt of providing supplemental nutrition, i.e., additional nutrients beyond that which the patient is able to ingest, represents one such ambiguity. The advanced cancer patient’s ability to eat normally is often compromised by tumor burden, chemotherapy, and other treatment regimens. Clinicians, and often families and other caregivers, struggle with the perception that the patient cannot eat in adequate quantity, and with the choice of whether and how to deliver nutritional support. Despite the prevalence of this concern, there is no established protocol delineating the best clinical approach to ensure that advanced cancer patients receive sufšcient nutrition. The relationship of
25.1 Introduction .......................................................................................................................... 289 25.2 Metabolic Changes in the Patient with Advanced Cancer ...................................................290 25.3 Cancer Anorexia-Cachexia Syndrome ................................................................................. 291 25.4 Total Parenteral Nutrition .....................................................................................................292 25.5 Clinical Risks Associated with TPN ....................................................................................292 25.6 Potential Negative Effects of TPN ........................................................................................ 293 25.7 Potential Positive Effects of TPN .........................................................................................294 25.8 Applications to Other Areas of Terminal or Palliative Care ................................................ 295 25.9 Guidelines for Clinical Practice ........................................................................................... 295
25.9.1 Guidelines for Patients with Advanced Cancer ........................................................ 295 25.9.2 Additional Factors In¬uencing the Palliative Use of TPN ....................................... 295 25.9.3 TPN: A Pragmatic Clinical Approach ......................................................................297
