engleski

Pharmaceutical consulting of oncology patient about the enteral nutrition

Cachexia is often associated with various types of carcinomas, especially with pancreatic and gastric carcinomas which have a high incidence of cachexia. Cachexia is causing worsening of the prognosis and reduces a quality of life. It takes a multimodal approach aimed at treating the cause of the disease that can eventually lead to cachexia. In addition to medical therapy, nutritional support can improve symptoms of the disease [1, 2]. The case of a patient with metastatic gastric cancer is presented. After extensive surgery, a patient became cachectic and was given nutritional support under the supervision of the health care team. A 47 year-old patient was hospitalized on 25th of August 2014 in the department of internal oncology in order to continue treatment according to the chemotherapy regimen of cisplatin and 5- fluorouracil. In early 2013, the patient began to feel severe pain in the abdomen and had lost 5 kilograms. Gastroenterology procedure found an extensive neoplastic process of the stomach, which resulted in a surgery. A total gastrectomy, splenopancreatomy and lymphadenectomy have been performed. Histopathological findings verified a metastatic stomach adenocarcinoma. Chemotherapeutic advisory board decided for a patient to be given five cycles of adjuvant chemotherapy with concomitant irradiation, with the second and third cycle being done by Macdonald protocol. Control tests conducted in May and June 2014 showed the dissemination of the disease for which antineoplastic treatment was prescribed. Postoperatively, the patient started to lose weight despite normal appetite. Laboratory findings during hospitalization showed hypoalbuminemia, decreased creatinine and decreased level of glucose. A nutritional support with a formulation designed specifically for oncology and cachexic patients was initiated along with megestrol acetate, which served as a hormonal support. A patient was discharged home with an improved general status. This case pointed at the clinical problem of cachexia which can go unnoticed and thus lead to a reduced chemotherapy response, lower functional performance and increased mortality [1]. Body weight loss after surgery occurs due to stress caused by surgery or trauma, which can all lead to a hypermetabolic state and consequent malnutrition. This situation can be additionally worsened by gastrectomy if the establishment of normal intestinal function is significantly delayed. [3] Therefore, a multidisciplinary approach is needed. A team consisted of doctors, pharmacists and a nurse can timely and effectively deal with mentioned condition.

oncology, enteral nutrition, consulting

nije evidentirano