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The role of parenteral and enteral/oral nutritional support in patients with cancer

Authors
Aminah Jatoi, MD
Charles L Loprinzi, MD
Section Editors
Paul J Hesketh, MD
Timothy O Lipman, MD
Deputy Editor
Diane MF Savarese, MD

INTRODUCTION

Weight loss is common among cancer patients, and can be attributed to many causes, including mucositis, inability to ingest or absorb adequate calories because of a problem with the alimentary tract, loss of appetite, and metabolic aberrations. Unintentional weight loss may be associated with decreased quality of life (QOL) and a poorer prognosis. Furthermore, for patients who are already in a catabolic state, the increased metabolic demands associated with anticancer treatment (particularly surgery) further worsen the problem. (See "Pathogenesis, clinical features, and assessment of cancer cachexia".)

Intuitively, it would seem that caloric repletion, by either the enteral or parenteral route, would be the optimal approach to the treatment of cancer-associated weight loss. However, the routine use of nutritional support in patients with incurable cancer is not totally evidence-based. Not all patients with malignancy or cancer treatment-associated weight loss benefit from nutritional support. Furthermore, the routine use of nutritional support in patients with advanced incurable cancer is associated with a higher risk of treatment-related complications [1,2]. Nevertheless, nutritional support is frequently prescribed for patients with cancer. In fact, malignant disease is the most frequent indication for home total parenteral nutrition (TPN), accounting for approximately one-half of all cases in one large series [3].

An overview of the general use of both parenteral and enteral/oral nutritional supplementation in cancer patients and detailed discussions of nutritional support related to the perioperative setting, hematopoietic cell transplantation, head and neck cancer, esophageal cancer, and in patients with advanced incurable cancers are discussed here. The use of nutritional support in surgical patients and the intensive care unit setting, and the basic principles of enteral and parenteral nutrition are discussed elsewhere. (See "Overview of perioperative nutritional support" and "Nutrition support in critically ill patients: An overview".)

NUTRITIONAL STATUS AND CANCER OUTCOMES

According to the Malnutrition Advisory Action Group of the British Association for Parenteral and Enteral Nutrition, malnutrition is defined as a nutritional status in which a deficiency in energy, protein, or other nutrients causes measurable adverse effects on tissues or body form, function, or clinical outcomes. Malnutrition occurs in 40 to 80 percent of cancer patients and is a major cause of morbidity and mortality in patients with advanced disease [4,5]. It is particularly frequent in patients with digestive and upper aerodigestive tract tumors. Malnutrition may be related to an inability to ingest or absorb nutrients because of a problem with the alimentary tract related to the primary disease process (ie, obstructing esophageal tumor) or cancer treatment (ie, combined modality therapy for head and neck cancer, which may cause severe oral mucositis), or the cancer-associated anorexia/cachexia syndrome. (See "Pathogenesis, clinical features, and assessment of cancer cachexia".)

Whatever the cause, malnutrition in cancer patients is associated with poorer overall survival in various malignancies [6-8], as well as reduced benefit from surgical [9,10] and medical therapies [11,12], a poorer tumor response to chemotherapy [6,7,12], increased chemotherapy-related toxicity [11,13,14], and poorer quality of life [7,15-17]. It is important to point out that although several investigators refer to "malnutrition" in cancer patients, the provision of calories is often not the most appropriate response to this situation, as caloric supplementation can lead to complications and no reversal of the clinical picture.

                    

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Literature review current through: Nov 2016. | This topic last updated: Wed Oct 28 00:00:00 GMT+00:00 2015.
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