Quality of life of patients receiving home parenteral or enteral nutrition support

Limited data are available on the impact of enterally or parenterally supplied home nutritional support on quality of life. Data from national registries have been useful in identifying the outcome of different patient groups in terms of their functional capacity and rehabilitation status. Results in patients with inflammatory bowel disease are used as the 'gold standard' for this type of therapy. The annual cost of home parenteral nutrition can range from $US100 000 to $US150 000 per patient, depending on the frequency of feeding. Only one cost-utility analysis has been reported in the literature, based on a Canadian home parenteral nutrition programme which suggested that the estimated quality-adjusted survival of patients receiving this treatment is 4 times greater than if they had not been treated. There are many controversial areas associated with the use of home parenteral and enteral nutrition, including the treatment of patients with terminal malignant disease or severe dementia, and those infected with human immunodeficiency virus. To date, the clinical benefit of providing this type of nutritional support for these patient groups has not been clearly demonstrated. Prospective randomised controlled trials are necessary to evaluate the costs and benefits of this expensive high technology treatment.