Division of Community Medicine and International Medicine, University of the Ryukyus Hospital, Nishihara, Nakagami, Okinawa 903-0215, Japan.
Nutrients. 2021 Mar 12;13(3):915. doi: 10.3390/nu13030915.
Cancer cachexia subsequently shifts to refractory cachexia, however, it is not easy to properly differentiate them in clinical settings. Patients considered refractory cachexia may include cachectic patients with starvation. This study aimed to identify these cachectic patients and to evaluate the effect of nutritional intervention for them. Study subjects were terminal cancer patients admitted for palliative care and were judged refractory cachexia in the last five years. We retrospectively examined to find useful indices for identifying such cachectic patients and for evaluating the effect of nutritional intervention. Out of 223 patients in refractory cachexia, 26 were diagnosed cachexia with starvation after symptom management. Comparing before and one week after this management, Palliative Performance Scale (PPS) and transthyretin significantly improved ( < 0.0001, = 0.0002, respectively) Then, we started nutritional intervention for these cachectic patients and divided into effective group ( = 17) and non-effective group ( = 9) using the criteria for cachexia. Comparing between the two groups, PPS significantly improved2 weeks after intervention in effective group ( = 0.006). Survival time was significantly longer in effective group ( = 0.008). PPS and transthyretin were useful for differential diagnosis of cachexia and refractory cachexia. PPS was useful for evaluating nutritional intervention for cachectic patients. Appropriate nutritional intervention improved survival.
癌症恶病质随后转变为难治性恶病质，但在临床环境中很难正确区分它们。被认为是难治性恶病质的患者可能包括因饥饿而恶病质的患者。本研究旨在确定这些恶病质患者，并评估对他们进行营养干预的效果。研究对象为接受姑息治疗并在过去五年中被判定为难治性恶病质的终末期癌症患者。我们回顾性检查以寻找识别这些恶病质患者和评估营养干预效果的有用指标。在 223 例难治性恶病质患者中，26 例经症状管理后被诊断为饥饿性恶病质。与管理前和管理后一周相比，姑息治疗表现量表（PPS）和转甲状腺素显著改善（<0.0001，=0.0002）。然后，我们对这些恶病质患者开始进行营养干预，并根据恶病质的标准将其分为有效组（n=17）和无效组（n=9）。在两组之间比较，有效组在干预后 2 周 PPS 显著改善（=0.006）。有效组的生存时间明显更长（=0.008）。PPS 和转甲状腺素可用于恶病质和难治性恶病质的鉴别诊断。PPS 可用于评估恶病质患者的营养干预效果。适当的营养干预可改善生存。
