Ernährung von Tumorpatienten

 

 Buy Article Permissions and Reprints

Zusammenfassung

Bei Patienten mit aktiver Tumorerkrankung entwickelt sich sehr häufig eine Mangelernährung. Der Gewichtsverlust ist mit einer reduzierten Lebensqualität und Leistungsfähigkeit sowie mit einer eingeschränkten Toleranz für antitumorale Therapien assoziiert. Gastrointestinale Störungen, quälende Schmerzzustände, psychosoziale Belastungen sowie Änderungen des metabolischen Milieus mit einer oft nachweisbaren tumorassoziierten systemischen Inflammationsreaktion führen zu Appetitverlust, verminderter Nahrungs- und Energieaufnahme, Fatigue, reduzierter Mobilität und weiterem Muskel- und Gewichtsverlust. Zentrale Ziele einer Stoffwechsel- und Ernährungsbetreuung onkologischer Patienten sind eine differenzierte Erfassung der Problemsituation, die gezielte Behandlung aller Faktoren, die die Nahrungsaufnahme und -verwertung stören, die Sicherung des erforderlichen Energie- und Nährstoffbedarfs, ein begleitendes Muskeltraining sowie antiinflammatorische und antikatabole Behandlungsansätze.

Abstract

Malnutrition develops frequently in cancer patients. Weight loss in these patients is associated with impaired quality of life and physical performance and a reduced tolerance of anticancer treatments. Gastrointestinal defects, chronic pain, psycho-social tensions and tumor-associated inflammatory reactions, all contribute to appetite loss, reduced intake of nutrients and energy, fatigue, diminished mobility and further loss of weight and muscles. Major aims of the nutritional and metabolic care of oncologic patients are the following: the careful assessment of the relevant problems; the targeted treatment of all factors interfering with nutritional intake and utilization; ensuring the required supply of nutrients and energy; exercise training; as well as anti-inflammatory and anti-catabolic strategies.

Literatur

• 1 Dewys W D, Begg C, Lavin P T et al. Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern Cooperative Oncology Group.  Am J Med. 1980;  69 491-497
  Google Scholar
• 2 Andreyev H J, Norman A R, Oates J et al. Why do patients with weight loss have a worse outcome when undergoing chemotherapy for gastrointestinal malignancies?.  Eur J Cancer. 1998;  34 503-509
  Google Scholar
• 3 Ross P J, Ashley S, Norton A et al. Do patients with weight loss have a worse outcome when undergoing chemotherapy for lung cancers?.  Br J Cancer. 2004;  90 1905-1911
  Google Scholar
• 4 Ravasco P, Monteiro-Grillo I, Vidal P M et al. Cancer: disease and nutrition are key determinants of patients’ quality of life.  Support Care Cancer. 2004;  12 246-252
  Google Scholar
• 5 Good R A, West A, Day N K et al. Effects of undernutrition of host cell and organ function.  Cancer Res. 1982;  42 (S 02) 737s-746s
  Google Scholar
• 6 Skipworth R JE, Stewart G D, Dejong C HC et al. Pathophysiology of cancer cachexia: much more than host-tumour interaction?.  Clin Nutr. 2007;  26 667-676
  Google Scholar
• 7 Montazeri A. Quality of life data as prognostic indicators of survival in cancer patients: an overview of the literature from 1982 to 2008.  Health Qual Life Outcomes. 2009;  7 102
  Google Scholar
• 8 Arends J. Mangelernährung bei Tumorpatienten.  Onkologe. 2008;  14 9-14
  Google Scholar
• 9 Evans W J, Morley J E, Argilés J et al. Cachexia: a new definition.  Clin Nutr. 2008;  27 793-799
  Google Scholar
• 10 Shizgal H M. The effect of malnutrition on body composition.  Surg Gynecol Obstet. 1981;  152 22-26
  Google Scholar
• 11 Cahill G F. Fuel metabolism in starvation.  Annu Rev Nutr. 2006;  26 1-22
  Google Scholar
• 12 Lundholm K, Holm G, Scherstén T. Insulin resistance in patients with cancer.  Cancer Res. 1978;  38 4665-4670
  Google Scholar
• 13 Pajak B, Orzechowska S, Pijet B et al. Crossroads of cytokine signaling – the chase to stop muscle cachexia.  J Physiol Pharmacol. 2008;  59 (S 09) 251-264
  Google Scholar
• 14 Norman K, Stobäus N, Zocher D et al. Cutoff percentiles of bioelectrical phase angle predict functionality, quality of life, and mortality in patients with cancer (14.07.2010). Im Internet: http://www.ncbi.nlm.nih.gov/pubmed/20631202 Stand: 20.07.2010
  Google Scholar
• 15 Prado C MM, Baracos V E, McCargar L J et al. Body composition as an independent determinant of 5-fluorouracil-based chemotherapy toxicity.  Clin Cancer Res. 2007;  13 3264-3268
  Google Scholar
• 16 Prado C MM, Lieffers J R, McCargar L J et al. Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study.  Lancet Oncol. 2008;  7 629-635
  Google Scholar
• 17 Dempsey D T, Feurer I D, Knox L S et al. Energy expenditure in malnourished gastrointestinal cancer patients.  Cancer. 1984;  53 1265-1273
  Google Scholar
• 18 Arends J, Bodoky G, Bozzetti F et al. ESPEN Guidelines on Enteral Nutrition: Non-surgical oncology.  Clin Nutr. 2006;  2 245-259
  Google Scholar
• 19 Kalm L M, Semba R D. They starved so that others be better fed: remembering Ancel Keys and the Minnesota experiment.  J Nutr. 2005;  135 1347-1352
  Google Scholar
• 20 Kotler D P, Tierney A R, Culpepper-Morgan J A et al. Effect of home total parenteral nutrition on body composition in patients with acquired immunodeficiency syndrome.  JPEN J Parenter Enteral Nutr. 1990;  14 454-458
  Google Scholar
• 21 Bozzetti F, Arends J, Lundholm K et al. ESPEN Guidelines on Parenteral Nutrition: non-surgical oncology.  Clin Nutr. 2009;  28 445-454
  Google Scholar
• 22 Thibault R, Goujon N, Le Gallic E et al. Use of 10-point analogue scales to estimate dietary intake: a prospective study in patients nutritionally at-risk.  Clin Nutr. 2009;  28 134-140
  Google Scholar
• 23 Oken M M, Creech R H, Tormey D C et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group.  Am J Clin Oncol. 1982;  5 649-655
  Google Scholar
• 24 Jensen G L, Mirtallo J, Compher C et al. Adult starvation and disease-related malnutrition: a proposal for etiology-based diagnosis in the clinical practice setting from the International Consensus Guideline Committee.  JPEN J Parenter Enteral Nutr. 2010;  34 156-159
  Google Scholar
• 25 Dulloo A G. Regulation of body composition during weight recovery: integrating the control of energy partitioning and thermogenesis.  Clin Nutr. 1997;  16 (S 01) 25-35
  Google Scholar
• 26 Streat S J, Beddoe A H, Hill G L. Aggressive nutritional support does not prevent protein loss despite fat gain in septic intensive care patients.  J Trauma. 1987;  27 262-266
  Google Scholar
• 27 Holm E, Kämmerer U. Fette und Kohlenhydrate in Ernährungskonzepten für Tumorpatienten.  Aktuel Ernahrungsmed. 2011;  36 286-298
  Google Scholar
• 28 Bruera E, Roca E, Cedaro L et al. Action of oral methylprednisolone in terminal cancer patients: a prospective randomized double-blind study.  Cancer Treat Rep. 1985;  69 751-754
  Google Scholar
• 29 Maltoni M, Nanni O, Scarpi E et al. High-dose progestins for the treatment of cancer anorexia-cachexia syndrome: a systematic review of randomised clinical trials.  Ann Oncol. 2001;  12 289-300
  Google Scholar
• 30 Jatoi A, Windschitl H E, Loprinzi C L et al. Dronabinol versus megestrol acetate versus combination therapy for cancer-associated anorexia: a North Central Cancer Treatment Group study.  J Clin Oncol. 2002;  20 567-573
  Google Scholar
• 31 Lundholm K, Daneryd P, Bosaeus I et al. Palliative nutritional intervention in addition to cyclooxygenase and erythropoietin treatment for patients with malignant disease: Effects on survival, metabolism, and function.  Cancer. 2004;  100 1967-1977
  Google Scholar
• 32 Lundholm K, Daneryd P, Körner U et al. Evidence that long-term COX-treatment improves energy homeostasis and body composition in cancer patients with progressive cachexia.  Int J Oncol. 2004;  24 505-512
  Google Scholar
• 33 Lundholm K, Gelin J, Hyltander A et al. Anti-inflammatory treatment may prolong survival in undernourished patients with metastatic solid tumors.  Cancer Res. 1994;  54 5602-5606
  Google Scholar
• 34 Colomer R, Moreno-Nogueira J M, García-Luna P P et al. N-3 fatty acids, cancer and cachexia: a systematic review of the literature.  Br J Nutr. 2007;  97 823-831
  Google Scholar
• 35 van der Meij B S, Langius J AE, Smit E F et al. Oral nutritional supplements containing (n-3) polyunsaturated fatty acids affect the nutritional status of patients with stage III non-small cell lung cancer during multimodality treatment.  J Nutr. 2010;  140 1774-1780
  Google Scholar
• 36 Murphy R A, Mourtzakis M, Chu Q SC et al. Nutritional intervention with fish oil provides a benefit over standard of care for weight and skeletal muscle mass in patients with nonsmall cell lung cancer receiving chemotherapy.  Cancer. 2011;  117 1775-1782
  Google Scholar
• 37 Murphy R A, Mourtzakis M, Chu Q SC et al. Supplementation with fish oil increases first-line chemotherapy efficacy in patients with advanced nonsmall cell lung cancer.  Cancer. 2011;  117 3774-3780
  Google Scholar
• 38 Adachi S, Takiguchi S, Okada K et al. Effects of ghrelin administration after total gastrectomy: a prospective, randomized, placebo-controlled phase II study.  Gastroenterology. 2010;  138 1312-1320
  Google Scholar
• 39 Biesalski H K. Mikronährstoffsupplemente bei onkologischen Patienten: Gibt es rationale Gründe?.  Aktuel Ernahrungsmed. 2011;  36 282-285
  Google Scholar
• 40 Arends J. Metabolism in cancer patients.  Anticancer Res. 2010;  30 1863-1868
  Google Scholar
• 41 Na H-K, Oliynyk S. Effects of physical activity on cancer prevention.  Ann N Y Acad Sci. 2011;  1229 176-183
  Google Scholar
• 42 Holmes M D, Chen W Y, Feskanich D et al. Physical activity and survival after breast cancer diagnosis.  JAMA. 2005;  293 2479-2486
  Google Scholar
• 43 Meyerhardt J A, Giovannucci E L, Holmes M D et al. Physical activity and survival after colorectal cancer diagnosis.  J Clin Oncol. 2006;  24 3527-3534
  Google Scholar
• 44 Meyerhardt J A, Heseltine D, Niedzwiecki D et al. Impact of physical activity on cancer recurrence and survival in patients with stage III colon cancer: findings from CALGB 89803.  J Clin Oncol. 2006;  24 3535-3541
  Google Scholar
• 45 McCann R M, Hall W J, Groth-Juncker A. Comfort care for terminally ill patients. The appropriate use of nutrition and hydration.  JAMA. 1994;  272 1263-1266
  Google Scholar

Dr. med. Jann Arends

Klinik für Tumorbiologie an der Albert-Ludwigs-Universität Freiburg

Breisacher Straße 117

79106 Freiburg

Email: arends@tumorbio.uni-freiburg.de