Nutrition in oncology and palliative care – desideratum versus reality

Abstract

Nutrition is an indispensable element in everyone’s existence, being essential for preventing complications in oncological patients. Weight loss and malnutrition are factors of poor prognosis, multimodal cancer therapy being inefficient in patients with nutritional deficiency. Nutritional support in cancer patients is one of the main cornerstones of curative cancer treatment, but also represents an indispensable component of palliative care. Enteral nutritional support can assure a proper metabolic status in patients with normal digestive system who can no longer feed per os. Parenteral nutrition is initiated in patients with severe digestive issues. Enteral nutritional support can be provided by gastrostomy or jejunostomy performed with formal surgery or percutaneous endoscopic gastrostomy (PEG) and other similar procedures. After the parenteral nutrition devices is installed, nutritional formulae are directly introduced in the patient’s stomach. There are different formulae, based on the patient’s needs, and different volumes introduced per meal, depending on the procedure (PEG allows a larger volume than classic gastrostomy). The parenteral nutritional support requires a central venous catheter and multiple formulae containing amino acids, glucose, lipids, salts and vitamins that are directly introduced in the patient’s blood flow. The main disadvantage of this procedure is that it can be sustained for maximum 15 days. A significant percent of the patients diagnosed with cervical cancer will require enteral nutritional support during oncological treatment and one year afterwards. PEG is a superior to classic gastrostomy,and it represents the ideal choice when it comes to oncological patients at risk of malnutrition. The devices used in this procedure allow a faster recovery, they have a low rate of complication, they are economically advantageous and the patient can resume the nutrition in 24-48 hours.