NUTRITION IN CANCER PATIENTS

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Oncologists are facing very often with the question: ,,Doctor, what should I eat, now that I have cancer?”. In many cases they are expecting some advices on what to avoid, taking into consideration that the beliefs are that some food is ,,feeding the cancer”. Meat, vitamins and proteins, in general, are the most blamed by patients.

On the other side, ESPEN Guidelines are mentioning that ,,malnutrition and a loss of muscle mass are frequent in cancer patients and have a negative effect on clinical outcome.” This may be the effect of disease per se, inadequate food intake, effect of chimiotherapy, decrease in phisical activity. There are some nutritional screening tools recommended by ESPEN, as: Malnutrition Universal Screening Tool (MUST), Nutritional Risk Screening (NRS 2002), Mini Nutritional Assessment (MNA), Geriatric Nutrion Risk Index (GNRI). These are used for evaluating the risk of malnutrition in speciffic population.1

It is difficult for oncologists, especially in clinics that don’t have a specialist in onco-nutrition, to explain to the patients the importance of nutrition for their disease evolution. A correct nutrition is having many involvements for this patients: increase in quality of life, helping them cope with therapy adverse events, like nausea, maintaining the intestinal barrier, increase survival. On a contrary, the malnutrition could have many consequences: reduction in glomerular filtration, alteration in cardiac function, altered drug pharmacokinetics, slow wound healing, impaired immunity, increase in lenght of hospitalisation days, and increase treatment costs.2

For patients with gastric cancer is even more important to maintain a good nutritional status and consequently a good performance status, in order to be able to receive further lines of therapies and increase survival.

According to ESPEN Guidelines, the aims of nutrition therapy are: nutrition and metabolic interventions, monitor relevant parameters, nutrition counselling, oral nutrition supplements and screening for nutritional risk.1

The nutrition counselling should start from the diagnosis, and for those patients undergoing surgery, it should start before the operation. The conclusion of a retrospective analysis, performed on a population of 1330 gastric cancer patients, over a two years period, was that preoperative body weight loss was an independent prognostic factor in overall survival, for patients with stage III gastric cancer. The 5-year OS increased from 41.1% to 26.5% (p<0.001), irrespectivelly the preoperative chemotherapy.3

The weight loss should be firstly prevented by establishing a tailored regimen, which includes nutrients intake but also physical activity and rest. A proper diet for cancer patients should include all classes of micronutrients, principally those that are essentials. Sometimes these patients need vitamins supplementation, but this needs to be done with caution as there was shown in a large meta-analysisof 68 randomized prevention trials including more than 230,000 participants, no protective effects of antioxidants but a slightly raised mortality in subjects consuming b-carotene, vitamin A, or vitamin E.4

It is a complex subject and the oncologic patients should be referred to a specialist in nutrition for a tailored regimen, but in the same time they can receive few general advices from the oncology department also, because unfortunately, in Romania, there are few centers in this moment that can offer nutrition counselling to cancer patients.

 

  1. Arends J, et al., ESPEN guidelines on nutrition in cancer patients, Clinical Nutrition (2016), http://dx.doi.org/ 10.1016/j.clnu.2016.07.015
  2. Roediger 1994; Green 1999; Zarowitz 1990
  3. Liu, Xuechao et al. “Gastric cancer, nutritional status, and outcome.” OncoTargets and therapy 10 2107-2114. 12 Apr. 2017, doi:10.2147/OTT.S132432
  4. Bjelakovic G, Nikolova D, Gluud LL, Simonetti RG, Gluud C. Mortality in randomized trials of antioxidant supplements for primary and secondary prevention: systematic review and meta-analysis. JAMA 2007;297:842e57.

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