Tchekmedyian N S
Pacific Shores Medical Group, Long Beach, CA 90813, USA.
Semin Oncol. 1998 Apr;25(2 Suppl 6):62-9.
Physicians are increasingly asked to consider the cost of interventions, including procedures and drugs, when making medical decisions. This article provides some practical information about the cost and efficacy of a variety of nutrition support measures for patients with cancer or acquired immunodeficiency syndrome-associated anorexia and undernutrition. Nutrition counseling, liquid homemade or commercially available food supplements, and appetite stimulants are relatively low-cost, effective means of nutrition support. Enteral nutrition requires invasive procedures, is more expensive, is associated with more potentially serious complications, and should be reserved for patients whose nutritional status cannot be maintained with less aggressive measures. Total parenteral nutrition is exceedingly expensive and seldom helpful; it should be reserved for those patients whose gastrointestinal tract is nonfunctional. In addition to nutritional parameters and cost, the clinician should consider patient preferences. Specific tools to assess the impact of nutrition support measures on patients' quality of life are under development.
