Regional Centre for Excellence in Palliative Care, Oslo University Hospital, Oslo, Norway.
Support Care Cancer. 2013 Jan;21(1):219-27. doi: 10.1007/s00520-012-1514-8. Epub 2012 Jun 10.
Cancer cachexia and low energy intake (EI) probably contribute to weight loss in advanced pancreatic cancer (PC). However, little is known about the actual EI in this disease. Aims were to assess EI, weight loss and symptoms during the disease course and investigate associations between symptoms and EI.
Thirty-nine patients (21 males) with advanced PC were consecutively included and followed every 4 weeks until the end of life. A 24-h dietary recall was used to assess EI. The Edmonton Symptom Assessment System (ESAS) and the PC-specific health-related quality of life questionnaire (QLQ-PAN26) were used for symptom assessment.
Median age was 62 years (48-88), WHO performance status 1 (0-2) and survival 5 months (1-25). Seventeen (44 %) patients had unresectable cancer, 16 (41 %) metastatic and six (15 %) recurrent disease. Upon inclusion, 37 (95 %) reported weight loss (median 4.0 kg per month). During follow-up, median weight loss per month was <1.0 kg. Forty to 65 % had EI <29 kcal/kg/day (cut-off value for weight maintenance) during the observation period but they did not lose more weight than patients with EI ≥ 29 kcal. Strong negative correlations (r range) were found between EI and pain (0.51-0.61), fatigue (0.54-0.67), oral dryness (0.61-0.64) and loss of appetite (0.53-0.71).
In this study, several symptoms influenced EI negatively. Low EI did not completely explain weight loss in this patient group, but careful monitoring and early follow-up of symptoms may be important interventions to reduce weight loss in advanced PC.
癌症恶病质和低能量摄入（EI）可能导致晚期胰腺癌（PC）的体重下降。然而，对于这种疾病的实际 EI 知之甚少。本研究旨在评估疾病过程中的 EI、体重减轻和症状，并探讨症状与 EI 之间的关系。
连续纳入 39 例（21 例男性）晚期 PC 患者，每 4 周随访一次，直至死亡。使用 24 小时膳食回顾法评估 EI。采用埃德蒙顿症状评估系统（ESAS）和 PC 特异性健康相关生活质量问卷（QLQ-PAN26）评估症状。
中位年龄为 62 岁（48-88 岁），WHO 体能状态为 1 级（0-2 级），生存时间为 5 个月（1-25 个月）。17 例（44%）患者为不可切除性肿瘤，16 例（41%）为转移性肿瘤，6 例（15%）为复发性肿瘤。纳入时，37 例（95%）患者报告体重减轻（每月平均 4.0kg）。随访期间，每月体重减轻中位数<1.0kg。40%-65%的患者在观察期间的 EI<29kcal/kg/天（维持体重的临界值），但他们的体重减轻并不比 EI≥29kcal/kg/天的患者多。EI 与疼痛（r 范围为 0.51-0.61）、疲劳（0.54-0.67）、口干（0.61-0.64）和食欲下降（0.53-0.71）呈强负相关。
在这项研究中，一些症状对 EI 产生负面影响。低 EI 并不能完全解释该患者组的体重减轻，但仔细监测和早期随访症状可能是减少晚期 PC 体重减轻的重要干预措施。
