open access
The role of artificial nutrition in gynecological cancer therapy
- Department of Gastroenterology, Clinical Hospital H. Swiecicki University of Medical Sciences, Poznan, Poland
- Department of Gynecology, Obstetrics and Gynecologic Oncology, Division of Gynecologic Oncology, Poznan University of Medical Sciences, Poznan, Poland
- Centre for Intestinal Failure, Department of General, Endocrinology and Gastroenterological Surgery, Poznan University of Medical Science, Poznan, Poland
open access
Abstract
Cancer patients are at risk of developing malnutrition from underlying disease as well as from cancer treatment. Moreover, weight loss is considered as a predictive factor for disease progression and shorter survival time. As many as 10–20% of patients with cancer die from the results of malnutrition, instead of from the cancer itself. In the case of cancer-related malnutrition, it is necessary to quickly implement individualized nutritional support depending on the type and stage of the disease, metabolic changes, the patient’s condition, expected survival and the function of the gastrointestinal tract. Artificial nutrition reduces the side effects of chemotherapy and improves immunity. Perioperatively it reduces the risk of infection, facilitates wound healing and shortens the length of hospitalization, thereby reducing the costs of the treat- ment. Initially, a malnourished patient, without gastrointestinal dysfunction, qualifies for nutritional counseling. When the energy needs cannot be met by normal feeding, nutritional supplements, taken orally, are recommended. The next step is to feed the patient by nasogastric tube or percutaneous endoscopic gastrostomy. Parenteral nutrition, which results in more side effects, is only started when enteral nutrition is insufficient to ensure adequate nutritional status or in cases of gastrointestinal tract obstruction. The benefit of parenteral nutrition is that it especially provides for those patients with gynaecological cancer who have radiation-induced intestinal damage and post-surgical complications such as short bowel syndrome. Palliative nutrition must to relieve hunger and thirst. Nutritional interventions should be individualized and focused on the changing nutrient needs of the patient and should be supported by physical activity. Regular assessment of the nutritional status of the patient should be an inherent element of the oncological treatment.
Abstract
Cancer patients are at risk of developing malnutrition from underlying disease as well as from cancer treatment. Moreover, weight loss is considered as a predictive factor for disease progression and shorter survival time. As many as 10–20% of patients with cancer die from the results of malnutrition, instead of from the cancer itself. In the case of cancer-related malnutrition, it is necessary to quickly implement individualized nutritional support depending on the type and stage of the disease, metabolic changes, the patient’s condition, expected survival and the function of the gastrointestinal tract. Artificial nutrition reduces the side effects of chemotherapy and improves immunity. Perioperatively it reduces the risk of infection, facilitates wound healing and shortens the length of hospitalization, thereby reducing the costs of the treat- ment. Initially, a malnourished patient, without gastrointestinal dysfunction, qualifies for nutritional counseling. When the energy needs cannot be met by normal feeding, nutritional supplements, taken orally, are recommended. The next step is to feed the patient by nasogastric tube or percutaneous endoscopic gastrostomy. Parenteral nutrition, which results in more side effects, is only started when enteral nutrition is insufficient to ensure adequate nutritional status or in cases of gastrointestinal tract obstruction. The benefit of parenteral nutrition is that it especially provides for those patients with gynaecological cancer who have radiation-induced intestinal damage and post-surgical complications such as short bowel syndrome. Palliative nutrition must to relieve hunger and thirst. Nutritional interventions should be individualized and focused on the changing nutrient needs of the patient and should be supported by physical activity. Regular assessment of the nutritional status of the patient should be an inherent element of the oncological treatment.
Keywords
parenteral nutrition; gynecological cancers; malnutrition; enteral nutrition; nutritional treatment
Title
The role of artificial nutrition in gynecological cancer therapy
Journal
Issue
Article type
Review paper
Pages
167-172
Published online
2019-03-29
Page views
4295
Article views/downloads
3864
DOI
Pubmed
Bibliographic record
Ginekol Pol 2019;90(3):167-172.
Keywords
parenteral nutrition
gynecological cancers
malnutrition
enteral nutrition
nutritional treatment
Authors
Magdalena Szewczuk
Emilia Gasiorowska
Konrad Matysiak
Ewa Nowak-Markwitz
- Gyan E, Raynard B, Durand JP, et al. NutriCancer2012 Investigator Group, NutriCancer2012 Investigator Group. Malnutrition in Patients With Cancer. JPEN J Parenter Enteral Nutr. 2017 [Epub ahead of print]; 42(1): 255–260.
- Pressoir M, Desné S, Berchery D, et al. Prevalence, risk factors and clinical implications of malnutrition in French Comprehensive Cancer Centres. Br J Cancer. 2010; 102(6): 966–971.
- Arends J, Baracos V, Bertz H, et al. ESPEN expert group recommendations for action against cancer-related malnutrition. Clin Nutr. 2017; 36(5): 1187–1196.
- Lacau St Guily J, Bouvard É, Raynard B, et al. NutriCancer: A French observational multicentre cross-sectional study of malnutrition in elderly patients with cancer. J Geriatr Oncol. 2018; 9(1): 74–80.
- Arends J, Bachmann P, Baracos V, et al. ESPEN guidelines on nutrition in cancer patients. Clin Nutr. 2017; 36(1): 11–48.
- Wong PW, Enriquez A, Barrera R. Nutritional support in critically ill patients with cancer. Crit Care Clin. 2001; 17(3): 743–767.
- Laird BJ, McMillan DC, Fayers P, et al. The systemic inflammatory response and its relationship to pain and other symptoms in advanced cancer. Oncologist. 2013; 18(9): 1050–1055.
- Johns N, Stephens NA, Fearon KCH. Muscle wasting in cancer. Int J Biochem Cell Biol. 2013; 45(10): 2215–2229.
- Kondrup J, Allison SP, Elia M, et al. Educational and Clinical Practice Committee, European Society of Parenteral and Enteral Nutrition (ESPEN). ESPEN guidelines for nutrition screening 2002. Clin Nutr. 2003; 22(4): 415–421.
- Aaldriks AbA, van der Geest LGM, Giltay EJ, et al. Frailty and malnutrition predictive of mortality risk in older patients with advanced colorectal cancer receiving chemotherapy. J Geriatr Oncol. 2013; 4(3): 218–226.
- Fearon K, Arends J, Baracos V. Understanding the mechanisms and treatment options in cancer cachexia. Nat Rev Clin Oncol. 2013; 10(2): 90–99.
- Lach K, Peterson SJ. Nutrition Support for Critically Ill Patients With Cancer. Nutr Clin Pract. 2017; 32(5): 578–586.
- Lembeck ME, Pameijer CR, Westcott AM. The Role of Intravenous Fluids and Enteral or Parenteral Nutrition in Patients with Life-limiting Illness. Med Clin North Am. 2016; 100(5): 1131–1141.
- Cotogni P. Enteral versus parenteral nutrition in cancer patients: evidences and controversies. Ann Palliat Med. 2016; 5(1): 42–49.
- Chow R, Bruera E, Chiu L, et al. Enteral and parenteral nutrition in cancer patients: a systematic review and meta-analysis. Ann Palliat Med. 2016; 5(1): 30–41.
- Orrevall Y. Parenteral nutrition in the elderly cancer patient. Nutrition. 2015; 31(4): 610–611.
- Henson CC, Burden S, Davidson SE, et al. Nutritional interventions for reducing gastrointestinal toxicity in adults undergoing radical pelvic radiotherapy. Cochrane Database Syst Rev. 2013(11): CD009896.
- Dev R, Dalal S, Bruera E. Is there a role for parenteral nutrition or hydration at the end of life? Curr Opin Support Palliat Care. 2012; 6(3): 365–370.
- Prevost V, Grach MC. Nutritional support and quality of life in cancer patients undergoing palliative care. Eur J Cancer Care (Engl). 2012; 21(5): 581–590.