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Titolo:
PARENTERAL VERSUS ENTERAL NUTRITION IN CANCER-PATIENTS - INDICATIONS AND PRACTICE
Autore:
MERCADANTE S;
Indirizzi:
SAMOT,PAIN RELIEF & PALLIAT CARE,VIA LIBERTA 191 I-90143 PALERMO ITALY BUCCHERI FERLA HOSP,DEPT ANESTHESIA & INTENS CARE PALERMO ITALY
Titolo Testata:
Supportive care in cancer
fascicolo: 2, volume: 6, anno: 1998,
pagine: 85 - 93
SICI:
0941-4355(1998)6:2<85:PVENIC>2.0.ZU;2-U
Fonte:
ISI
Lingua:
ENG
Soggetto:
BONE-MARROW TRANSPLANTATION; MULTIMODALITY THERAPY; BOWEL OBSTRUCTION; HOME; GLUTAMINE; SUPPORT; TRIAL; RADIATION; INFUSION; INJURY;
Keywords:
ENTERAL NUTRITION; PARENTERAL NUTRITION; CANCER;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Science Citation Index Expanded
Science Citation Index Expanded
Citazioni:
75
Recensione:
Indirizzi per estratti:
Citazione:
S. Mercadante, "PARENTERAL VERSUS ENTERAL NUTRITION IN CANCER-PATIENTS - INDICATIONS AND PRACTICE", Supportive care in cancer, 6(2), 1998, pp. 85-93

Abstract

Prospective randomly controlled trials have failed to demonstrate theclinical efficacy of providing nutritional support to most cancer patients in;terms of morbidity, mortality, and duration of hospitalization. Serious shortcomings in study design have limited the possibility of drawing definitive conclusions from the data. Thus, nutritional intervention needs to be seen as a method of support, with the aim of maintaining nutritional and functional status during the stress of the oncology treatment to prevent or attenuate cachexia. There is no disease during which the patient benefits from prolonged wasting. Pretreatmentweight loss is quoted as a major indicator of poor survival and response to therapy of cancer patients. As a consequence, an early and serial assessment of nutritional status, perhaps followed by an immediate intervention with nutritional support is strongly recommended. There are other specific reasons for using the gut rather than the intravenous route for nutrient administration besides the often reported disadvantage of significant cost. Local intestinal stimulation prevents the mucosal atrophy and bacterial translocation that can be triggered by several precipitating factors, as frequently seen in oncologic patients. These include endotoxin, radiation therapy, cytotoxic and immunosuppressive drugs, cytokines, bowel and biliary obstruction, broad-spectrumantibiotics, and the tumour itself, as well as parenteral nutrition (PN). As the enteral route of nutritional support has been found to be as good as or preferable to PN in terms of maintenance of nutritional status or immune function, prevention of bacterial translocation, maintenance of normal gut flora, transit and histology, and prevention of hypercatabolic responses to stressful events, it is always preferable in terms of physiological response, local and systemic competence, quality of life and cost, and should be the method of choice for the nutritional support of cancer patients. Although retrospective studies of PN suggest a benefit for patients with cancer who are undergoing surgery, radiation, or chemotherapy, carefully designed, prospective studies report less conclusive findings. The failure of conventional PN to improve clinical outcomes in patients with cancer may be related to thefact that standard formulations do not address or reverse abnormalities of intermediate metabolism that result in cancer cachexia. Supplemental substances have been proposed in an attempt to improve the efficacy of PN, including insulin, growth hormone and branched chain amino acids. The difficult task is to identify those patients who ape at riskfor malnutrition and at the same time identify the subset of patientswho will benefit clinically from parenteral nutritional repletion. Severe malnutrition in patients requiring surgery, bone marrow transplantation in patients unable to tolerate enteral supplementation and postoperative complications necessitating nutritional support are specificindications. Routine use of PN should be discouraged.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 05/12/20 alle ore 18:57:33