OPTIMIZING THE NUTRITIONAL SUPPORT IN THE ELDERLY CANCER PATIENT

Abstract

The optimal nutritional support of the elderly cancer patients includes two main issues: choice of the proper administration route and choice of the best nutritional regimen. The choice of the way of administering the nutritional support first relies on the availability of the oral and of the enteral route. If the patient is able to eat or to drink by mouth a nutritional counseling combined with oral supplements represent the first approach to pursue. There is a wide variety of supplements in the market which may be enriched with anti-inflammatory or anabolic substrates and differ as regards the calorie/protein ratio. The value of this approach is limited but the discomfort for the patient and the invasiveness of the procedure are quite limited. In general the oral nutritional support is performed as a preventive measure in so-called pre-cachectic patients (Aapro et al., Ann Oncol 2014), in those with limited weight loss and mainly affected by anorexia or early satiety, with tumours confined to the extra-gastrointestinal area. If gut is working but the oral route is not available, the option is to feed the patient through a nasogastric/enteric tube or a gastrostomy/jejunostomy. This enteral route is classical approach for many dysphagic patients with head-neck tumour undergoing oncologic therapy or inoperable, and those with an obstructing lesion of the sovramesocolic area who are found unresectable at laparotomy. Finally the intravenous nutrition is reserved to all patients requiring a nutritional support but with a non-working or non-accessible gut. However a so-called supplemental parenteral nutrition is often performed also inmalnourished/anorectic patients able to eat, because of the ease to cover a large part of the energy and protein requirement through a limited volume of concentrated infusional bags. Whatever is the route, the pathophysiologic characteristics of the elderly cancer patients require that the nutritional regimen be restricted in volume, with a calorie load of about 30 kcal/kg/day, with a high FAT/CHO ratio, enriched in BCAA and essential amino acid and reaching a dose of 1.5 g AA/kg/day or more. Disclosure of interest: None declared