Nutritional support for a cancer patient

Abstract

Oesophageal cancer patients very frequently lose their body weight, which leads to malnutrition and accelerates the development of cachexia. Weight loss and development of malnutrition accelerate the development of cachexia and deteriorate the functional state of patients and their quality of life. Functional state and quality of life of patients thus become worse. This also results in poorer tumour response to treatment, which is accompanied by adverse events and decreased survival.
There are numerous causes of weight loss and development of malnutrition in patients with gastrointestinal tumours, which often develop already at the onset of the disease. Therefore, the diagnosis of cachexia and nutritional management of the patient should be undertaken at the same time as treatment of the cancerous disease. They are performed in the same manner as any other medical therapy. Nutritional intervention, as the basic measure for preventing malnutrition and development of cachexia, must be started early enough to prevent and/or minimise further loss of body cell mass. The energy needs of cancer patients are comparable to those of patients who do not have cancer. Protein requirements are 1.2-2.0 g/kg of body weight/day. In patients with cachexia, we can use modulation of metabolism by omega-3 fatty acids.

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Povzetek

Bolniki z rakom požiralnika in želodca zelo pogosto izgubljajo telesno maso, kar vodi v podhranjenost ter pospešuje razvoj kaheksije. Hujšanje in razvoj podhranjenosti pospešujeta razvoj kaheksije, znižujeta funkcionalno stanje bolnikov ter njihovo kakovost življenja. Funkcionalno stanje in kakovost življenja bolnikov sta slabša. Slabši je odziv tumorja na zdravljenje, to spremlja več neželenih sopojavov in slabše preživetje.
Vzroki za hujšanje in razvoj podhranjenosti so pri bolnikih s tumorji zgornjih prebavil številni ter se pogosto pojavijo že ob začetku bolezni. Zato naj diagnostika kaheksije in prehranska obravnava bolnika potekata vzporedno z zdravljenjem rakaste bolezni. Izvajata se na enak način kot vsaka druga medicinska terapija. Prehransko intervencijo, kot osnovni ukrep preprečevanja podhranjenosti in razvoja kaheksije, je treba pričeti dovolj zgodaj, da preprečimo in/ali zmanjšamo nadaljnjo izgubo telesne celične mase. Energetske potrebe bolnikov z rakom so primerljive z energetskimi potrebami bolnikov, ki nimajo raka. Potrebe po beljakovinah so 1,2 do 2,0 g/kg telesne teže/dan. Pri bolnikih s kaheksijo lahko uporabimo modulacijo presnove z omega-3 maščobnimi kislinami.