TERMINALLY ILL PATIENT

Terminally Ill Patient



Terminally Ill Patient

ABstract

Total parenteral nutrition (TPN) is often used as an adjunct to cancer therapy. However, it is increasingly being used in terminally ill cancer patients without clearly defined reasons. To determine the validity of the use of TPN in terminally ill cancer patients, 26 patients with limited life expectancy due to end-stage cancer were given TPN by their physicians, and the validity of its use was evaluated using the criteria of 1) quality of life, and 2) ultimate outcome. Patients were divided into two groups according to the use of TPN. Group I = TPN as adjunct of medical therapy, n = 15 (eight male, seven female), mean age 32 y. Group II = TPN for in-hospital supportive care, n = 11 (two male, nine female), mean age 56 y. Nutritional status on admission, quality of life (assessed by extent of daily activities, pain, and ability to sustain oral intake), and ultimate treatment outcome were determined. Mean weight loss in patients in Group I was 8.6 kg, 11 patients out of 15 were malnourished; mean weight loss in patients in Group II was 21 kg, and all of the 11 patients belonging to this group were malnourished. Two patients of Group I improved their quality of life, while 6 declined and 7 died; in Group II, 3 improved their quality of life, 4 declined, and 4 died. We conclude that when TPN was given either as an adjunct to in-hospital aggressive therapy for cancer or for in-hospital supportive care, quality of life did not improve in the majority of patients; nor did it influence ultimate outcome. These objective data, thus, raise the question of the validity of the use of TPN in terminally ill cancer patients. However, barring the cost factor, it is recognized that subjective reasons for giving TPN to terminally ill cancer patients persist and include compassionate, ethical, religious, or emotional reasons.

Legalizing euthanasia will convey calm to the patients who have been in sad agony striving hard to refurbish wellbeing but have nothing less wish but sufferings. Legalization of euthanasia will convey respite to the affiliated persons with the terminally sick persevering too.

Introduction

Malnutrition is a common manifestation of cancer patients, which is often present with loss of appetite and ineffective utilization of nutrients.Fifty to eighty percent of patients with malignancies may also develop cachexia, a syndrome characterized by weight loss and host tissue wasting that has a major impact on the quality of life and survival.Loss of appetite results in malnutrition, in impaired immune function against the tumor,and inability to withstand the adverse effects of vigorous antineoplastic therapy. For these reasons, clinicians frequently prescribe nutritional therapy for cancer patients, who represent approximately 33% of all patients receiving total parenteral nutrition (TPN) each year. Because TPN can deliver nutrients efficiently into the bloodstream, it seemed to be a promising therapy for malnutrition in cancer. It was hoped that as an adjunctive therapy, TPN would have a favorable impact on the clinical outcome of patients ...