ESPEN GUIDELINESESPEN Guidelines on Enteral Nutrition: Non-surgical oncology☆
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:
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preventing and treating undernutrition,
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enhancing anti-tumour treatment effects,
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reducing adverse effects of anti-tumour therapies,
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improving quality of life.
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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Cited by (0)
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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
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The authors of the DGEM (German Society for Nutritional Medicine) guidelines on enteral nutrition in oncology are acknowledged for their contribution to this article.