Nutritional Management of Patients with Esophageal and Esophagogastric Junction Cancer

Abstract

BACKGROUND: Malnutrition is common in patients with esophageal and esophagogastric cancer. Compared to patients with other digestive and extradigestive neoplasia, the highest incidence (78.9%) was found in those with esophageal cancer. Malnutrition is associated with postoperative complications, increased morbidity, and prolonged hospital stays. METHODS: The authors review the impact and causes of malnutrition in esophageal cancer patients and present strategies that can be used to preserve or restore the nutritional status in this patient population throughout treatment. RESULTS: Patients usually are unable to sustain weight on oral intake alone and require additional means of nutritional support. Several methods can be used to provide nutritional care to the esophageal cancer patient, such as diet modification, oral supplementation, and enteral or parenteral nutrition. The enteral route is preferred due to preservation of gut integrity, reduced risk of complications, and less expense. In terminally ill patients, minimal nutritional intervention may be all that is needed to achieve patient comfort. CONCLUSIONS: In order to improve clinical outcomes and the quality of life for patients with esophageal and esophagogastric cancers, the extent of malnutrition must be identified and treated.

Evaluation of Quality of Life Following Placement of Self-Expanding Plastic Stents as a Bridge to Surgery in Patients Receiving Neoadjuvant Therapy for Esophageal Cancer

“…Rates of malnutrition and cachexia associated with this disease have been reported to be as high as 85% at the time of initial diagnosis [1,2]. Malnutrition is well established as a significant risk factor for the intolerance to essential neoadjuvant therapy and subsequent surgical postoperative morbidity and mortality [3,4].…”

An Investigation into the Current Peri-Operative Nutritional Management of Oesophageal Carcinoma Patients in Major Carcinoma Centres in England

“…A particularly high incidence has been reported amongst patients with upper gastrointestinal carcinoma. [1][2][3][4] We have shown in this study that 66% of specialist centres for the management of patients with upper gastrointestinal carcinoma do not perform nutritional screening or assessment pre-operatively. This is essential for the identification of those already malnourished or with significant risk of nutritional problems.…”

“…[1][2][3][4] Inadequate nutrient intake coupled with cancer cachexia leads to deterioration in nutritional status which has been found to increase postoperative complications. 5,6 Oral intake following oesophagogastrectomy may be restricted by anorexia, nausea, early satiety and altered intestinal motility.…”

Fluoroscopically-guided palliative stenting for the management of malignant oesophageal obstruction: A five year experience

“…20,23,24 Oesophageal cancer is a debilitating illness with reports as high as 80% of patients presenting with weight loss. 25,26 This relates to actual dysphagia-related anorexia and cancer cachexia. 14 Cachexia is characterised by involuntary weight loss associated with reduced muscle mass, generalised weakness, oedema and deteriorating physical and mental function.…”