Caccialanza Riccardo, Pedrazzoli Paolo, Cereda Emanuele, Gavazzi Cecilia, Pinto Carmine, Paccagnella Agostino, Beretta Giordano Domenico, Nardi Mariateresa, Laviano Alessandro, Zagonel Vittorina
1. Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy;
2. Division of Medical Oncology, Department of Hemato-Oncology Fondazione IRCCS Policlinico San Matteo, Pavia, Italy;
J Cancer. 2016 Jan 1;7(2):131-5. doi: 10.7150/jca.13818. eCollection 2016.
Malnutrition is a frequent problem in cancer patients, which leads to prolonged hospitalization, a higher degree of treatment-related toxicity, reduced response to cancer treatment, impaired quality of life and a worse overall prognosis. The attitude towards this issue varies considerably and many malnourished patients receive inadequate nutritional support. We reviewed available data present in the literature, together with the guidelines issued by scientific societies and health authorities, on the nutritional management of patients with cancer, in order to make suitable and concise practical recommendations for appropriate nutritional support in this patient population. Evidence from the literature suggests that nutritional screening should be performed using validated tools (the Nutritional Risk Screening 2002 [NRS 2002], the Malnutrition Universal Screening Tool [MUST], the Malnutrition Screening Tool [MST] and the Mini Nutritional Assessment [MNA]), both at diagnosis and at regular time points during the course of disease according to tumor type, stage and treatment. Patients at nutritional risk should be promptly referred for comprehensive nutritional assessment and support to clinical nutrition services or medical personnel with documented skills in clinical nutrition, specifically for cancer patients. Nutritional intervention should be actively managed and targeted for each patient; it should comprise personalized dietary counseling and/or artificial nutrition according to spontaneous food intake, tolerance and effectiveness. Nutritional support may be integrated into palliative care programs. "Alternative hypocaloric anti-cancer diets" (e.g. macrobiotic or vegan diets) should not be recommended as they may worsen nutritional status. Well-designed clinical trials are needed to further our knowledge of the nutritional support required in different care settings for cancer patients.
营养不良是癌症患者中常见的问题，会导致住院时间延长、治疗相关毒性程度更高、对癌症治疗的反应降低、生活质量受损以及总体预后更差。对这个问题的态度差异很大，许多营养不良的患者获得的营养支持不足。我们回顾了文献中现有的数据，以及科学协会和卫生当局发布的关于癌症患者营养管理的指南，以便为这一患者群体的适当营养支持提出合适且简洁的实用建议。文献证据表明，应使用经过验证的工具（营养不良通用筛查工具 [MUST]、营养不良筛查工具 [MST]、微型营养评定法 [MNA]）在诊断时以及根据肿瘤类型、分期和治疗在疾病过程中的定期时间点进行营养筛查。有营养风险的患者应立即转介至临床营养服务部门或具备临床营养记录技能的医务人员处进行全面的营养评估和支持，特别是针对癌症患者。应积极管理并针对每位患者进行营养干预；根据自发食物摄入量、耐受性和效果，营养干预应包括个性化的饮食咨询和/或人工营养。营养支持可纳入姑息治疗计划。不建议采用“替代低热量抗癌饮食”（如生机饮食或纯素饮食），因为它们可能会使营养状况恶化。需要设计良好的临床试验来进一步了解癌症患者在不同护理环境中所需的营养支持。
