Expert Consensus on Nutritional Therapy for Malignancies
Expert Consensus on Nutritional Therapy for Malignancies
Continuous development of cancer treatment technologies and methods has extended the survival time of patients with malignant tumors, making these conditions more of a controllable and curable chronic diseases. Therefore, maintenance of the quality of life should be a major focus in the modern oncology. As an emerging interdisciplinary subject, nutritional oncology looks into the underlying mechanisms of malnutrition in malignant patients to identify the most appropriate methods for assessing the nutritional risks and status of cancer patients, seeking to improve the efficacy of anti-cancer therapy as well as the quality of life with nutritional therapy. What distinguish this from general nutriology is the abnormal metabolic state in patients with advanced and end-stage cancer as a result of the stress state and constant proliferation of tumor tissues in the tumor-bearing body. In addition, unlike surgery, radiotherapy, chemotherapy, molecular targeted therapy and other anti-cancer approaches, nutrition therapy does not kill tumor cells directly. Therefore, to establish the nutritional oncology with Chinese characteristics, oncologists and nutritionists should make joint efforts to continuously promote the research and development in this field (Table 1).
Nutrition therapy has become an important component of the multidisciplinary treatment of patients with malignant tumors. To standardize nutritional therapy for patients at the perioperative phase and during chemotherapy or palliative period, and ensure reasonable, effective delivery of care, the Experts Committee on Nutritional Therapy for Cancer Patients of CSCO developed the expert consensus upon extensive consultation and public opinion research in accordance with the specific situation in China, and incorporating the latest guidelines for nutritional treatment by the European Society for Clinical Nutrition and Metabolism (formerly the European Society of Parenteral and Enteral Nutrition, ESPEN) and American Society for Parenteral and Enteral Nutrition (ASPEN). For the purpose of this consensus, the following terms are defined as follows:
1. Introduction Other Section
Continuous development of cancer treatment technologies and methods has extended the survival time of patients with malignant tumors, making these conditions more of a controllable and curable chronic diseases. Therefore, maintenance of the quality of life should be a major focus in the modern oncology. As an emerging interdisciplinary subject, nutritional oncology looks into the underlying mechanisms of malnutrition in malignant patients to identify the most appropriate methods for assessing the nutritional risks and status of cancer patients, seeking to improve the efficacy of anti-cancer therapy as well as the quality of life with nutritional therapy. What distinguish this from general nutriology is the abnormal metabolic state in patients with advanced and end-stage cancer as a result of the stress state and constant proliferation of tumor tissues in the tumor-bearing body. In addition, unlike surgery, radiotherapy, chemotherapy, molecular targeted therapy and other anti-cancer approaches, nutrition therapy does not kill tumor cells directly. Therefore, to establish the nutritional oncology with Chinese characteristics, oncologists and nutritionists should make joint efforts to continuously promote the research and development in this field (Table 1).
Nutrition therapy has become an important component of the multidisciplinary treatment of patients with malignant tumors. To standardize nutritional therapy for patients at the perioperative phase and during chemotherapy or palliative period, and ensure reasonable, effective delivery of care, the Experts Committee on Nutritional Therapy for Cancer Patients of CSCO developed the expert consensus upon extensive consultation and public opinion research in accordance with the specific situation in China, and incorporating the latest guidelines for nutritional treatment by the European Society for Clinical Nutrition and Metabolism (formerly the European Society of Parenteral and Enteral Nutrition, ESPEN) and American Society for Parenteral and Enteral Nutrition (ASPEN). For the purpose of this consensus, the following terms are defined as follows:
Nutritional therapy: the administration of a relatively comprehensive combination of nutrients, generally through the oral, enteral or parenteral routes, for metabolic conditioning;
Enteral nutrition (EN): provision of nutrients through the digestive tract, including, based on different compositions, the delivery of macromolecule polymers (whole protein) and small molecule polymers (amino acids and short peptides);
Parenteral nutrition (PN): intravenous delivery of nutrients, including amino acids, fats, carbohydrates, vitamins and minerals, to inhibit catabolism, promote anabolism, and maintain the functionality of structural proteins for patients in whom gastrointestinal uptake and utilization of nutrients is impossible;
Malnutrition: an adverse event for both body functions and clinical outcomes resulting from deficient or excessive energy, protein and other nutrients;
Nutritional insufficiency: usually referring to protein-energy malnutrition (PEM), a set of specific symptoms related to nutritional deficiencies in patients who have insufficient energy or protein intake, or malabsorption;
Nutritional risk: the probability of negative impact on disease or surgery-related clinical outcomes (infection-related complications, length of stay, etc.) arising from the existing or potential nutritional and metabolic status;
Nutritional risk screening: a fast, easy way used by clinical care providers to determine whether a further comprehensive nutritional assessment and a nutritional treatment plan are needed for a certain cancer patient;
Nutritional assessment: a comprehensive examination and evaluation of the nutrition metabolism and body functions for a patient, used by nutritionists to take into account indications and possible side effects when developing nutrition treatment plans; and
Cachexia: a complex syndrome found in cancer patients, characterized by chronic, progressive and unconscious weight loss, often accompanied by loss of appetite, satiety and fatigue, which can be either insensitive or partially sensitive to nutritional therapy.
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