Cotogni Paolo, Pedrazzoli Paolo, De Waele Elisabeth, Aprile Giuseppe, Farina Gabriella, Stragliotto Silvia, De Lorenzo Francesco, Caccialanza Riccardo
Pain Management and Palliative Care, Department of Anesthesia, Intensive Care and Emergency, Molinette Hospital, University of Turin, Turin, Italy.
Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo and Department of Internal Medicine, University of Pavia, Pavia, Italy.
J Cancer. 2019 Jul 10;10(18):4318-4325. doi: 10.7150/jca.31611. eCollection 2019.
One of the challenges during chemotherapy and radiotherapy is to complete the planned cycles and doses without dose-limiting toxicity. Growing evidence clearly demonstrates the relationship between dose-limiting toxicity and low muscle mass. Moreover, malnutrition leads to low performance status, impaired quality of life, unplanned hospital admissions, and reduced survival. In the past, the lack of clear and authoritative recommendations and guidelines has meant that oncologists have not always fully appreciated the importance of nutritional therapy in patients receiving anticancer treatments. Therefore, collaboration between oncologists and clinical nutrition specialists needs to be urgently improved. Recent guidelines from scientific societies and practical recommendations by inter-society consensus documents can be summarized as follows: 1) timely nutritional therapy should be carefully considered if patients undergoing anticancer treatments are malnourished or at risk of malnutrition due to inadequate oral intake; 2) if oral intake is inadequate despite counseling and oral nutritional supplements, supplemental enteral nutrition or, if this is not sufficient or feasible, parenteral nutrition should be considered; 3) home artificial nutrition should be prescribed and regularly monitored using defined protocols developed between oncologists and clinical nutrition specialists; 4) appropriate nutritional management in the context of simultaneous care should become a guaranteed right for all patients with cancer. The purpose of this review is to provide oncologists with an overview of the aims and current evidence about nutrition in oncology, together with updated practical and concise recommendations on the application of nutritional therapy in cancer patients receiving chemoradiotherapy.
化疗和放疗期间的挑战之一是在不出现剂量限制毒性的情况下完成计划的疗程和剂量。越来越多的证据清楚地表明了剂量限制毒性与低肌肉量之间的关系。此外，营养不良会导致身体状况不佳、生活质量受损、意外住院以及生存率降低。过去，由于缺乏明确且权威的建议和指南，肿瘤学家并不总是充分认识到营养治疗在接受抗癌治疗患者中的重要性。因此，迫切需要加强肿瘤学家与临床营养专家之间的合作。科学协会的最新指南和跨协会共识文件的实用建议可总结如下：1）如果接受抗癌治疗的患者因口服摄入量不足而营养不良或有营养不良风险，应仔细考虑及时进行营养治疗；2）如果尽管进行了咨询并使用了口服营养补充剂，但口服摄入量仍不足，则应考虑补充肠内营养，或者在这不足或不可行的情况下，考虑肠外营养；3）应按照肿瘤学家和临床营养专家制定的明确方案开具家庭人工营养处方并定期监测；4）在同步护理的背景下进行适当的营养管理应成为所有癌症患者的一项应有权利。本综述的目的是向肿瘤学家概述肿瘤学中营养的目标和当前证据，以及关于在接受放化疗的癌症患者中应用营养治疗的最新实用且简明的建议。
