Abstract
Malnutrition, which commonly occurs in perioperative patients with cancer, leads to decreased muscle mass, hypoalbuminemia, and edema, thereby increasing the patient’s risk of various complications. Thus, the nutritional management of perioperative patients with cancer should be focused on to ensure that surgical treatment is safe and effective, postoperative complications are prevented, and mortality is reduced. Pathophysiological and drug-induced factors in elderly patients with cancer are associated with the risk of developing malnutrition. Pathophysiological factors include the effects of tumors, cachexia, and anorexia of aging. Metabolic changes, such as inflammation, excess catabolism, and anabolic resistance in patients with tumor-induced cancer alter the body’s ability to use essential nutrients. Drug-induced factors include the side effects of anticancer drugs and polypharmacy. Drug–drug, drug–disease, drug–nutrient, and drug–food interactions can significantly affect the patient’s nutritional status. Furthermore, malnutrition may affect pharmacokinetics and pharmacodynamics, potentiate drug effects, and cause side effects. This review outlines polypharmacy and malnutrition, the impact of malnutrition on drug efficacy, drug–nutrient and drug–food interactions, and intervention effects on polypharmacy or cancer cachexia in elderly perioperative patients with cancer.
Highlights
Cancers are among the leading causes of morbidity and mortality worldwide, and the number of new cases is expected to rise significantly over the few decades
In elderly perioperative patients with cancer, a multidisciplinary team comprising physicians, pharmacists, nurses, dietitians, and other professionals should be aware of the potential effects of individual drugs and polypharmacy on perioperative nutritional status and seek to reduce negative impacts
In the case of malnutrition and sarcopenia, rehabilitation should be combined with aggressive nutritional therapy so that energy and protein are added to the daily energy expenditure, which will improve the nutritional status
Summary
Cancers are among the leading causes of morbidity and mortality worldwide, and the number of new cases is expected to rise significantly over the few decades. Malnutrition often decreases the bioavailability of drugs and alters their pharmacokinetic and pharmacodynamic properties, which increases the patient’s sensitivity to the drug; even at the usual dose, the drug will have a stronger effect and higher incidence rate of side effects This gives rise to a vicious circle, wherein polypharmacy, in excess, degrades the nutritional status, and the degraded nutritional status demands increased doses of drugs with the increased occurrence of undesirable side effects [9]. Patients with cancer often take a large number of medications to prevent or reduce side effects in addition to their multimorbidity. In elderly perioperative patients with cancer, a multidisciplinary team comprising physicians, pharmacists, nurses, dietitians, and other professionals should be aware of the potential effects of individual drugs and polypharmacy on perioperative nutritional status and seek to reduce negative impacts. This review outlines polypharmacy and malnutrition, the impact of malnutrition on drug efficacy, and drug–nutrient interactions in elderly patients with cancer during the perioperative period
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