Marín Caro Mónica María, Laviano Alessandro, Pichard Claude
Clinical Nutrition, Geneva University Hospital, 1211 Geneva 14, Geneva, Switzerland.
Clin Nutr. 2007 Jun;26(3):289-301. doi: 10.1016/j.clnu.2007.01.005. Epub 2007 Mar 21.
The evaluation of quality of life (QoL) assesses patients' well-being by taking into account physical, psychological and social conditions. Cancer and its treatment result in severe biochemical and physiological alterations associated with a deterioration of QoL. These metabolic changes lead to decreased food intake and promote wasting. Cancer-related malnutrition can evolve to cancer cachexia due to complex interactions between pro-inflammatory cytokines and host metabolism. Beside and beyond the physical and the metabolic effects of cancer, patients often suffer as well from psychological distress, including depression. Depending on the type of cancer treatment (either curative or palliative) and on patients' clinical conditions and nutritional status, adequate and patient-tailored nutritional intervention should be prescribed (diet counselling, oral supplementation, enteral or total parenteral nutrition). Such an approach, which should be started as early as possible, can reduce or even reverse their poor nutritional status, improve their performance status and consequently their QoL. Nutritional intervention accompanying curative treatment has an additional and specific role, which is to increase the tolerance and response to the oncology treatment, decrease the rate of complications and possibly reduce morbidity by optimizing the balance between energy expenditure and food intake. In palliative care, nutritional support aims at improving patient's QoL by controlling symptoms such as nausea, vomiting and pain related to food intake and postponing loss of autonomy. The literature review supports that nutritional care should be integrated into the global oncology care because of its significant contribution to QoL. Furthermore, the assessment of QoL should be part of the evaluation of any nutritional support to optimize its adequacy to the patient's needs and expectations.
生活质量（QoL）评估通过综合考虑身体、心理和社会状况来评估患者的幸福感。癌症及其治疗会导致严重的生化和生理改变，进而导致生活质量下降。这些代谢变化会导致食物摄入量减少并加剧消瘦。由于促炎细胞因子与宿主代谢之间的复杂相互作用，癌症相关营养不良可能会发展为癌症恶病质。除了癌症的身体和代谢影响之外，患者还常常遭受心理困扰，包括抑郁。根据癌症治疗的类型（治愈性或姑息性）以及患者的临床状况和营养状况，应制定适当的、针对患者的营养干预措施（饮食咨询、口服补充剂、肠内营养或全胃肠外营养）。这种应尽早开始的方法可以减轻甚至扭转患者不佳的营养状况，改善其身体状况，从而提高其生活质量。伴随治愈性治疗的营养干预具有额外的特定作用，即通过优化能量消耗与食物摄入之间的平衡来提高对肿瘤治疗的耐受性和反应，降低并发症发生率，并可能降低发病率。在姑息治疗中，营养支持旨在通过控制与食物摄入相关的恶心、呕吐和疼痛等症状以及推迟自主能力丧失来提高患者的生活质量。文献综述支持，由于营养护理对生活质量有重大贡献，因此应将其纳入全球肿瘤护理中。此外，生活质量评估应作为任何营养支持评估的一部分，以优化其对患者需求和期望的适配性。
