Focusing on the nutritional status of cancer patients: malnutrition seriously affects tumor prognosis

Global cancer mortality rates have remained high over the past half centuryAccording to the WHO Global Cancer Statistics Report, there were 18.1 million new cases of cancer worldwide and 9.6 million deaths from cancer in 2018Cancer remains the world's highest prevalence and mortality rate, regardless of advances in human technology and medical care.2How to reduce cancer-related mortality and improve the quality of life of patients has been a major concern for the global economy
malnutrition can cause canceras early as the 1960s, epidemiological studies have shown a relationship between multiple cancers and dietary nutritional factorsFor example, people at high risk of esophageal cancer usually lack fruits, vegetables and animal products in their diets, so the absence of trace elements is considered the main cause of high incidence of esophageal cancer, and similarly, a high proportion of people with a diet of vegetables and fruits have a significantly lower risk ofstomach cancer, which is closely related to the increase in vitamin C and beta carotene levels in the serum
Nearly 50% of cancer deaths worldwide (about 8.9 million per year) are attributed to malnutrition-related tumors, most commonlypancreatic cancer
, esophageal, stomach, lung, liver and large-
, according to the 2017 WHO's Cancer Bulletin The mortality rates for lung, stomach and liver cancer were also in the top three among the 36 cancers counted by the WHO in 2018 (Table 1) How does malnutrition differ between different types of cancer patients? Table 1 Statistics on the number of new cases and deaths of 36 cancers in 2018
data source: GLOBOCAN 2018 digestive tumor patients are at high risk of malnutrition
some studies have calculated the relationship between tumor sites and malnutrition incidence of 1,588 cancer patients in Korea, and the results show that the incidence of malnutrition is higher for esophageal cancer, pancreatic bile duct and cancer Among them, the incidence of malnutrition in patients with esophageal, pancreatic bile duct and lung cancer was 52.9%, 47.6% and 42.8%, respectively, compared with the significant increase in stomach, liver and colorectal cancer (P 0.001) Another study, which collected information on a total of 1,903 cancer patients in 154 hospitals in 24 French cities, showed a total malnutrition rate of 39 per cent, of which pancreatic and esophagus-gastric cancers had a malnutrition rate of 66.7 per cent and 60.2 per cent (Figure 2) In addition to the impact of tumor location, will different treatment options also have an impact on the incidence of malnutrition in cancer patients? Figure 1 The incidence of malnutrition in different types of cancer patients 2 The incidence of malnutrition in different types of cancer patients chemotherapy is also susceptible to malnutrition in cancer patients
malnutrition is not only related to the severity of the disease, but also to the treatment programmes received by the patient The results showed that for patients of the same type of cancer, patients who received chemotherapy and other supportive treatments were more likely to develop malnutrition than those who received surgery , with a relatively low incidence of malnutrition in patients after surgery and a generally higher rate of malnutrition in patients after chemotherapy Further, for patients with colon cancer and liver cancer, the incidence of malnutrition in patients receiving supportive treatment increased significantly compared to those with chemotherapy (Figure 3) Figure 3 The incidence of malnutrition after different types of cancer patients received treatment from different protocols (%) A: surgery; B: chemotherapy; C: Support ingest treatment improve nutrition to help patients recover, reduce death and recurrence malnutrition is more common in hospital patients According to statistics, the incidence of malnutrition among all hospitalized patients is about 20-40%, and as complications increase and hospital stays increase, malnutrition rates will increase At the same time, cancer patients in hospital are more likely to have nutritional disorders than other patients with the disease, about 25 to 70% the malnutrition rates of different types of cancer patients varied significantly, but from the onset of the disease, 84% of patients had significant weight loss malnutrition in cancer patients further increases the length of time in hospital (LOS) and reduces the quality of life (QoL) In addition, what effect does malnutrition have on the recurrence and fatality rates of cancer patients? studies have calculated malnutrition rates and prognosis in 70 per cent of hospitals in Australia-Victoria at two point in 2012 and 2014 Statistical results of malnutrition in patients showed a significant decrease in the incidence of malnutrition in most types of tumors in 2014 compared to 2012 (Figure 4) Figure 4 Malnutrition rates for different types of cancer patients at two points in time digestive : including endocrine and thyroid tumors #; interesting, the 30-day prognosis of the other part of the study showed that the mortality rate fell from 81% in 2012 to 75% in 2014, and the probability of patients relapsing within 30 days of admission decreased from 90% in 2012 to 67% in 2014 (Table 2) combined, malnutrition increases the likelihood of death and re-admission within 30 days table 2 2 patients 30 days prognostic results the pay close attention to the clinical nutrition guidance of cancer patients can be seen, because of the cancer disease itself and the treatment process caused by the damage to the patient's body, cancer patients often have a very high risk of malnutrition In severe cases, malnutrition can develop into a visor, further affecting the patient's prognosis, complications, and a serious threat to the patient's life and health The European Society for Clinical Nutrition and Metabolism (ESPEN) expert group published the clinical nutrition guidance literature on cancer patients
highlights three key steps in nutritional care for cancer patients: (1) should be screened the risk of malnutrition in all cancer patients in the care of all cancer patients, regardless of body mass index (2) expand nutrition-related evaluation systems, taking into account anorexia, inflammatory biomarkers, resting energy consumption, and physical function testing and evaluation (3) develop a personalized nutritional intervention program for patients, and comprehensively develop a care program that includes increased nutritional intake, reduced inflammation and metabolic stress, and enhanced physical activity 's Freddie, Bray, Jacques, et al Global Cancer Statistics 2018: GLOBOCAN estimates of the world for 36 cancers in 185 countries (J) CA: a cancer journal clinician fors, 2018 The Cancer Research UK - Ludwig Cancer Research Nutrition and Cancer Research Collaborative Group Now eamto catalyze research in nutrition and cancer oedd oedd insanau BMC Medicine, 2019, 17 (1): 148 Key T J, Bradbury K E, Perez-Cornago A, et al Diet, nutrition, and cancer risk: what do we know and what is the way? J.: RMD Open, 2020, 368:m511 s4 Baracos V E Cancer-associated dydd d'Oreal.j European Journal of Clinical Nutrition, 2018, 72 (9): 1255-1259 Na B G , Han S S , Cho Y A , et al Conservative Status of Patients with Cancer: AIve Cohort Study of 1,588 Nutrition and Cancer, 2019:1-9 H?buterne X, Lemari? E, Michallet M, et al Prevalence of the nutrition and now use nutrition support in patients with cancer Jpen journal of parenteral nutrition, 2014, 38 (2: 196-204.
Martin L , Senesse P , Gioulbasanis I , et al Diagnostic Criteria for the Class of The Class of Cancer-Associated Weight Loss Journal of Clinical Oncology, 2015, 33 (1): 90-99 , Marshall K M , Loeliger J , Nolte L , et al Prevalence of the bar d'oedd and on the sex sydd s vision in cancer services: a comparison of two points time Clinical Nutrition, 2018: S0261561418301560 J Arends, V Baracos, H Bertz, et al ESPEN expert group for against datingd-cancer-cancer Clinical Nutrition, 2017, 36 (5): 1187-1196 Source: MedSci Original