How important is nutritional support for cancer patients?

Nutritional therapy is the same as anti-tumor therapy, and there is no room for relaxation! During clinical rounds, cancer patients often ask, "Doctor, I don’t want to hang the nutrition needle every day, can I not hang it?", or sometimes I hear complaints from patients, "Doctor, today is to hang the fat for me again.
Milk, amino acids, vitamins, but I didn’t give me more bottles of anti-tumor drugs.
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The patients all have a common idea: nutrition injections are not necessary, as long as anti-tumor drugs are enough.

In fact, they did not realize the importance of nutritional support for cancer treatment.

What are the causes of malnutrition in cancer patients? According to statistics, the incidence of malnutrition in cancer patients is as high as 40%-80%, and it often occurs in gastric cancer, esophageal cancer, pancreatic cancer, liver cancer, biliary cancer, oral cancer, larynx, lung cancer, bowel cancer, etc.

50%-80% of cancer patients will further develop cachexia, and 20% of tumor patients' direct cause of death is malnutrition and cachexia, rather than the tumor itself.

The reasons include the following aspects: ▌ Tumor factors Tumor cells have strong proliferation ability, which seizes and consumes most of the nutrients needed for normal metabolism of the body; some metabolites released by tumors cause nausea, vomiting, abnormal taste and smell, anorexia, energy Significant decline in intake and utilization, causing malnutrition; head and neck cancer, esophagus, and gastric cancer can cause dysphagia and swallowing pain, causing patients to have difficulty eating, and further cause malnutrition; inflammatory mediators released by tumors can cause body sugar, fat, Abnormal protein metabolism, including increased energy consumption and low utilization efficiency, rapid loss of fat stored in the body, excessive decomposition of muscle protein, and malnutrition.

▌ Therapeutic factors Fasting before surgery for surgical treatment, and failure to eat normally for a long time after surgery will affect the patient’s food intake, and the stress response caused by surgical trauma will increase the body’s catabolism and energy consumption, and the body will break down muscles and muscles.
Fat leads to malnutrition.

Gastrointestinal reactions caused by radiotherapy or chemotherapy or targeted drugs, such as loss of appetite, nausea and vomiting, diarrhea, etc.
, while the patient's food intake is reduced, leading to malnutrition.▌ Pain and psychological factors Cancer pain in cancer patients acts as a stressor, which promotes the body's metabolism and leads to malnutrition.

In addition, the patient's negative psychology, such as fear, depression, despair, etc.
, can cause gastrointestinal dysfunction, decreased appetite, and reduced intake, leading to malnutrition.

How to assess the nutritional risk of cancer patients? Currently, in clinical practice, Nutrition Risk Screening 2002 (NRS 2002) is recommended as a nutritional risk screening for inpatients, including three aspects: severity of disease (0-3 points), nutritional status score (0-3 points), and age Scoring, on the basis of the above scores, one point is added to those aged 70 years old, and the total score is 0-7.

The score cut point for whether there is nutritional risk is set as 3 points, that is, NRS score ≥ 3 is a nutritional risk, and nutritional intervention is required; while those with NRS <3 have no nutritional risk, they should be screened weekly during their hospitalization Check once.

Prevention and treatment strategies for malnutrition in cancer patients Malnutrition and body wasting are common lethal factors in patients with malignant tumors, which directly affect the effect of tumor treatment, increase the incidence of complications, reduce the quality of life, and even affect the prognosis.

Cancer patients have different conditions, and nutritional support treatment strategies are also different, which can be divided into non-end-stage and end-stage cancer patients.

End-stage cancer patients refer to patients who have lost the indications of conventional anti-tumor treatment, including surgery, radiotherapy, chemotherapy and molecular targeted drug therapy.
Generally speaking, the expected survival time is less than 3 months, otherwise they are non-end-stage patients.

▌ Patients with non-terminal tumors 1.
Surgical treatment: The goal of nutritional therapy is to improve the patient's tolerance to surgery and reduce the incidence of surgical complications and surgical mortality.

Studies have shown that for surgical patients with moderate or severe nutritional deficiencies, nutritional therapy 10 to 14 days before surgery can reduce the incidence of surgical complications.

For patients who are not malnourished, mildly malnourished, or have enough oral intake within 7 days after surgery, preoperative parenteral nutrition is not beneficial.

As long as the patient has part of the digestion and absorption function of the gastrointestinal tract, enteral nutrition should be considered first as far as possible.

Patients who are unable to enteral nutrition or cannot meet the metabolic needs of the body should choose parenteral nutrition.
Once the patient's intestinal function is restored, they should transition to enteral feeding as soon as possible.

The traditional fasting preparation measures 10-12 hours before surgery can make patients enter a catabolic state prematurely, which is actually not conducive to postoperative recovery.

Therefore, anesthesia societies in many countries have changed the preoperative fasting time for elective surgery patients to 6 hours, while preoperative water deprivation only needs 2 hours.

2.
Chemotherapy and radiotherapy: The goal of nutritional therapy is to prevent and treat malnutrition or cachexia, improve the tolerance and compliance of patients to chemotherapy and radiotherapy, control the adverse reactions of chemotherapy and radiotherapy, and improve the quality of life.

Routine nutritional therapy is not recommended for patients who are not undernourished.

Before the start of treatment, patients with moderate or severe malnutrition, or severe adverse reactions during chemotherapy or radiotherapy, who are expected to be unable to eat for more than a week or more, should receive nutritional therapy in time.

Enteral nutrition is the first choice.
For patients who cannot tolerate enteral nutrition, parenteral nutrition is recommended.

If the daily intake of energy and protein through the gastrointestinal tract is less than 60% of the target amount for more than 10 days, parenteral nutrition should be supplemented.

▌ Patients with end-stage cancer patients with end-stage malignant tumors are often accompanied by severe cachexia.
The principle of nutrition therapy for these patients is to ensure the quality of life and relieve symptoms, but whether it can prolong their survival is still lacking high standards of evidence-based evidence.
Medical evidence.

Routine nutritional therapy is not recommended for patients with end-stage cancer.

For those who have the opportunity to receive effective anti-tumor drugs, nutritional therapy will provide opportunities for treatment, so that patients who have lost their indications can get treatment opportunities again, which is beneficial to improving the quality of life and prolonging the survival period.

For patients nearing the end of life, only a very small amount of food and water are needed to reduce hunger and thirst and prevent mental confusion caused by dehydration.

Overnutrition treatment will increase the metabolic burden of patients and affect their quality of life.

Nutritional treatment methods can be based on the following "five-step" treatment principles.

When the relevant treatment lasts for 3-5 days and still cannot meet 60% of the patient's target energy demand, the next step of treatment principle should be selected.

The first step: diet + nutrition education (including nutrition consultation, diet guidance and diet adjustment); the second step: diet + oral nutritional supplement (ONS); the third step: total enteral nutrition (TEN); the fourth step: part Enteral nutrition (PEN) + partial parenteral nutrition (PPN); fifth step: complete parenteral nutrition (TPN).

Although there is no evidence that nutritional support can improve the survival prognosis for patients who do not have malnutrition, but for patients who already have malnutrition, timely nutritional support treatment can significantly improve the tolerance of treatment and improve the quality of life.
Survival has some benefits.

Reference materials: [1] Wu Guohao.
Pay attention to the malnutrition and prevention of malignant tumor patients.
Chinese Cancer Clinic, 2014,41(18):1145-1149.
[2] Ying Limei, Chen Fangfang, Chen Yidan, etc.
Nutrition for domestic cancer patients Analysis of risk and malnutrition research status.
Electronic Journal of Tumor Metabolism and Nutrition, 2017, 4(2): 226-231.
[3] CSCO Cancer Nutrition Therapy Expert Committee.
Expert consensus on nutritional therapy for patients with malignant tumors.
Journal of Clinical Oncology, 2012,17(1):59-73.
[4]Wu Beiwen.
Research progress in the diagnosis and treatment of malnutrition in patients with malignant tumors.
Shanghai Nursing, 2017,17(2):5-9.
[5] Zhang Hao, Cong Qingxue.
Nutritional support treatment for patients with malignant tumors.
Medical Information, 2014(13): 596-597.
[6] Xia Weibo, et al.
, Consensus on the clinical application of vitamin D and its analogues.
Chinese Journal of Osteoporosis and Bone Mineral Diseases, 2018(01):p.
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Source: Medical Oncology Channel