Elsevier

Clinical Nutrition

Volume 25, Issue 2, April 2006, Pages 245-259
Clinical Nutrition

ESPEN GUIDELINES
ESPEN Guidelines on Enteral Nutrition: Non-surgical oncology

https://doi.org/10.1016/j.clnu.2006.01.020Get rights and content

Summary

Enteral nutrition (EN) by means of oral nutritional supplements (ONS) and tube feeding (TF) offers the possibility of increasing or ensuring nutrient intake in cases where normal food intake is inadequate.

These guidelines are intended to give evidence-based recommendations for the use of ONS and TF in cancer patients. They were developed by an interdisciplinary expert group in accordance with officially accepted standards, are based on all relevant publications since 1985 and were discussed and accepted in a consensus conference.

Undernutrition and cachexia occur frequently in cancer patients and are indicators of poor prognosis. EN should be started if undernutrition already exists or if food intake is markedly reduced for more than 7–10 days. Standard formulae are recommended for EN. Nutritional needs generally are comparable to non-cancer subjects. In cachectic patients metabolic modulators such as progestins, steroids and possibly eicosapentaenoic acid may help to improve nutritional status. EN is indicated preoperatively for 5–7 days in cancer patients undergoing major abdominal surgery. During radiotherapy of head/neck and gastrointestinal regions dietary counselling and ONS prevent weight loss and interruption of radiotherapy. Routine EN is not indicated during (high-dose) chemotherapy.

The full version of this article is available at www.espen.org.

Section snippets

What is cancer cachexia?

In the majority of tumour-bearing patients systemic proinflammatory processes are activated. Resulting metabolic derangements include insulin resistance, increased lipolysis and high normal or increased lipid oxidation with loss of body fat, increased protein turnover with loss of muscle mass and an increase in production of acute phase proteins.

The systemic inflammatory reaction that develops with many cancers is an important cause of loss of appetite (anorexia) and weight. The syndrome of

Indications and goals of EN

2.1. What are specific nutritional goals in cancer patients?

Therapeutic goal for cancer patients is the improvement of function and outcome by:

  • preventing and treating undernutrition,

  • enhancing anti-tumour treatment effects,

  • reducing adverse effects of anti-tumour therapies,

  • improving quality of life.

Comment: An improvement in survival due to nutritional interventions has not yet been demonstrated convincingly. However, it should be considered that the main reason for the lack of evidence of

EN in special situations

3.1. What is the indication for perioperative EN in cancer patients?

General indications for perioperative EN also apply for cancer patients. The strongest recommendations relevant to cancer patients refer to severe nutritional risk states and to preoperative nutrition. Refer to guidelines “Surgery incl. Organ Transplantation” for further details and comments.

Patients with severe nutritional risk benefit from nutritional support for 10–14 days prior to major surgery even if surgery has to be

Risks of EN

4.1. Does EN “feed” the tumour?

There are no reliable data that show any effect of EN on tumour growth. Such theoretical considerations should, therefore, have no influence on the decision to feed a cancer patient (C).

Comment: There are no well-controlled clinical studies by which this issue may be judged. There are, however, a number of observations in cancer patients treated with parenteral nutrition (PN) or EN. All of these studies where performed in patients with gastrointestinal or head and

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    For further information on methodology see Schütz et al.144 For further information on definition of terms see Lochs et al.145 For cancer patients receiving surgery see guidelines “Surgery incl. Organ Transplantation” Weimann et al.146

    ☆☆

    The authors of the DGEM (German Society for Nutritional Medicine) guidelines on enteral nutrition in oncology are acknowledged for their contribution to this article.

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