Nutritional support in oncology: the place of parenteral nutrition (literature review)

Abstract

Currently nutritional support is considered as one of the most important components of the treatment of cancer patients. This is due to the positive effect of correction of nutritional status on the course of the underlying disease, the tolerability of antitumor treatment, rehabilitation measures and quality of life. The most important principle of nutritional support is its continuity at all stages of the patient's curation: polyclinic, inpatient, rehabilitation. The purpose of the review was to discuss nutritional support for cancer patients with an emphasis on parenteral nutrition. Out of more than 120 initially selected literature sources from various databases (Scopus, Web of science, RSCI, etc.), 55 sources were left for analysis mainly over the past 5 years, earlier publications were used while maintaining their informativeness for clinicians. The modern concept of parenteral nutrition implies the appointment of drugs “three in one”. Parenteral nutrition should include not only macronutrients, but also micronutrients: fat- and water-soluble vitamins, ω-3 fatty acids. It has been established that the development of infectious complications with nutritional support is not related to its type, but to the calorie intake. The issues of additional parenteral nutrition with inadequate enteral nutrition are examined. The clinician should personalize nutritional support taking into account the type of tumor process, its stage, the characteristics of the patient and the severity of eating disorders. During the treatment of patients with oncological diseases, it is necessary to assess the state of their nutritional status and, if necessary, carry out correction. The doctor is obliged to choose the optimal way to provide the patient with energy and plastic materials – oral supplemental nutrition, enteral nutrition, parenteral nutrition or a combination of them. Clinical practice shows that the rejection of parenteral nutrition is accompanied by a decrease in the quality of nutritional support. The choice of the type of nutritional support is based on the indications for its implementation, which are detailed in the clinical recommendations. Strict adherence to the algorithm of correction of nutritional status depending on the stage of cancer, the patient's condition, the type of antitumor therapy will optimize the results of treatment and improve the quality of life.