engleski

Nutrition of oncology patients – new guidelines of the European Society for Clinical Nutrition and Metabolism (ESPEN)

Tumor cachexia is a multifactorial syndrome characterized by loss of muscle mass (with or without fat loss) that can not be fully recovered by the standard nutritional support, resulting in progressive weakening of the body functions. In 2011, a panel of international experts has developed a framework for the definition and classification of tumor cachexia. Tumor cachexia should be understood as a continuity that begins with diagnosis of malignant disease. Our task is to recognize the right stage of tumor cachexia so that the patient could be provided with adequate nutritional support. We should not fully rely on our clinical assessment and it is necessary to standardize the assessment using different screening tools. The most commonly used NRS 2002 (Nutritional Risk Screening) is a validated tool. However, this tool is not specific for cancer patients, so today the Good Nutrition Practice (GNP) tool is also being implemented. The necessity of compulsory nutritive screening from the time of diagnosis of cancer is recognized by ESPEN in its new guidelines issued in 2016. In accordance with their recommendations, it is necessary to evaluate the intake of nutrients and symptoms affecting the nutrition status after screening. Nutritional support is mandatory in all patients with nutritional risk for which curative or palliative surgery is planned ; in patients planned for radiation therapy, especially of head and neck, chest and gastrointestinal tract ; and during systemic antineoplastic therapy. If oral ingestion of nutrients is insufficient, if necessary, enteral and parenteral nutrition should be initiated. Access to nutritional status must be regular and multiprofessional and should last for the entire duration of the disease. Treatment of cachectic patients must be multimodal, and it includes nutrition, exercise and pharmacological preparations. It is recommended to take omega-3 fatty acids (at least 2 grams per day) as it consequently reduces the formation of infl ammatory mediators, improves appetite and affects body mass increase. It is necessary to increase the share of energy obtained by fat degradation rather than the share obtained by decomposition of carbohydrates. A timely staging of tumor cachexia, the initiation of a multimodal approach within the multiprofessional team and following the ESPEN guidelines is necessary to infl uence the quality of life of cancer patients and all other patients in nutritional risk.

tumor cachexia ; oncology ; nutrition

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