Management of Cancer Cachexia: ASCO Guideline
Management of Cancer Cachexia: ASCO Guideline
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DOI：
10.1200/jco.20.00611
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发表时间：
2020-07-20
影响因子：
45.3
通讯作者：
Loprinzi, Charles L.
中科院分区：
文献类型：
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作者：
Roeland, Eric J.;Bohlke, Kari;Loprinzi, Charles L.
目的为晚期癌症成年患者癌症恶病质的临床管理提供循证指导。方法对文献进行系统回顾，收集有关癌症恶病质的营养、药物和其他干预措施（如运动）的证据。 PubMed 和 Cochrane 图书馆检索了 1966 年至 2019 年 10 月 17 日发表的随机对照试验 (RCT) 和随机对照试验的系统评价。ASCO 召集了一个专家小组来审查证据并制定建议。结果该评价包括 20 项系统评价和 13 项额外的随机对照试验。据报道，在一些试验中，饮食咨询，无论有或没有口服营养补充剂，都可以增加体重，但证据仍然有限。与改善食欲和/或体重相关的药物干预包括黄体酮类似物和皮质类固醇。其他评估的干预措施要么没有益处，要么没有足够的益处证据来得出疗效结论。证据的局限性包括与晚期癌症一致的高退出率，以及不同研究中感兴趣的结果和结果评估方法的差异。建议提供饮食咨询的目的是为患者和护理人员提供恶病质管理的建议。不应常规使用肠内饲管和肠外营养。在缺乏更强有力的证据的情况下，不能推荐特定的药物干预作为护理标准；因此，临床医生可能会选择不开专门用于治疗癌症恶病质的药物。尽管如此，当决定尝试一种药物来改善食欲和/或改善体重增加时，目前可用的药物干预措施包括黄体酮类似物和短期（数周）皮质类固醇。
PURPOSETo provide evidence-based guidance on the clinical management of cancer cachexia in adult patients with advanced cancer.METHODSA systematic review of the literature collected evidence regarding nutritional, pharmacologic, and other interventions, such as exercise, for cancer cachexia. PubMed and the Cochrane Library were searched for randomized controlled trials (RCTs) and systematic reviews of RCTs published from 1966 through October 17, 2019. ASCO convened an Expert Panel to review the evidence and formulate recommendations.RESULTSThe review included 20 systematic reviews and 13 additional RCTs. Dietary counseling, with or without oral nutritional supplements, was reported to increase body weight in some trials, but evidence remains limited. Pharmacologic interventions associated with improvements in appetite and/or body weight include progesterone analogs and corticosteroids. The other evaluated interventions either had no benefit or insufficient evidence of benefit to draw conclusions on efficacy. Limitations of the evidence include high drop-out rates, consistent with advanced cancer, as well as variability across studies in outcomes of interest and methods for outcome assessment.RECOMMENDATIONSDietary counseling may be offered with the goals of providing patients and caregivers with advice for the management of cachexia. Enteral feeding tubes and parenteral nutrition should not be used routinely. In the absence of more robust evidence, no specific pharmacological intervention can be recommended as the standard of care; therefore, clinicians may choose not to prescribe medications specifically for the treatment of cancer cachexia. Nonetheless, when it is decided to trial a drug to improve appetite and/or improve weight gain, currently available pharmacologic interventions that may be used include progesterone analogs and short-term (weeks) corticosteroids.