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Download Survival in cancer patients randomized to nutritional support
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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)
