St Columba's Hospice, Centre for Education and Research, Edinburgh, UK.
Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK.
Support Care Cancer. 2020 Apr;28(4):1877-1889. doi: 10.1007/s00520-019-04999-4. Epub 2019 Jul 29.
Recent guidelines by the European Society for Clinical Nutrition and Metabolism (ESPEN) have advocated increased attention to nutritional support in all patients with cancer; however, little is known about the optimal type of nutritional intervention. The aim of this review was to assess the current evidence for nutrition support in patients with incurable cancer.
This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Embase, MEDLINE and CINAHL were searched from 1990 to 2018. Evidence was appraised using a modified risk of bias table, based on guidance from the Cochrane Handbook for Systematic Reviews of Interventions.
Sixty studies were assessed of which twelve met the eligibility criteria. Eleven studies examined body composition, with six studies reporting improvements in weight. Six studies examined nutritional status with three studies reporting an improvement. Nine studies examined nutritional intake with six showing improvements including significant improvements in dietary and protein intake. Ten studies examined quality of life, with six studies reporting improvements following intervention. The most common nutritional interventions examined were nutrition counselling and dietary supplementation.
There is moderate quality evidence to support the need for increased attention to nutrition support in patients with incurable cancer; however, despite some statistically significant results being reported, the clinical effects of them were small. Key questions remain as to the optimal timing for these interventions to be implemented (e.g. cachexia stage, illness stage and timing with anticancer therapy) and the most appropriate endpoint measures.
欧洲临床营养与代谢学会（ESPEN）最近的指南主张更加关注所有癌症患者的营养支持；然而，对于最佳营养干预类型知之甚少。本综述旨在评估目前在不可治愈癌症患者中进行营养支持的证据。
本综述按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行。从 1990 年到 2018 年，检索了 Embase、MEDLINE 和 CINAHL。使用来自 Cochrane 干预系统评价手册的指导，根据修改后的偏倚风险表评估证据。
评估了 60 项研究，其中 12 项符合入选标准。11 项研究检查了身体成分，其中 6 项研究报告体重有所改善。6 项研究检查了营养状况，其中 3 项报告有所改善。9 项研究检查了营养摄入量，其中 6 项显示有所改善，包括饮食和蛋白质摄入量的显著改善。10 项研究检查了生活质量，其中 6 项研究报告干预后有所改善。检查最多的营养干预措施是营养咨询和膳食补充。
有中等质量的证据支持需要更加关注不可治愈癌症患者的营养支持；然而，尽管报告了一些具有统计学意义的结果，但它们的临床效果很小。关于这些干预措施实施的最佳时机（例如恶病质阶段、疾病阶段和与抗癌治疗的时间）以及最合适的终点测量指标，仍存在关键问题。
