The efficacy of nutritional assessment and support in cancer surgery

Smale, Brian F.; Mullen, James L.; Buzby, Gordon P.; Rosato, Ernest F.

doi:10.1002/1097-0142(19810515)47:10<2375::aid-cncr2820471009>3.0.co;2-i

Cited by 165 publications

(55 citation statements)

References 15 publications

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“…Cancer patients with a PNI greater than 40% have been shown to have a significant decrease in postoperative morbidity and mortality if given preoperative total parenteral nutrition; no difference was noted in patients with a PNI below 40% [29]. The NI is based purely on laboratory parameters (IgM, prealbumin, complement C 3 , fibrinogen, cholesterol, retinol-binding protein, thyroxin-binding globulin); decreasing values indicate increased postoperative complication rates and mortality.…”

Section: Subjective Global Assessmentsupporting

confidence: 68%

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Assessment of nutritional status in cancer patients: widely neglected?

Delmore

1997

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Frank cachexia is usually evident in the clinical evaluation, but important metabolic alterations in tumour-bearing patients with slight weight changes are frequently overlooked. Since several factors are involved in cancer-induced malnutrition (marasmus type descriptive of general inadequate food intake, kwashiorkor type descriptive of inadequate protein intake/increased turnover), medical/dietary history and physical examination (dynamic weight loss, vitamin/mineral deficiency) should be complemented by simple additional laboratory tests. Minimal baseline testing may include: weight loss (> 5%/month = severe) and serum albumin (< 24 g/l = severe). Anthropometric measurements (triceps skin fold, midarm muscle circumference) for the assessment of fat deposits and lean body mass are rarely used in a routine clinical setting owing to great variations among individuals and interobserver measurement variability. The Prognostic Nutritional Index (PNI), including serum parameters, immune competence testing and anthropometrics (but no further dietary parameters, i.e. dynamic weight loss), has proved to be quite a reliable method of predicting postoperative morbidity/mortality and of selecting cancer patients for aggressive preoperative nutritional interventions. For clinical studies including the evaluation of nutritional status (stratification, prognostic impact) and/or outcome (nutritional interventions), a simple standardized and validated assessment protocol including dietary history, specific physical examination and widely available laboratory testing should be implemented to document significant nutritional alterations. Body weight alone will often fail to demonstrate important disease- or therapy-related changes in caloric intake or metabolic rate.

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Section: Subjective Global Assessmentsupporting

confidence: 68%

“…Anthropometric responses to nutritional interventions are slow [29]. Measurements may be markedly affected by non-nutritional factors.…”

Section: Anthropometricsmentioning

confidence: 99%

Assessment of nutritional status in cancer patients: widely neglected?

Delmore

1997

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“…Early studies suggested that aggressive nutritional therapy could improve the response to antineoplastic treatments or reduce the incidence and/or severity of complications in these patients [3,18]. However, later randomized controlled studies have suggested that aggressive nutritional therapy has no impact on tumor response, toxicity, or survival [1,9].…”

Section: Introductionmentioning

confidence: 99%

Nutrition and hydration for terminal cancer patients in Taiwan

Chiu

Chuang

et al. 2002

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Many medical professionals are still confused when facing the reduction of food or fluid intake in terminal cancer patients. The aim of this study was to assess the frequency and causes of the inability of eating or drinking in terminal cancer patients and to investigate the use of artificial nutrition and hydration (ANH); the frequency, type, and the extent to which staff found ANH to be ethically justified. Three hundred forty-four consecutive patients with terminal cancer admitted to a palliative care unit in Taiwan were recruited. A structured data collection form was used daily to evaluate clinical conditions, which were analyzed at the time of admission, 1 week after admission and 48 h before death. One hundred thirty-three (38.7%) of the 344 patients were unable to take water or food orally on admission; the leading cause was GI tract disturbances (58.6%). This impaired ability to eat or drink had become worse 1 week after admission (39.1%, P<0.01) and again 48 h before death (60.1%, P<0.001). The total rate of ANH use declined significantly, from 57.0% to 46.9% 1 week after admission ( P<0.001), but rose again to the same level as at admission in the 48 h before death (53.1%, P=0.169). Parenteral hydratation could be reduced significantly 1 week after admission ( P<0.05), but no reduction was possible in the 48 h before death; nor was it possible to reduce the nutrition administered. Multiple Cox regression analysis shows that the administration of ANH, either at admission or 2 days before death, did not have any significant influence on the patients' survival (HR: 0.88, 95% CI: 0.58-1.07; HR: 1.03, 95% CI: 0.76-1.38). In conclusion, sensitive care and continuous communication will probably lessen the use of ANH in terminal cancer patients. We have found it easier to reduce artificial hydratation than artificial nutrition, which corresponds to local cultural practice. Whether or not ANH was used did not influence survival in this study. Thus, the goals of care for terminal cancer patients should be refocused on the promotion of quality of life and preparation for death, rather than in simply making every effort to improve the status of hydratation and nutrition.

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“…Malnourished patients are less likely than better nourished patients to tolerate surgery, radiation, and chemotherapy [1,32,41], and they often endure serious complications such as delayed wound healing, fistula formation, and infection. Malnourished patients also are hospitalized longer [26], and have a diminished quality of life [36] and lower survival rate than well-nourished patients [31].…”

Section: Introductionmentioning

confidence: 99%