Nordøy Tone, Thoresen Lene, Kvikstad Anne, Svensen Rune
Lindring i Nord, Kreftavdelingen Universitetssykehuset Nord-Norge.
Tidsskr Nor Laegeforen. 2006 Feb 23;126(5):624-7.
Patients with non-curable cancer represent a large and heterogeneous group in which malnutrition and weight loss is a frequent finding. This article is based on relevant literature and our own clinical experience. For every patient a thorough examination of possible underlying causes should be explored and corrected as soon as possible (secondary cachexia). However, in many patients primary cachexia is the cause, a catabolic condition where muscle protein and lipids are degraded and even aggressive nutrition will not reverse the process. This condition is very different from starvation. Metoclopramide, corticosteroids and gestagens can relieve symptoms as anorexia, chronic nausea and asthenia which frequently occur in patients with cachexia. Treatments that may maintain or increase muscle function and modulate inflammatory processes are new approaches, such as eicosapentaneoic acid, adenosine triphosphate, specific amino acids and nonsteroidal antiinflammatory drugs. Nutrition is an integrated part of supportive therapy to all cancer patients, unless expected survival is short. At this time in life, nutrition will not influence survival and focus should be on symptom control.
无法治愈的癌症患者构成了一个庞大且异质性的群体，其中营养不良和体重减轻是常见现象。本文基于相关文献及我们自己的临床经验。对于每一位患者，都应全面探究可能的潜在病因并尽快加以纠正（继发性恶病质）。然而，在许多患者中，原发性恶病质才是病因，这是一种分解代谢状态，肌肉蛋白和脂质会被降解，即便积极的营养支持也无法逆转这一过程。这种情况与饥饿截然不同。甲氧氯普胺、皮质类固醇和孕激素可缓解恶病质患者常出现的厌食、慢性恶心和乏力等症状。可能维持或增强肌肉功能并调节炎症过程的治疗方法是新的途径，如二十碳五烯酸、三磷酸腺苷、特定氨基酸和非甾体抗炎药。营养是所有癌症患者支持性治疗的一个组成部分，除非预期生存期很短。在这个阶段，营养不会影响生存期，重点应放在症状控制上。
