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ESPEN Congress Glasgow
2002
Debate: Nutritional Support VS Metabolic
Manipulation in the Cancer Patient
PRO
Kent Lundholm
How to manage cancer cachexia?
NUTRICEUTICALS/
Nutrition
versus
DRUGS/
Nutrition
••
Ken Fearon
Kent Lundholm
Systemic inflammation - nutritional support
Has nutritional support a role in
cancer treatment/palliation ?
Yes it has!
•
•
•
•
Metabolic alterations in cancer cachexia
Investigative technology
Own studies and interpretation of results
Major conclusions
Nutrition and Chemotherapy
•
•
•
•
•
Unrealistic expectations
Therefore supoptimal study design
Nutritional state can be improved/protected
Function is not improved
HrQoL has been poorly evaluated
Randomized study on 309 patients
Indomethacin
Erythropoietin
Indomethacin
Erythropoietin
Nutrition (oral, iv)
No difference between the study and control group at randomization
wight loss (8-9%)
ESR (36-44 mm/h)
Alb/s (34-36 g/l)
Food intake in unselected cancer patients randomized to nutritional
support during 1-24 months follow up, p<0.001
2500
2250
2000
Kcal/day
1750
1500
nutrition
control
1250
1000
750
500
250
0
0
3
7
Months
>10
Daily energy blance in unselected cancer patients randomized to
nutritional support during 1-24 months follow up, p<0.001
Daily energy balance (kcal/day)
1000
800
600
Nutrition
Controls
400
200
0
0
3
7
Months
>10
Survival in unselected cancerpatients randomized
to nutritional support, p<0.001
1
Cum. Survival
,8
,6
nutrition
,4
controls
,2
0
0
100
200
300
Days
400
500
600
Main conclusions
• Cancer cachexia is essentially partial
starvation
• Systemic inflammation can be
(preferentially) attenuated with NSAID
• Nutrition is effective, but should be
provided early
Main conclusions
• Perioperative nutrition is a matter of
preventing further deterioration
• Amino acid solutions are still a weak
component in treatment programs
• Glutamine is not the solution on this
problem !!!
Main conclusion
• Thus, Dr Fearon can sleep well- nutrition
works in cancer treatment/palliation
• Metabolic manipulation alone is not an
alternative.
• Long term nutrition should be the goal
No references provided by the author(s)