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Squaring off over total parenteral nutrition

John Elliott
JAMA. 1980;243(16):1610-1616. doi:10.1001/jama.1980.03300420004002.
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It is nearly 20 years since Stanley J. Dudrick, MD, now chairman of the Department of Surgery at the University of Texas Health Science Center at Houston, proposed that intravenous hyperalimentation (IVH) could improve the quality of life and the ability of some cancer patients to tolerate aggressive forms of chemotherapy. In that time, the debate over the technique (also referred to as total parenteral nutrition [TPN]) has periodically flared into controversy.

Today there is no doubt that TPN can be a truly lifesaving treatment in some cancer patients. But does the technique actually lengthen survival times? Which patients will respond best to TPN, and which cancers will be most affected? Perhaps most important of all, does TPN improve a cancer patient's tolerance to therapy, as Dudrick first proposed in 1963?

To all of these questions, and particularly the last, there are conflicting answers.

The latest debate on TPN—which may


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