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Nutritional support in patients with oesophageal cancer.

Abstract

BACKGROUND

Obesity and overweight are risk factors for developing an oesophageal cancer, especially the adenocarcinoma in the distal oesophagus or at the gastroesophageal junction, and many patients still are overweight at the clinical presentation even if they are losing weight. Main mechanisms involved in weight loss are a decreased nutrients' intake and an alteration in metabolism due to a cytokine-driven inflammatory status. Malnutrition is a risk factor for a poor compliance to chemotherapy and radiation therapy and finally for the oncologic outcome. There is scientific evidence that frequently both conditions exist but in the advanced stages of disease metabolic alterations play a major role and are responsible for the poor response to nutritional support.

METHODS

The literature about the nutritional support in patients with cancer of the oesophagus has been reviewed with special emphasis on randomised clinical trials whenever available. In surgical patients, both overweight and weight loss increase the risk of postoperative complications.

RESULTS

In non-dysphagic patients receiving a neo-adjuvant oncologic treatment, the simple use of oral nutritional supplements is little effective in ameliorating the nutritional status, in contrast, an intensive dietetic surveillance associated with oral supplements can lead to better nutritional status, improved quality of life and better compliance with therapy. In dysphagic patients, many comparative non-randomised clinical studies have shown clinical benefits from tube feeding on the nutritional status and compliance with therapy. There is no apparent difference on the metabolic efficacy of the enteral versus parenteral nutrition. Studies on peri-operative nutrition in oesophagectomy patients were often underpowered and, hence, inconclusive, but the large experience on the nutritional support in patients with gastrointestinal cancer undergoing major abdominal surgery has clearly shown the benefits of the enteral nutrition. Both the American and the European Society for Parenteral and Enteral Nutrition have recognised a grade A recommendation for the nutritional support of malnourished gastrointestinal cancer patients undergoing major surgery.

CONCLUSIONS

In patients with oesophageal cancer on chemotherapy and/or radiation therapy, enteral nutrition (oral supplements +/- intensive counselling or tube feeding) is nutritionally and clinically beneficial. In surgical patients, a broad experience in major abdominal surgery supports the peri-operative use of enteral nutrition and especially of immune-enteral nutrition.

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  • Publisher Full Text
  • Authors+Show Affiliations

    Residenza Le Querce-Milano Due, 20090 Segrate, Italy. dottfb@tin.it

    Source

    MeSH

    Enteral Nutrition
    Esophageal Neoplasms
    Female
    Gastrostomy
    Humans
    Intubation, Gastrointestinal
    Male
    Malnutrition
    Nutritional Support
    Parenteral Nutrition
    Quality of Life
    Randomized Controlled Trials as Topic

    Pub Type(s)

    Journal Article
    Review

    Language

    eng

    PubMed ID

    19551411

    Citation

    Bozzetti, Federico. "Nutritional Support in Patients With Oesophageal Cancer." Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer, vol. 18 Suppl 2, 2010, pp. S41-50.
    Bozzetti F. Nutritional support in patients with oesophageal cancer. Support Care Cancer. 2010;18 Suppl 2:S41-50.
    Bozzetti, F. (2010). Nutritional support in patients with oesophageal cancer. Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer, 18 Suppl 2, pp. S41-50.
    Bozzetti F. Nutritional Support in Patients With Oesophageal Cancer. Support Care Cancer. 2010;18 Suppl 2:S41-50. PubMed PMID: 19551411.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Nutritional support in patients with oesophageal cancer. A1 - Bozzetti,Federico, Y1 - 2009/06/24/ PY - 2009/03/24/received PY - 2009/05/13/accepted PY - 2009/6/25/entrez PY - 2009/6/25/pubmed PY - 2013/1/30/medline SP - S41 EP - 50 JF - Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer JO - Support Care Cancer VL - 18 Suppl 2 N2 - BACKGROUND: Obesity and overweight are risk factors for developing an oesophageal cancer, especially the adenocarcinoma in the distal oesophagus or at the gastroesophageal junction, and many patients still are overweight at the clinical presentation even if they are losing weight. Main mechanisms involved in weight loss are a decreased nutrients' intake and an alteration in metabolism due to a cytokine-driven inflammatory status. Malnutrition is a risk factor for a poor compliance to chemotherapy and radiation therapy and finally for the oncologic outcome. There is scientific evidence that frequently both conditions exist but in the advanced stages of disease metabolic alterations play a major role and are responsible for the poor response to nutritional support. METHODS: The literature about the nutritional support in patients with cancer of the oesophagus has been reviewed with special emphasis on randomised clinical trials whenever available. In surgical patients, both overweight and weight loss increase the risk of postoperative complications. RESULTS: In non-dysphagic patients receiving a neo-adjuvant oncologic treatment, the simple use of oral nutritional supplements is little effective in ameliorating the nutritional status, in contrast, an intensive dietetic surveillance associated with oral supplements can lead to better nutritional status, improved quality of life and better compliance with therapy. In dysphagic patients, many comparative non-randomised clinical studies have shown clinical benefits from tube feeding on the nutritional status and compliance with therapy. There is no apparent difference on the metabolic efficacy of the enteral versus parenteral nutrition. Studies on peri-operative nutrition in oesophagectomy patients were often underpowered and, hence, inconclusive, but the large experience on the nutritional support in patients with gastrointestinal cancer undergoing major abdominal surgery has clearly shown the benefits of the enteral nutrition. Both the American and the European Society for Parenteral and Enteral Nutrition have recognised a grade A recommendation for the nutritional support of malnourished gastrointestinal cancer patients undergoing major surgery. CONCLUSIONS: In patients with oesophageal cancer on chemotherapy and/or radiation therapy, enteral nutrition (oral supplements +/- intensive counselling or tube feeding) is nutritionally and clinically beneficial. In surgical patients, a broad experience in major abdominal surgery supports the peri-operative use of enteral nutrition and especially of immune-enteral nutrition. SN - 1433-7339 UR - https://www.unboundmedicine.com/medline/citation/19551411/Nutritional_support_in_patients_with_oesophageal_cancer_ L2 - https://dx.doi.org/10.1007/s00520-009-0664-9 DB - PRIME DP - Unbound Medicine ER -