Nutrition support and clinical outcome in advanced cancer patients
Nutrition support and clinical outcome in advanced cancer patients
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DOI：
10.1017/s0029665118000459
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发表时间：
2018-11-01
影响因子：
7
通讯作者：
Koverech, Angela
中科院分区：
文献类型：
--
作者：
Laviano, Alessandro;Di Lazzaro, Luca;Koverech, Angela
新诊断的癌症患者经常被发现患有转移性疾病，这对有效治疗的递送提出了额外的挑战。化疗和放疗与副作用有关，这些副作用降低了对治疗的耐受性和肿瘤反应的可能性。确定对治疗反应降低的可预防因素将转化为对癌症患者的更好护理。在其他因素中，营养不良（如通过非自愿体重减轻诊断）和恶病质（如通过肌肉减少症揭示）是普遍公认的负面预后因素。营养治疗在改善癌症患者身体成分和临床结果方面的作用不太确定。缺乏令人信服的证据的原因是多方面的，主要与营养试验的设计不当有关。转移性癌症患者应接受数量和质量充足的饮食，如果食物耐受性降低，则需要人工营养。最重要的是，营养护理应针对食物摄入减少/合成代谢反应受损的潜在机制，并旨在最大限度地减少分解代谢危机的影响，以最大限度地提高恢复期。早期联合使用补充能量和蛋白质以及炎症反应调节剂已被证明可改善营养状况，也可能有益于临床结果。作为早期姑息治疗的一部分，营养治疗可以提高癌症患者的生活质量，并可能延长生存期，而开发新药的成本只有一小部分。
Newly diagnosed cancer patients are frequently found suffering from a metastatic disease, which poses additional challenges to the delivery of effective therapies. Chemotherapy and radiotherapy are associated with side effects which reduce tolerance to treatment and likelihood of tumour response. Identifying preventable factors of reduced response to therapy would translate into better care of cancer patients. Among other factors, malnutrition, as diagnosed by non-volitional weight loss, and cachexia, as revealed by sarcopenia, are universally recognised negative prognostic factors. Less certainty exists on the role of nutrition therapy in improving cancer patients' body composition and clinical outcome. The reasons for the lack of convincing evidence are manifold, mostly related to the poor design of nutritional trials. Metastatic cancer patients should receive a quantitatively and qualitatively adequate diet, and in case of reduced tolerance of food, artificial nutrition is indicated. Most importantly, nutritional care should target the underlying mechanisms of reduced food intake/impaired anabolic response, and aim at minimising the impact of catabolic crisis, to maximise the recovery phase. The combined and early use of supplemental energies and proteins, as well as modulators of inflammatory response has been shown to improve nutritional status and may also benefit clinical outcome. When part of early palliative care, nutrition therapy improves cancer patients' quality of life and may prolong survival at a fraction of the costs of developing new drugs.