Non-surgical oncology - Guidelines on Parenteral Nutrition,
Chapter 19.
Arends J, Zuercher G, Dossett A, Fietkau R, Hug M, Schmid I, Shang E, Zander A; Working group for developing the guidelines for parenteral nutrition of The German Association for Nutritional Medicine.
Source
Dept. of Medical Oncology, Tumour Biology Center, University of Freiburg, Germany.Ger Med Sci. 2009 Nov 18;
Abstract
Reduced
nutritional state is associated with unfavourable outcomes and a lower
quality of life in patients with malignancies. Patients with active
tumour disease frequently have insufficient food intake. The resting
energy expenditure in cancer patients can be increased, decreased, or
remain unchanged compared to predicted values. Tumours may result in
varying degrees of systemic pro-inflammatory processes with secondary
effects on all significant metabolic pathways. Therapeutic objectives
are to stabilise nutritional state with oral/enteral nutrition and
parenteral nutrition (PN) and thus to prevent or reduce progressive
weight loss. The maintenance or improvement of quality of life, and the
increase in the effectiveness and a reduction in the side-effects of
antitumor therapy are further objectives.
Indications for PN in tumour patients are essentially identical to those in patients with benign illnesses, with preference given to oral or enteral nutrition when feasible. A combined nutritional concept is preferred if oral or enteral nutrition are possible but not sufficient. There are generally no accepted standards for ideal energy and nutrient intakes in oncological patients, particularly when exclusive artificial nutrition is administered.
The use of PN as a general accompaniment to radiotherapy or chemotherapy is not indicated, but PN is indicated in chronic severe radiogenic enteritis or after allogenic transplantation with pronounced mucositis or GvH-related gastrointestinal damage for prolonged periods, with particular attention to increased risk of bleeding and infection. No PN is necessary in the terminal phase.
Indications for PN in tumour patients are essentially identical to those in patients with benign illnesses, with preference given to oral or enteral nutrition when feasible. A combined nutritional concept is preferred if oral or enteral nutrition are possible but not sufficient. There are generally no accepted standards for ideal energy and nutrient intakes in oncological patients, particularly when exclusive artificial nutrition is administered.
The use of PN as a general accompaniment to radiotherapy or chemotherapy is not indicated, but PN is indicated in chronic severe radiogenic enteritis or after allogenic transplantation with pronounced mucositis or GvH-related gastrointestinal damage for prolonged periods, with particular attention to increased risk of bleeding and infection. No PN is necessary in the terminal phase.
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