SINPE Position Paper on the use of home parenteral nutrition in cancer patients

cancer patients dates back to 1975 [1], its use has never gained wide acceptance among oncologists. Only in recent years has HPN prompted renewed interest [2-4], possibly because the availability of new anticancer drugs made imperative allowing completion of scheduled therapies to achieve full benefit despite treatment-associated toxicities. A major barrier to development and implementation of HPN programmes in cancer patients is the lack of statistically robust randomized controlled trials (RCTs), which inform strong recommendations in international guidelines. However, it has been already noted [5] that the peculiar design of nutrition trials may not fully fit the procedures required to issue guidelines. In particular, the inclusion of a no-nutrition arm may not be ethically possible when hypo- or aphagic cancer patients are studied. Furthermore, the growing awareness of the role of inflammation in the pathophysiology of cancer cachexia has led some oncologists to underestimate the potential of nutritional support as if the hypophagic cachectic patient ceased to require nutritive substrates to sustain the body's physiologic functions. Finally, the uncertainty about the indications of HPN is also due