gms | German Medical Science

Cancer patients with weight loss encounter higher morbidity and mortality and have reduced quality of life. Insufficient energy and nutrient intake together with humoral and inflammatory reactions participate in the development of malnutrition. For treatment, nutritional measures as well as drugs are available. As patients often suffer from malnourishment already at the time of diagnosis and malnutrition may emerge in every stage of disease, nutritional counseling should be included in treatment from the beginning. Crucial for indication and supervision of nutritional treatment is repeated assessment of nutritional status and of energy and nutrient intake. If oral intake is < 500 kcal/d, nutrional deficiency is manifest, values < 60% of calculated need are insufficient. Treatment consists firstly in optimizing oral nutrition. Enteral nutrition is indicated, when this is not possible and nutrition deficiency is expected for > 5 days resp. 3-5 days in patients with preexisting severe malnutrition. This applies also, when insufficient oral food intake for > 14 days is expected. Oral nutrition can be provided in general as wholefood, modified according to patients wish as favored diet. Addition of formula diet and supplements is recommended. Especially in patients with pancreatic cancer, clues exist for favorable influence of 2-3 g eicosapentaenic acid on bodyweight. Neutropenic and immune compromised patients require low germ food in order to reduce infection risk, including abstaining from raw or not thorougly cooked food and mould cheese. In severe malnutrition, before surgery, nutritional therapy for 10-14 days preceding the intervention is recommended. Independent of nutritional status, formula diet with immunstimulating agents 5-7 days before performing abdominal surgery lowers postoperative risk of infection. There are no fix rules for energy and nutrient supply. The following recommendations are given for total energy requirement: bedridden patient: 25 kcal/d, mobile patient 30-35 kcal/d. The recommended protein supply is 1,2-2,0 protein/kg/ d., proportion of fat in total energy supply >35%. Recommendations for vitamine and trace elements needs correspond to those of healthy. Drug theray of malnutrition uses appetite stimulating agents (prokinetics, cannabinoids, steroids, gestagens) and / or antiinflammatory (glucocorticoids, gestagens, NSAID, n3-fatty acids , melatonin) drugs.