Dell Deena Damsky
Fox Chase Cancer Center, Philadelphia, PA, USA.
Clin J Oncol Nurs. 2002 Jul-Aug;6(4):235-8. doi: 10.1188/02.CJON.235-238.
Cancer cachexia generally is considered to be the end stage in the progression of nutritional deterioration and wasting of malignancy (Ottery, 1995). In patients with advanced cancer, this condition is very common and decreases quality of life, as well as survival (Fearon et al., 2001; Ottery; Smith & Souba, 2001; Whitman, 2000). However, if early diagnosis and intervention can control cachexia, the potential exists to greatly improve a patient's quality of life and prolong survival. Because metabolic alterations inhibit the effective use of conventional nutritional support, anti-inflammatory agents or fish oil are possible options. Orexigenic agents may be prescribed if patients wish to improve oral intake. Steroids and progestational agents may be used to attempt to improve mood and appetite. Nutrition affects symptoms that need to be managed effectively. Nurses should work aggressively to correct factors that contribute to decreased food intake (e.g., nausea, pain) and correct factors that worsen debility (e.g., anemia). Information must be presented so that informed choices can be made and realistic eating goals set. An interdisciplinary approach that involves the nurse, physician, dietician, and possibly social worker or case manager, as well as the patient and family, is necessary to identify nutritional alterations, assess specific needs, and plan individual interventions. Whitman (2000) stated that counseling is the most effective and least expensive intervention. It may be conducted by any member of the healthcare team and should be combined with other interventions. Palliation of cachexia in patients with advanced cancer is a challenge for nurses. Hopefully, early and judicious use of these interventions may decrease the significant morbidity and mortality that result from cancer cachexia.
癌症恶病质通常被认为是恶性肿瘤营养恶化和消瘦进展的终末期（奥特里，1995年）。在晚期癌症患者中，这种情况非常常见，会降低生活质量以及生存率（费伦等人，2001年；奥特里；史密斯和苏巴，2001年；惠特曼，2000年）。然而，如果能早期诊断并进行干预以控制恶病质，就有可能极大地提高患者的生活质量并延长生存期。由于代谢改变会抑制传统营养支持的有效利用，抗炎药物或鱼油可能是选择之一。如果患者希望增加口服摄入量，可开具食欲增进剂。类固醇和孕激素类药物可用于尝试改善情绪和食欲。营养会影响需要有效管理的症状。护士应积极努力纠正导致食物摄入量减少的因素（如恶心、疼痛），并纠正使身体虚弱加重的因素（如贫血）。必须提供相关信息，以便患者做出明智的选择并设定切实可行的饮食目标。需要一种跨学科方法，涉及护士、医生、营养师，可能还有社会工作者或病例管理员，以及患者和家属，以识别营养改变、评估具体需求并规划个体化干预措施。惠特曼（2000年）指出，咨询是最有效且成本最低的干预措施。它可由医疗团队的任何成员进行，并且应与其他干预措施相结合。缓解晚期癌症患者的恶病质对护士来说是一项挑战。希望早期明智地使用这些干预措施可能会降低癌症恶病质导致的显著发病率和死亡率。
