Palliative nutritional intervention in addition to cyclooxygenase and erythropoietin treatment for patients with malignant disease:: Effects on survival, metabolism, and function -: A randomized prospective study
Palliative nutritional intervention in addition to cyclooxygenase and erythropoietin treatment for patients with malignant disease:: Effects on survival, metabolism, and function -: A randomized prospective study
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DOI：
10.1002/cncr.20160
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发表时间：
2004-05-01
期刊：
影响因子：
6.2
通讯作者：
Lindholm, E
中科院分区：
文献类型：
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作者：
Lundholm, K;Daneryd, P;Lindholm, E
背景营养在恶性肿瘤相关恶病质患者姑息治疗中的作用尚不清楚。本研究的目的是确定专门的、以营养为重点的患者护理是否可以改善恶性疾病伴发的体重减轻患者的整体代谢和功能结果，这些患者接受了全身性的环氧化酶[考克斯]抑制剂沿着促红细胞生成素（EPO）治疗。309例因实体瘤发生进行性恶病质的恶性疾病患者（主要是胃肠道病变）随机接受考克斯抑制剂（吲哚美辛，50 mg，每日两次）和EPO（每周15- 40，000个单位）沿着，以营养为中心的病人护理（口服营养支持和家庭全胃肠外营养[TPN]），以减轻炎症、预防贫血和改善营养状况。对照组患者接受相同剂量的吲哚美辛和EPO，而研究组患者则没有额外的营养支持。所有患者均接受治疗并随访至死亡。在治疗开始前和治疗期间定期（治疗开始后每2-30个月）进行生化测定（血液、肝脏、肾脏和甲状腺）、营养状态评估（摄食量和身体组成）和运动试验，同时测量运动前和运动期间的全身呼吸气体交换。在“意向治疗”和“实际治疗”的基础上进行统计分析。约50%的研究患者接受了家庭TPN，未发生严重并发症。在整个观察期间，rhEPO预防了研究患者和对照患者的贫血发展。意向治疗分析显示，营养支持患者的能量平衡得到改善（P < 0.03）;研究患者和对照患者之间的结果没有观察到其他显著差异。治疗分析显示，接受营养的患者生存期延长（P < 0.01），能量平衡改善（P < 0.001），体脂增加（P < 0.05），最大运动能力提高（P < 0.04）。在最大运动量时，研究组患者的代谢效率也有增加的趋势（P < 0.06）。目前的研究结果强烈支持营养是影响生存的限制因素，营养支持保护继发于恶性疾病的进行性恶病质患者的综合代谢和代谢功能。
BACKGROUND. The role of nutrition in the palliative treatment of patients with malignancy-related cachexia is unclear. The goal of the current study was to determine whether specialized, nutrition-focused patient care could improve integrated whole-body metabolism and functional outcome in unselected weight-losing patients with malignant disease who were receiving systemic antiinflammatory (cyclooxygenase [COX]-inhibitory) treatment along with erythropoietin (EPO) support.METHODS. Three hundred nine patients with malignant disease who experienced progressive cachexia due to solid tumors (primarily gastrointestinal lesions) were randomized to receive a COX inhibitor (indomethacin, 50 mg twice daily) and EPO (15-40,000 units per week) along with specialized, nutrition-focused patient care (oral nutritional support and home total parenteral nutrition [TPN]) provided on a patient-by-patient basis to attenuate inflammation, prevent anemia, and improve nutritional status. Control patients received the same indomethacin and EPO doses that study patients received without the added nutritional support. All patients were treated and followed until death. Biochemical assays (blood, liver, kidney, and thyroid), nutritional state assessment (food intake and body composition), and exercise testing with simultaneous measurement of whole-body respiratory gas exchange before and during exercise were performed before the start of treatment and then at regular intervals during the treatment period (every 2-30 months after treatment initiation). Statistical analyses were performed on 'intention-to-treat' and 'as-treated' bases.RESULTS. Home TPN was provided to approximately 50% of the study patients without severe complications. Over the entire observation period, rhEPO prevented the development of anemia in both study patients and control patients. Intention-to-treat analysis revealed an improvement in energy balance for nutritionally supported patients (P < 0.03); no other significant differences in outcome between study patients and control patients were observed. As-treated analysis demonstrated that patients receiving nutrition experienced prolonged survival (P < 0.01), which was accompanied by improved energy balance (P < 0.001), increasing body fat (P < 0.05), and a greater maximum exercise capacity (P < 0.04). A trend toward increased metabolic efficiency at maximum exercise (P < 0.06) for study patients relative to control patients also was observed.CONCLUSIONS. The results of the current study strongly support that nutrition is a limiting factor influencing survival and that nutritional support protects integrated metabolism and metabolic function in patients with progressive cachexia secondary to malignant disease.