Schneider S, Blanc-Vincent M P, Nitenberg G, Senesse P, Bachmann P, Colomb V, Desport J C, Gory-Delabaere G, Kere D, Raynard B, Melchior J C
FNCLCC, Standards, Options, Recommandations, 101, rue de Tolbiac, 75654 Paris Cedex 13.
Bull Cancer. 2001 Jun;88(6):605-18.
The "Standards, Options and Recommendations" (SOR) project, started in 1993, is a collaboration between the Federation of the French Cancer Centres (FNCLCC), the 20 French Cancer Centres and specialists from French Public Universities, General Hospitals and Private Clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and outcome for cancer patients. The methodology is based on literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery.
To develop clinical practice guidelines according to the definitions of the Standards, Options and Recommendations project for home parenteral or enteral nutrition in adult cancer patients.
Data were identified by searching Medline, Cancerlit, web sites and using the personal reference lists of members of the expert groups. Once the guidelines were defined, the document was submitted for review to 72 independent reviewers.
The main recommendations for home parenteral or enteral nutrition in adult cancer patients are: 1) Home parenteral or enteral nutrition concerns cancer patients with malnutrition or with inadequate/impossible oral intake, during therapy of because of therapeutic after-effects (standard). Same indications apply for home and hospital artificial nutrition (standard). 2) Patients need a multidisciplinary follow-up (oncologists, nutritionists, and pain specialists), and this follow-up will make treatment adaptations according to the nutritional status possible (recommendation, expert agreement). An active participation of patients and/or their family circle is very important (standard). 3) The benefit of home parenteral or enteral nutrition on the quality of life of terminally ill patients (vs. hydration) has not been demonstrated. When life expectancy is below 3 months, and the Karnofsky index below 50, the drawbacks of home artificial nutrition are more important than its advantages. In this case, home parenteral or enteral nutrition is not recommended (recommendation, expert agreement). 4) Prospective clinical trials are recommended to evaluate the impact of home nutrition on quality of life in cancer patients (expert agreement). 5) The use of educational booklets that mention the telephone number of a referent health care and what to do when a problem happens (e.g. fever on home parenteral nutrition) is recommended (expert agreement). In France, patients should be referred to authorized home parenteral nutrition centres (recommendation, expert agreement).
“标准、选项与建议”（SOR）项目始于1993年，是法国癌症中心联合会（FNCLCC）、20家法国癌症中心以及法国公立大学、综合医院和私立诊所的专家之间的合作项目。主要目标是制定临床实践指南，以提高癌症患者的医疗质量和治疗效果。该方法基于多学科专家小组的文献综述和批判性评估，并参考癌症护理专家的反馈意见。
根据“标准、选项与建议”项目的定义，制定针对成年癌症患者家庭肠外或肠内营养的临床实践指南。
通过检索Medline、Cancerlit、网站以及使用专家组成员的个人参考文献列表来确定数据。一旦指南确定，该文件将提交给72名独立评审员进行审核。
针对成年癌症患者家庭肠外或肠内营养的主要建议如下：1）家庭肠外或肠内营养适用于患有营养不良或经口摄入不足/无法经口摄入的癌症患者，适用于治疗期间或因治疗后遗症（标准）。家庭和医院人工营养的适用指征相同（标准）。2）患者需要多学科随访（肿瘤学家、营养师和疼痛专家），这种随访将使根据营养状况调整治疗成为可能（建议，专家共识）。患者和/或其家属的积极参与非常重要（标准）。3）家庭肠外或肠内营养对晚期患者生活质量（与补液相比）的益处尚未得到证实。当预期寿命低于3个月且卡诺夫斯基指数低于50时，家庭人工营养的弊端大于其益处。在这种情况下，不建议进行家庭肠外或肠内营养（建议，专家共识）。4）建议进行前瞻性临床试验以评估家庭营养对癌症患者生活质量的影响（专家共识）。5）建议使用提及主管医疗保健人员电话号码以及出现问题（如家庭肠外营养时发热）时应采取措施的教育手册（专家共识）。在法国，患者应转诊至经授权的家庭肠外营养中心（建议，专家共识）。
