Efficacy of Parenteral Nutrition in Patients at the Palliative Phase of Cancer.
Prospective, Multicenter, Randomized Controlled Study Evaluating the Efficacy of Parenteral Nutrition on the Quality of Life and Overall Survival in Patients in the Palliative Phase of Cancer.
In malnourished patients in the palliative phase of cancer, the question is raised of the
relevance of implementing artificial nutritional assistance instead of oral feeding when
this is possible.
Medical prescription and implementation of artificial nutrition at this stage of the illness
seem less governed by data acquired by science than by subjective reasons (related to
beliefs, to a cultural or religious tradition, to the symbolic role of eating, to the deeply
ingrained fear of dying of hunger, to a portrayal of care, etc.) while interacting with
teams, the patient and his family and relatives.
And yet, the benefits/risk balance and the effect on quality of life of parenteral nutrition
in a palliative situation for patients presenting with a normal alimentary tract is poorly
understood. The discomfort and risks of central venous or nasogastric artificial nutrition
require that the benefits of artificial nutrition be proven. The nature of these benefits
relate first and foremost to the quality of life experienced by the patient in such a
context. Only a controlled randomized study may lead to an optimal palliative nutritional
management of undernutrition to be determined, and to inform the patient and his/her
relatives clearly in order for them to express their preferences.
We hypothesize that abstaining from artificial parenteral central venous nutrition and
associated hydration for nutritional purposes improves quality of life without significant
loss of survival compared to implementing artificial nutrition, when considered, in the
absence of any specific curative treatment in anorexic patients in the palliative phase of
To test this hypothesis, we propose to carry out a multicenter, prospective, controlled,
randomized study in order to evaluate the efficacy of implementing parenteral nutrition
compared to abstaining from doing so on the quality of life of undernourished patients in
the palliative phase of cancer. The effect on overall survival and the nutritional
parameters will be evaluated.
The ALIM K trial will be carried out in 12 centres specializing in supportive and
onco-hematology care .
Nutrition Aspect of Cancer, End Stage Cancer
Palliative Phase of Cancer, Quality of life, Parenteral nutrition, Undernutrition
Centre Hospitalier Universitaire de Besancon
Centre Hospitalier Universitaire de Besancon, Institut Curie, Institut de Cancérologie de Lorraine, Centre Paul Strauss, Institut Jean-Godinot, Gustave Roussy, Cancer Campus, Grand Paris, Institut Paoli-Calmettes, Centre Leon Berard, Henri Mondor University Hospital, Centre Oscar Lambret, Centre Georges Francois Leclerc, Centre Francois Baclesse
Pazart L, Cretin E, Grodard G, Cornet C, Mathieu-Nicot F, Bonnetain F, Mercier M, Cuynet P, Bouleuc C, Aubry R; ALIM-K study investigational group.. Parenteral nutrition at the palliative phase of advanced cancer: the ALIM-K study protocol for a randomized controlled trial. Trials. 2014 Sep 24;15:370. doi: 10.1186/1745-6215-15-370.