Supportive Ernährungstherapie für onkologische PatientInnen während der Behandlungsphase

Zusammenfassung

Insbesondere für onkologische PatientInnen besteht während der Therapiephase ein erhöhtes Risiko für eine reduzierte Flüssigkeits-, Energie- und Nährstoffzufuhr, was wiederum zur Mangelernährung führen kann. Zunehmende Evidenzen belegen den negativen Effekt der Mangelernährung auf Therapieerfolg, Morbidität und Mortalität. Daher sind angemessene ernährungstherapeutische Maßnahmen unabdingbar. Gezielte Ernährungsinterventionen sollen der Ätiologie einer Mangelernährung (wie z. B. Diarrhoe, Übelkeit und Appetitlosigkeit) entgegenwirken und sollten patientenzentriert erfolgen. Hierzu gehört auch die Beseitigung von Fehlinformation und die Vermittlung von praktischen und einsetzbaren Empfehlungen.

Abstract

Oncology patients often find it challenging to reach their energy and fluid requirements, which in turn can lead to malnutrition. An increasing body of evidence demonstrates the negative effect of malnutrition on therapeutic outcomes, morbidity, and mortality. Therefore, appropriate nutrition interventions are essential. Effective patient-centered nutritional interventions should treat the etiological basis of malnutrition such as diarrhea, nausea and reduced appetite. This approach also includes eliminating disinformation and providing practical and applicable recommendations.

Schlüsselwörter

Ernährung - Onkologie - Mangelernährung - Appetitverlust - Durchfall - Übelkeit und Erbrechen

Key words

nutrition - oncology - malnutrition - diarrhea - nausea and vomiting - reduced appetite

• Literatur

• 1 Nekhlyudov L, Levit L, Hurria A, Ganz PA. Patient-centered, evidence-based, and cost-conscious cancer care across the continuum: Translating the Institute of Medicine report into clinical practice. CA Cancer J Clin 2014; 64: 408-421
• 2 Findlay M, Bauer J, Shaw T. et al. "There's a lot of talent in the room but it's only really the medical talent that gets heard": a qualitative exploration of multidisciplinary clinicians' perspectives of optimal nutrition care of patients with head and neck cancer. Support Care Cancer 2021; 29: 6399-6409
• 3 Levonyak NS, Hodges MP, Haaf N. et al. Implementation of a quality improvement project to increase access to dietitian services for patients with gastrointestinal cancer in a safety-net hospital system. JCO Oncol Pract 2021; 17: e1048-e1054
• 4 European Commission. Europe’s Beating Cancer Plan. Communication from the Commission to the European Parliament and the Council [June 2022] Available from https://ec.europa.eu/health/system/files/2022-02/eu_cancer-plan_en_0.pdf
• 5 De Groot LM, Lee G, Ackerie A, van der Meij BS. Malnutrition screening and assessment in the cancer care ambulatory setting: mortality predictability and validity of the Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF) and the GLIM Criteria. Nutrients 2020; 12: 2287
• 6 Arends J, Bachmann P, Baracos V. et al. ESPEN guidelines on nutrition in cancer patients. Clin Nutr 2017; 36: 11-48
• 7 Laviano A, Di Lazzaro L, Koverech A. Nutrition support and clinical outcome in advanced cancer patients. Proc Nutr Soc 2018; 77: 388-393
• 8 Schuetz P, Fehr R, Baechli V. et al. Individualised nutritional support in medical inpatients at nutritional risk: a randomised clinical trial. Lancet 2019; 393: 2312-2321
• 9 Kaegi-Braun N, Tribolet P, Gomes F. et al. Six-month outcomes after individualized nutritional support during the hospital stay in medical patients at nutritional risk: Secondary analysis of a prospective randomized trial. Clin Nutr 2021; 40: 812-819
• 10 Richards J, Arensberg MB, Thomas S. et al. Impact of early incorporation of nutrition interventions as a component of cancer therapy in adults: A review. Nutrients 2020; 12: 3403
• 11 Marshall KM, Loeliger J, Nolte L. et al. Prevalence of malnutrition and impact on clinical outcomes in cancer services: A comparison of two time points. Clin Nutr 2019; 38: 644-651
• 12 Swan WI, Vivanti A, Hakel-Smith NA. et al. Nutrition care process and model update: toward realizing people-centered care and outcomes management. J Acad Nutr Die 2017; 117: 2003-2014
• 13 Cederholm T, Jensen GL, Correia M. et al. GLIM criteria for the diagnosis of malnutrition - A consensus report from the global clinical nutrition community. Clin Nutr 2019; 38: 1-9
• 14 Warren S. The immediate causes of death in cancer. The American Journal of the Medical Sciences 1932; 184: 610-615
• 15 Van Cutsem E, Arends J. The causes and consequences of cancer-associated malnutrition. Eur J Oncol Nurs 2005; 9 (Suppl 2) S51-S63
• 16 Erickson N. et al. Ernährungspraxis Onkologie. Stuttgart: Schattauer; 2017
• 17 Mazzuca F, Onesti CE, Roberto M. et al. Lean body mass wasting and toxicity in early breast cancer patients receiving anthracyclines. Oncotarget 2018; 9: 25714-25722
• 18 Ali R, Baracos VE, Sawyer MB. et al. Lean body mass as an independent determinant of dose-limiting toxicity and neuropathy in patients with colon cancer treated with FOLFOX regimens. Cancer Med 2016; 5: 607-616
• 19 Drami I, Pring ET, Gould L. et al. Body composition and dose-limiting toxicity in colorectal cancer chemotherapy treatment; a systematic review of the literature. Could muscle mass be the new body surface area in chemotherapy dosing?. Clin Oncol (R Coll Radiol) 2021; 33: e540-e552
• 20 Bruno KA, Sobreira da Silva MJ, Chaves GV. Association of body composition with toxicity to first-line chemotherapy and three-year survival in women with ovarian adenocarcinoma. Acta Oncol 2021; 60: 1611-1620
• 21 Hopkinson J. Psychosocial support in cancer cachexia syndrome: The evidence for supported self-management of eating problems during radiotherapy or chemotherapy treatment. Asia Pac J Oncol Nurs 2018; 5: 358-368
• 22 Oberholzer R, Hopkinson JB, Baumann K. et al. Psychosocial effects of cancer cachexia: a systematic literature search and qualitative analysis. J Pain Symptom Manage 2013; 46: 77-95
• 23 Sonneborn-Papakostopoulos M, Dubois C, Mathies V. et al. Quality of life, symptoms and dietary habits in oncology outpatients with malnutrition: A cross-sectional study. Med Oncol 2021; 38: 20
• 24 Hauner H, Kocsis A, Jaeckel B. et al. Häufigkeit eines Risikos für Mangelernährung bei Patienten in onkologischen Schwerpunktpraxen – eine Querschnittserhebung. Dtsch Med Wochenschr 2020; 145: e1-e9
• 25 Arraras JI, Giesinger J, Shamieh O. et al. Cancer patient satisfaction with health care professional communication: An international EORTC study. Psychooncology 2022; 31: 541-547
• 26 Maschke J, Kruk U, Kastrati K. et al. Nutritional care of cancer patients: a survey on patients' needs and medical care in reality. Int J Clin Oncol 2017; 22: 200-206
• 27 Henson CC, Burden S, Davidson SE, Lal S. Nutritional interventions for reducing gastrointestinal toxicity in adults undergoing radical pelvic radiotherapy. Cochrane Database Syst Rev 2013; CD009896
• 28 Erickson N, Holch J, Heinemann V. Bedeutung des Ernährungszustands für den Krankheitsverlauf onkologischer Patienten. Internistische Praxis 2019; 60: 456-466
• 29 Henry B. End of life feeding: Ethical and legal considerations. Physiol Behav 2020; 217: 112800
• 30 Andreyev J, Ross P, Donnellan C. et al. Guidance on the management of diarrhoea during cancer chemotherapy. Lancet Oncol 2014; 15: e447-e460
• 31 Shaw C, Taylor L. Treatment-related diarrhea in patients with cancer. Clin J Oncol Nurs 2012; 16: 413-417
• 32 Benson AB, Ajani JA, Catalano RB. et al. Recommended guidelines for the treatment of cancer treatment-induced diarrhea. J Clin Oncol 2004; 22: 2918-2926
• 33 Bossi P, Antonuzzo A, Cherny NI. et al. Diarrhoea in adult cancer patients: ESMO Clinical Practice Guidelines. Ann Oncol 2018; 29 (Suppl 4) iv126-iv142
• 34 Muehlbauer PM, Thorpe D, Davis A. et al. Putting evidence into practice: evidence-based interventions to prevent, manage, and treat chemotherapy- and radiotherapy-induced diarrhea. Clin J Oncol Nurs 2009; 13: 336-341
• 35 Navari RM. Managing nausea and vomiting in patients with cancer: What works. Oncology (Williston Park) 2018; 32: 121-125 131, 136
• 36 Horn CC, Wallisch WJ, Homanics GE, Williams JP. Pathophysiological and neurochemical mechanisms of postoperative nausea and vomiting. Eur J Pharmacol 2014; 722: 55-66
• 37 Jordan K, Gralla R, Jahn F, Molassiotis A. International antiemetic guidelines on chemotherapy induced nausea and vomiting (CINV): content and implementation in daily routine practice. Eur J Pharmacol 2014; 722: 197-202
• 38 Fillon M. The social media cancer misinformation conundrum. CA Cancer J Clin 2022; 72: 3-4
• 39 Marton RM, Wang X, Barabási A-L, Ioannidis JP. Science, advocacy, and quackery in nutritional books: an analysis of conflicting advice and purported claims of nutritional best-sellers. Palgrave Communications 2020; 6: 43
• 40 Löser C, Fruehauf S, Müller M. et al. Moderne Ernährungstherapie bei onkologischen Patienten – ein Positionspapier. Akt Ernährungsmed 2014; 39: 127-131
• 41 Wirth R, Smoliner C, Spamer C. et al. Do doctors know how much nutrition patients need--a survey from Germany?. Eur J Clin Nutr 2014; 68: 840-843
• 42 Keinki C, Rudolph I, Ruetters D. et al. The quality of patient information booklets for cancer patients - an evaluation of free accessible material in German language. J Cancer Educ 2018; 33: 1132-1139
• 43 Keinki C, Seilacher E, Ebel M. et al. Information needs of cancer patients and perception of impact of the disease, of self-efficacy, and locus of control. J Cancer Educ 2016; 31: 610-616
• 44 Muscaritoli M, Molfino A, Scala F. et al. Nutritional and metabolic derangements in Mediterranean cancer patients and survivors: the ECPC 2016 survey. J Cachexia Sarcopenia Muscle 2019; 10: 517-525
• 45 Bautista JR, Zhang Y, Gwizdka J. Healthcare professionals' acts of correcting health misinformation on social media. Int J Med Inform 2021; 148: 104375
• 46 Grimes DR. The struggle against cancer misinformation. Cancer Discov 2022; 12: 26-30