Nutrition in oncology

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Nutrients are key for life

Nutrition plays an important role in many aspects of cancer development and is an important supportive therapy throughout the whole pathway of cancer treatment. Adequate nutrition support can help cancer patients maintain weight and lean body composition, offering better recovery from nutrition impact symptoms and improving quality of life. 1, 2, 3, 4

Improving nutrition for better recovery

Nutritional intervention can improve clinical outcomes in certain cancer types (e. g. head and neck cancer) or treatments (e. g. chemo-radiotherapy) where reduced food intake is prevalent and is not accompanied by severe metabolic derangements. In such patients, conventional screening, assessment and appropriate nutritional intervention is predicted to have beneficial effects. 5

Malnutrition is a major cause of morbidity and mortality in tumor patients 6 and causes negative effects on tissue, body structure, organ functions as well as on the overall clinical course. 7 Up to 80% of all tumor patients have already lost weight when diagnosed. 6 This initial weight loss is particularly pronounced in patients with pancreatic, gastric, esophageal and head and neck tumors. 30 % of these patients experienced already a significant weight loss of 10 % or more of their body weight at the time of diagnosis. 6 Cachexia is one specific metabolic form of malnutrition that occurs particularly at advanced cancer stages. 8 Criteria for tumor cachexia are the combination of malnutrition and systemic inflammatory reaction. A nutritional deficiency of this sort has an unfavorable effect on the quality of life and the prognosis of the tumor patient. Both the response to antitumor therapies and the survival time are negatively affected. 9 Furthermore, there is also often a clear economic burden resulting from nutritional deficiency due to the frequent and longer hospital stays and higher therapy costs associated with it.

Estimated age-standardised incidence and mortality rates: both sexes. 10

Goals of Nutrition Therapy in cancer treatment

(ESPEN Guideline Cancer 2016)

  • Maintain or improve food intake
  • Mitigate metabolic derangements
  • Maintain skeletal muscle mass and physical performance
  • Reduce the risk of reductions or interruptions of scheduled anti-cancer treatments
  • Improve quality of life

Nutrition Therapy in malnourished or risk of malnutrition cancer patients

  • May help to improve body weight and energy intake 5
  • Can reduce the incidence of postoperative infectous and non-infectous complications, together with a positive effect on length of hospitalization 11
  • May improve physical activity and quality of life 5
  • Can diminish negative effects of radiotherapy on nutrition status 5
  • May improve survival 5, 9
  • Can improve quality of life 2, 5
  • May reduce cancer treatment toxicity 5, 12

Prescription

Prior to prescribing Clinical Nutrition in connection with oncological treatment, the nutritional regimens and the optimal pathway of delivery are decided based on individual patient characteristics so as to ensure adequate nutritional support. B. Braun offers a wide range of parenteral and enteral solutions and services to coverbthe specific needs of oncology patients.

Patient Access

After phycisians have chosen a specific nutritional strategy, they will prepare the patient for the appropriate access route.

B. Braun medical devices make it easy for the healthcare team to administer Enteral and Parenteral Nutrition products in a safe and efficient manner.

Preparation/ Compounding

In this step, the prescribed products are prepared for subsequent parenteral and / or enteral application. To support compatibility for the parenteral solution, B. Braun provides easy to mix multi-chamber bags, supplements, and compatibility tools. The enteral diets are delivered as ready-to-use solutions.

Application

The defined nutrition route is decisive for the application of Clinical Nutrition. Infusion pumps with dedicated sets for Enteral and / or Parenteral Nutrition solutions to support correct administration. For patients with stress-induced hyperglycemia, glucose management systems help control blood glucose levels in order to prevent hyper- and hypoglycemia as well as blood glucose variability. Tube misconnections are a major concern, especially in an Oncology setting. By offering dedicated enteral and parenteral administration sets, B. Braun provides a clear equipment-based means of enhancing patient safety.

Discharge Management

After hospitalization, patients may have to stay on IV medication, or continuing either their parenteral or enteral treatment at home or in alternative care settings. Discharge Management integrates all activities which are required to provide continuous support of the patient and hand over to nursing services.

B. Braun provides product and service systems for the treatment of patients after discharge from the hospital. Discharge Management

Tools and services

References

General literature

Description Document Link

1. Santarpia L, Contaldo F, Pasasini F. Nutritional sccreening and early treatment of malnutrition in cancer patients. J Cachexia Sarcopenia Muscle. 2011 Mar, 2(1):27-35.

2. Borges L, Paiva S, Silveira D, Assuncao M, Gonzalez M. Can nutritional status influence the quality of life of cancer patients?. Revista de Nutricao 23(5): 745-753. 2010.

3. Kreitler S, Barak F, Danieli-Siegelman N, Ostrowsky A. Nutrition and quality of life in advanced cancer patients. Psycho-Oncology 23( Suppl.3):338-417. 2014.

4. Insering EA, Capra S, Bauer JD. Nutrition intervention is beneficial in oncology outpatients receiving radiotherapy to the gastrointestinal or head and neck area. British journal of cancer (2004) 91, 447-452.

5. Arends J, Bachmann P, Baracos V, et all. ESPEN guidelines on nutrition in cancer patients. Clinical Nutrition 36 (2017) 11-48.

6. DeWys WD, Begg C, Lavin PT et al.: Prognostic effect of weight lossprior to chemotherapy in cancer patients. Am J Med 1980, 69: 491-7

7. Stratton RJ: Disease-related malnutrition. An evidence-based approach to treatment. Hrsg. Stratton RJ, Green CJ, Elia M. CABI Publishing, Wallingford 2003.

8. Tisdale MJ: Cachexia in cancer patients. Nat Rev Cancer 2002: 862-71.

9. Andreyev HJN et al.: Why do patients with weight loss have a worse outcome when undergoing chemotherapy for gastrointestinal malignancies? Eur J Cancer 1998; 34: 503-9.

10. WHO, International agency for research on cancer. GLOBOCAN 2012: Estimated cancer incidence, mortality and prevalence worldwide in 2012.

11.  Xia Yan, Fu-Xian Zhou, Tian Lan, hui Xu, xiao-xi Yang, Cong-hua Xie, Jing Dai, Zhen-ming Fu, Yan Gao, Lu-lu Chen. Optimal postoperative nutrition support for patients with gastrointestinal malignancy: a systematic review and meta-analysis. Clinical Nutrition 36 (2016) 710-721.

12. Paccagnella A, Morasutti I, Rosti G. Nutritional intervention for improving treatment tolerance in cancer patients. Current opinion in oncology. July 2011, vol 23, issue 4 -p 322-330.