Aim • the administration of total parenteral nutrition (tPN) in terminally ill cancer patients is aggressive with a relatively high risk of complications. In this paper, we investigated the use of tPN in Lebanese cancer patients at end of life. to our knowledge, this is the first study describing tPN administration to Middle Eastern patients with advanced cancer.

Methods• we conducted this observational study at hôtel-Dieu de France University hospital, Lebanon. Eligible cases included all cancer patients that died at our institution between the 1st of January and the 31st of December 2014. the patients and tumors characteristics as well as the management plan were retrieved from the hospital records. Results • Our study enrolled 129 cancer patients at end of life among which 39% had received tPN: 28% during the last 6 weeks and 34% during the last 3 months. the mean duration of tPN administration was 33 days (range: 1 to 211). the mean duration between the end of tPN administration and death was 37 days (range: 0 to 315). tPN administration correlated negatively to hyperlipidemia (OR = 0.33; 95% CI [0.12 - 0.87]) and to the presence of three cardiovascular risk factors (OR = 0.28; 95% CI [0.10 - 0.80]). On the other hand, it correlated positively to gastrointestinal tumors (OR = 3.9; 95% CI [1.3 - 11.7]) and to imaging studies during the last month of life (OR = 3.4; 95% CI [1.3 - 9.0]). In the multivariate analysis, only hyperlipidemia was found to be a significant determinant of the tPN administration (p = 0.010; ORa= 0.29 [0.11 - 0.74]).

Conclusion • the prevalent use of tPN at end of life underlines a difficulty in adopting a palliative care approach in our population. this is truly applicable in Middle Eastern populations that seem to refuse a patient-centered supportive care approach.

Keywords: Middle East; total parenteral nutrition; end of life; cancer; palliative care