ESPEN Guidelines on Parenteral Nutrition: Non-surgical oncology
Section snippets
Preliminary remarks
The opportunity has been taken to address what is often considered a controversial area, given the considerable differences in the use of parenteral nutrition (PN) in non-surgical oncology practice around the world. The authors have aimed to present the data in a format that addresses common clinical problems, and to identify clearly where evidence-based recommendations can be made. In many cases the evidence base is not strong and some recommendations have necessarily been the result of expert
What is cancer cachexia?
From the clinical point of view cancer cachexia is a complex syndrome characterized by a chronic, progressive, involuntary weight loss which is poorly or only partially responsive to standard nutritional support and it is often associated with anorexia, early satiety and asthenia. It is usually attributable to two main components: a decreased nutrient intake (which may be due to critical involvement of the gastrointestinal tract by the tumor, or to cytokines and similar anorexia-inducing
What are the specific nutritional goals of PN in cancer patients?
Therapeutic goals for PN in cancer patients are the improvement of function and outcome by:
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preventing and treating under-nutrition/cachexia,
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enhancing compliance with anti-tumor treatments,
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controlling some adverse effects of anti-tumor therapies,
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improving quality of life (Grade C).
PN is ineffective and probably harmful in non-aphagic oncological patients in whom there is no gastrointestinal reason for intestinal failure (Grade A).
PN is recommended in patients with severe mucositis or severe
Is peri-operative PN indicated in cancer patients?
Yes. Perioperative PN is recommended in malnourished candidates for artificial nutrition, when EN is not possible, (Grade A).
Peri-operative PN should not be used in well-nourished cancer patients (Grade A).
Comments: In weight-losing cancer patients, at least two RCTs112, 113 have shown that peri-operative EN (with/without immune nutrients) is more effective than perioperative PN. However, if for any reason peri-operative EN is not feasible, peri-operative PN starting 7–10 days pre-operatively
Does PN “feed” the tumor?
Probably yes. Although PN supplies nutrients to the tumor, there is no evidence that this has deleterious effects on the outcome. This consideration should therefore have no influence on the decision to feed a cancer patient when PN is clinically indicated (Grade C).
Comments: The majority of the studies investigating the relationship between PN and tumor growth have been performed in tumor-bearing animals. However, the effects of PN on experimental tumors cannot be translated in the human field
Conflict of interest
Conflict of interest on file at ESPEN ([email protected]).
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