Nutritional Therapy In Cancer Patients Research Articles

The knowledge and the clinical practice of Brazilian physicians about nutritional therapy in cancer patients

The knowledge and the clinical practice of Brazilian physicians about nutritional therapy in cancer patients

NUTRITIONAL SUPPORT FOR CANCER PATIENTS IN THE EARLY POSTOPERATIVE PERIOD

Relevance: The modern medicine, evaluating patients’ nutritional status is a priority for many specialists. The incidence of nutritional deficiency in cancer pathology increases annually by 65-85%. The nutritional status of patients is represented by a decrease in life expectancy, deterioration of immediate and long-term treatment results, a decrease in the tolerability of therapy, and a decrease in the quality of life. Early detection of nutritional insufficiency and evaluation of the patient’s nutritional status makes it possible for early provision of nutritional therapy and has a positive effect before the operation, during and after the operating period, reduces postoperative complications, and reduces the duration of stay in the hospital. This article reflects on the features of evaluating the nutritional status and methods of correction of clinical nutrition.
 The study aimed to analyze the effectiveness of cancer patients’ nutrition in the early postoperative period and determine the optimal method of its implementation.
 Methods: We compared the clinical effectiveness of enteral and parenteral nutrition methods in the complex of postoperative therapeutic measures on the hepato-pancreatic-duodenal zone.
 Results: On Days 10-12 after surgery, 12 out of 17 control group patients had normal nutritional status judging by their Subjective Global Assessment (SGA) and Nutritional Risk Index (NRI), and five had moderate malnutrition. After enteral nutrition was added (on Days 13-15), no malnutrition cases in this group were detected. The total blood protein in the subjects showed a significant difference between the average values of indicators in clinical groups for the entire study period (p<0.05). The average total blood protein by Day 8 after surgery was 62.5±10.0 g/L in the leading group and 57.5±10.1 g/L in the control group. The change in the blood biochemical composition was due to the volume, duration, and nature of the surgical intervention.
 Conclusion: When using nutritional therapy in cancer patients operated on for tumors of the hepato-pancreatic-duodenal zone in the early postoperative period, the enteral route of administration of nutrient mixtures is preferred, provided there is no pronounced intestinal paresis and purulent discharge from the stomach.

Нутритивная недостаточность и нутритивная терапия у онкологических больных. Обзор современных рекомендаций

Нутритивная недостаточность является часто встречающимся осложнением течения онкологического заболевания. По результатам Европейской ассоциации нутритивной терапии (2017), частота нутритивной недостаточности у онкологических больных колебалась от 47 до 89 %. Нутритивная недостаточность может достигать терминальных проявлений и протекать в форме синдрома анорексии-кахексии, являясь непосредственной причиной смерти у 4 из 20 онкологических больных. Прогноз для больных раком с потерей веса хуже, чем у больных без потери веса. Хотя стадия опухоли и резистентность к противоопухолевой терапии являются основными прогностическими факторами выживаемости больных, большое количество данных литературы показывает, что потеря веса является значительным и часто независимым предиктором снижения выживаемости у онкологических больных. В обзоре рассмотрены вопросы улучшения нутритивного статуса онкологических больных и основные подходы к терапии этого осложнения.

Omega-3 fatty acids ameliorate doxorubicin-induced cardiorenal toxicity: In-vivo regulation of oxidative stress, apoptosis and renal Nox4, and in-vitro preservation of the cytotoxic efficacy.

This study examines the protective effects of omega‐3 fatty acids (OMG), a frequently used nutritional therapy in cancer patients, against doxorubicin (DOX)‐induced acute cardiorenal toxicity in rats, and evaluates the cytotoxic activity of DOX when used with OMG against breast cancer cell line. Five groups of rats were treated for 4 consecutive weeks with vehicle (groups I & II), or OMG (25, 50 or 100 mg/kg/day, po; groups III, IV & V, respectively). After twenty-four hours, the last four groups were injected with DOX (200 mg/kg, ip). In DOX-treated rats, the altered ECG, serum cardiac and renal function biomarkers, and histopathological features indicated the induction of cardiorenal toxicity. Increased oxidative and apoptotic markers in both organs was observed, with elevated renal contents of NADPH-oxidase-4 (Nox4) and renin. OMG pretreatment improved those DOX-induced impairments in a dose-dependent manner, and showed antioxidant and antiapoptotic effects with regulation of renal Nox4 expression. The in-vitro study showed preservation of the cytotoxic activity of DOX on MCF7 cell line in the presence of OMG. The data suggests OMG for protection against acute DOX‐induced cardiorenal damage without affecting the latter antitumor activity. It proposes regulation of oxidative stress, Nox4 activity and apoptosis as contributing protective mechanisms.

Nutritional Therapy in Cancer Patients Receiving Chemoradiotherapy: Should We Need Stronger Recommendations to Act for Improving Outcomes?

One of the challenges during chemotherapy and radiotherapy is to complete the planned cycles and doses without dose-limiting toxicity. Growing evidence clearly demonstrates the relationship between dose-limiting toxicity and low muscle mass. Moreover, malnutrition leads to low performance status, impaired quality of life, unplanned hospital admissions, and reduced survival.In the past, the lack of clear and authoritative recommendations and guidelines has meant that oncologists have not always fully appreciated the importance of nutritional therapy in patients receiving anticancer treatments. Therefore, collaboration between oncologists and clinical nutrition specialists needs to be urgently improved.Recent guidelines from scientific societies and practical recommendations by inter-society consensus documents can be summarized as follows: 1) timely nutritional therapy should be carefully considered if patients undergoing anticancer treatments are malnourished or at risk of malnutrition due to inadequate oral intake; 2) if oral intake is inadequate despite counseling and oral nutritional supplements, supplemental enteral nutrition or, if this is not sufficient or feasible, parenteral nutrition should be considered; 3) home artificial nutrition should be prescribed and regularly monitored using defined protocols developed between oncologists and clinical nutrition specialists; 4) appropriate nutritional management in the context of simultaneous care should become a guaranteed right for all patients with cancer.The purpose of this review is to provide oncologists with an overview of the aims and current evidence about nutrition in oncology, together with updated practical and concise recommendations on the application of nutritional therapy in cancer patients receiving chemoradiotherapy.

Metabolic Alterations and Nutritional Therapy in Cancer Patients

Metabolic Alterations and Nutritional Therapy in Cancer Patients

The use of a protein and energy dense eicosapentaenoic acid containing supplement for malignancy‐related weight loss in children

The aim of nutritional therapy in cancer patients is to prevent weight loss and to improve functional capacity and quality of life. Clinical studies however, have continued to demonstrate that a reduction in body weight loss is difficult to achieve in cancer cachexia. Several studies have shown that supplementation with eicosapentaenoic acid (EPA), an omega-3 fatty acid, has anti-cachectic effects in adult cancer patients. This study evaluated the clinical effects of a protein and energy dense EPA containing nutritional supplement in a group of pediatric cancer patients receiving active chemotherapy treatment. The study was a prospective, randomized, single center, open-label design. Fifty-two patients diagnosed with pediatric malignant disease and receiving intensive chemotherapy were included. Thirty-three patients received a nutritional supplement containing EPA in addition to their regular food intake. Nineteen control patients did not receive supplementation. Patients were examined and their data (body weight, body mass index, and weight percentile) were recorded regularly once a month for 3 months. A subgroup of patients was evaluated for 6 months. At 3 months, there were significantly fewer patients in the treatment group as compared to controls that showed losses in body weight (P = 0.001), BMI (P = 0.002), and a negative deviation in weight percentile (P = 0.021). In addition, remission rate was significantly (P = 0.036) higher in the treatment group as compared to controls. This study demonstrates a decrease in cancer-induced weight loss in pediatric patients fed a protein and energy dense nutrition supplement containing EPA.

Tomato products and lycopene supplements: mandatory components in nutritional treatment of cancer patients?

This review presents the latest experimental and clinical research focussing on the relationship between the intake of tomato products and lycopene supplementation and carcinogenesis, with the aim of drawing conclusions for concepts of clinical nutritional support. Apart from the preventative role of tomato products/lycopene intake there is evidence that oral supplementation of these compounds in cancer patients may also improve the biomarkers of carcinogenesis and reduce tumour growth. New experimental studies in animal models provide insights concerning the potential mechanism(s). Although the first clinical trials are promising, it is too early to make final recommendations for nutritional therapy in cancer patients. Whether the bioactive compound in tomatoes is lycopene or whether other substrates contribute to the beneficial physiological effects is still unclear.

Nutritional Support of Patients with Cancer of the Gastrointestinal Tract

Malnutrition is extremely common in patients with malignant disease. Whereas the causes are multifactorial, the predominant factor is the imbalance between nutrient intake and host nutrient requirements. Furthermore, the evidence suggests that cachexia is related to abnormal changes in host intermediary metabolism induced by host-tumor interactions, and endogenous peptides such as TNF may be important mediators. The role of nutritional therapy in cancer patients remains to be defined. Clearly, patients with severe malnutrition benefit from nutritional intervention. However, the benefit of nutritional therapy in less severe cases of malnutrition as an adjuvant to oncologic therapy has yet to be established.

Indications for and results of nutritional therapy in cancer patients.

Malnutrition is one of the typical consequences of tumor burden and tumor therapy. Its first clinical manifestations are weight loss in adults and failure to gain weight in children. The etiology of cancer patients’ malnutrition is multifactorial, and, as yet, incompletely understood.

Plasma proteins as indices of response to nutritional therapy in cancer patients.

The use of plasma albumin (ALB), transferrin (TFN), prealbumin (TBPA), retinol-binding protein (RBP), triceps skin fold (TSF), and midarm muscle circumference (MAMC) as determinants of response to nutritional therapy (TPN) was investigated in 40 cancer patients during preoperative TPN. Thirty-one patients received 90% or more of their anabolic caloric requirement (Harris-Benedict equation) by means of TPN. During this study period (average 11.1 +/- 4.7 days) nutritional assessments were completed before TPN and on the last day of TPN before surgery. Average weight loss based on usual body wt (UBW) and ideal body wt (IBW) was 19 +/- 11% and 9 +/- 15%, respectively (not significant, NS). Weight loss (UBW) correlated with ALB (P less than 0.001), TBPA (P less than 0.005) and RBP (P less than 0.02) but did not correlate with TFN (P less than 0.06), TSF, and MAMC. Weight loss (IBW) correlated with TSF (P less than 0.01) and MAMC (P less than 0.03) but did not correlate with plasma protein (PP). During TPN the average percent increases for PP were 0.1% (ALB, NS), 20% (TFN, NS), 60% (TBPA, P less than 0.02), and 116% (RBP, P less than 0.005). These results suggest that plasma TBPA and RBP are significant parameters of response to short-term nutritional therapy in cancer patients.