ESPEN guidelines on nutrition in cancer patients
ESPEN guidelines on nutrition in cancer patients
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DOI：
10.1016/j.clnu.2016.07.015
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发表时间：
2017-02-01
影响因子：
6.3
通讯作者：
Preiser, Jean-Charles
中科院分区：
文献类型：
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作者：
Arends, Jann;Bachmann, Patrick;Preiser, Jean-Charles
癌症是全世界发病率和死亡率的主要原因之一，预计今后几十年新病例数将大幅增加。与此同时，所有类型的癌症治疗，如手术，放射治疗和药物治疗正在改善其复杂性，精确性和针对个体癌症特定特征的能力。因此，虽然许多癌症可能仍然无法治愈，但它们可能会转化为慢性疾病。然而，所有这些治疗都被癌症患者中由肿瘤或其治疗引起的营养不良和代谢紊乱的频繁发展所阻碍或排除。制定这些循证指南的目的是将目前最好的证据和专家意见转化为多学科团队的建议，这些团队负责识别，预防和治疗成人癌症患者营养不良的可逆因素。该指南由ESPEN和欧洲抗癌行动伙伴关系（EPAAC）委托并提供财政支持，EPAAC是欧盟一级的倡议。指南小组的成员由ESPEN挑选，包括一系列专业和专业领域。我们根据皮科格式，基于临床问题检索荟萃分析、系统综述和比较研究。使用GRADE方法对证据进行评估和合并，以制定临床建议。由于现有证据不足，列出了相关的未决问题，应通过未来的研究加以解决。营养不良和肌肉质量损失在癌症患者中很常见，对临床结果有负面影响。它们可能是由食物摄入不足、体力活动减少和分解代谢紊乱引起的。为了筛查、预防、详细评估、监测和治疗营养不良，参与治疗癌症患者的每个机构都应制定标准作业程序、责任和质量控制程序。所有癌症患者都应定期筛查营养不良的风险或存在。在所有患者中，除临终关怀外，应通过逐步提供从咨询到肠外营养的营养干预来满足能量和底物要求。然而，营养干预的益处和风险必须与晚期疾病患者的特殊考虑相平衡。营养保健应始终伴随着运动训练。为了对抗晚期癌症患者的营养不良，几乎没有药理学试剂和药物营养素，其效果有限。癌症幸存者应定期进行体育活动，并采取谨慎的饮食。(C)2016年欧洲临床营养与代谢学会。由爱思唯尔有限公司出版。保留所有权利。
Cancers are among the leading causes of morbidity and mortality worldwide, and the number of new cases is expected to rise significantly over the next decades. At the same time, all types of cancer treatment, such as surgery, radiation therapy, and pharmacological therapies are improving is sophistication, precision and in the power to target specific characteristics of individual cancers. Thus, while many cancers may still not be cured they may be converted to chronic diseases. All of these treatments, however, are impeded or precluded by the frequent development of malnutrition and metabolic derangements in cancer patients, induced by the tumor or by its treatment. These evidence-based guidelines were developed to translate current best evidence and expert opinion into recommendations for multi-disciplinary teams responsible for identification, prevention, and treatment of reversible elements of malnutrition in adult cancer patients. The guidelines were commissioned and financially supported by ESPEN and by the European Partnership for Action Against Cancer (EPAAC), an EU level initiative. Members of the guideline group were selected by ESPEN to include a range of professions and fields of expertise. We searched for meta-analyses, systematic reviews and comparative studies based on clinical questions according to the PICO format. The evidence was evaluated and merged to develop clinical recommendations using the GRADE method. Due to the deficits in the available evidence, relevant still open questions were listed and should be addressed by future studies. Malnutrition and a loss of muscle mass are frequent in cancer patients and have a negative effect on clinical outcome. They may be driven by inadequate food intake, decreased physical activity and catabolic metabolic derangements. To screen for, prevent, assess in detail, monitor and treat malnutrition standard operating procedures, responsibilities and a quality control process should be established at each institution involved in treating cancer patients. All cancer patients should be screened regularly for the risk or the presence of malnutrition. In all patients with the exception of end of life care energy and substrate requirements should be met by offeiing in a step-wise manner nutritional interventions from counseling to parenteral nutrition. However, benefits and risks of nutritional interventions have to be balanced with special consideration in patients with advanced disease. Nutritional care should always be accompanied by exercise training. To counter malnutrition in patients with advanced cancer there are few pharmacological agents and pharmaconutrients with only limited effects. Cancer survivors should engage in regular physical activity and adopt a prudent diet. (C) 2016 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.