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Mangelernährung bei Tumorpatienten

Ursachen, Diagnostik und Kodierung

Malnutrition in cancer

Pathophysiology and diagnostic concepts

Der Onkologe Aims and scope

Zusammenfassung

Ernährungsstörungen treten bei Tumorpatienten häufig bereits vor Diagnosestellung auf. Diese Defizite gefährden die Toleranz gegenüber Tumortherapien und schränken die Erkrankungsprognose ein. Ein tumorassoziierter Gewichtsverlust ist auch für Übergewichtige ungünstig, da er oft gerade die vitale Zellmasse betrifft. Eine zentrale Ursache für die Entstehung einer Mangelernährung ist eine tumorassoziierte systemische Inflammationsreaktion. Eine pathophysiologisch orientierte praktikable Diagnostik sollte regelmäßig Gewicht, Appetit, Essmenge und die Akutphasenreaktion erfassen. Veränderungen dieser Parameter werden als praktikable Definitionsmerkmale der kodierbaren zugehörigen DRG-Diagnosen vorgestellt. Eine verbindliche Einigung auf praktikable Definitionen der ernährungsrelevanten Diagnose-Codes liegt jedoch noch nicht vor.

Abstract

Nutritional deficits are frequent in cancer patients even before tumor diagnosis. These deficits increase the toxicity of cancer therapies and impair overall survival. Tumor-associated weight loss also has a negative impact in overweight individuals because of the often pronounced loss in body cell mass. An important cause of malnutrition is a tumor-associated systemic inflammatory response. The diagnostic approach should be simple and practical and follow the underlying pathophysiology; therefore, patients should be monitored regularly for weight, appetite, nutritional intake, and inflammatory response. Abnormalities in these parameters appear to be suited for defining diagnoses within the German DRG system.

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Literatur

  1. Allison SP (1992) The uses and limitations of nutritional support. Clin Nutr 11: 319–330

    Article  PubMed  CAS  Google Scholar 

  2. Andreyev HJN, Norman AR, Oates J, Cunningham D (1998) Why do patients with weight loss have a worse outcome when undergoing chemotherapy for gastrointestinal malignancies? Eur J Cancer 34: 503–509

    Article  PubMed  CAS  Google Scholar 

  3. Arends J, Bodoky G, Bozzetti F et al. DGEM (Deutsche Gesellschaft für Ernährungsmedizin): Zürcher G, Fietkau R, Aulbert E, Frick B, Holm M, Kneba M, Mestrom HJ, Zander A (2006) ESPEN Guidelines on Enteral Nutrition: Non-surgical oncology. Clin Nutr 25: 245–259

    Article  PubMed  CAS  Google Scholar 

  4. Bishop CW, Bowen PE, Ritchey SJ (1981) Norms for nutritional assessment of American adults by upper arm anthropometry. Am J Clin Nutr 34: 2530–2539

    PubMed  CAS  Google Scholar 

  5. Cahill GF Jr (2006) Fuel Metabolism in Starvation. Annu Rev Nutr 26: 1–22

    Article  PubMed  CAS  Google Scholar 

  6. Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ (2003) Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med 348: 1625–1638

    Article  PubMed  Google Scholar 

  7. Coussens LM, Werb Z (2002) Inflammation and cancer. Nature 420: 860–867

    Article  PubMed  CAS  Google Scholar 

  8. Darwin C (1859) The origin of species by means of natural selection. John Murray, London

  9. Dawkins R (1976) The selfish gene. Oxford University Press, Oxford

  10. Deans C, Wigmore SJ (2005) Systemic inflammation, cachexia and prognosis in patients with cancer. Curr Opin Clin Nutr Metab Care 8: 265–269

    Article  PubMed  CAS  Google Scholar 

  11. Detsky AS, McLaughlin JR, Baker JP et al. (1987) What is subjective global assessment of nutritional status? JPEN J Parenter Enteral Nutr 11: 8–13

    Article  PubMed  CAS  Google Scholar 

  12. DeWys WD, Begg C, Lavin PT et al. (1980) Prognostic effect of weight loss prior to chemotherapy in cancer patients. Am J Med 69: 491–497

    Article  PubMed  CAS  Google Scholar 

  13. Fearon KCH, Barber MD, Falconer JS et al. (1999) Pancreatic cancer as a model: inflammatory mediators, acute-phase response, and cancer cachexia. World J Surg 23: 584–588

    Article  PubMed  CAS  Google Scholar 

  14. Kondrup J, Rasmussen HH, Hamberg O, Stanga Z, Ad Hoc ESPEN Working Group (2003) Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr 22: 321–336

    Article  PubMed  Google Scholar 

  15. Kotler DP, Wang J, Pierson RN (1985) Body composition studies in patients with the acquired immunodeficiency syndrome. Am J Clin Nutr 42: 1255–1265

    PubMed  CAS  Google Scholar 

  16. Kotler DP (2000) Cachexia. Ann Intern Med 133: 622–634

    PubMed  CAS  Google Scholar 

  17. Moses AW, Slater C, Preston T et al. (2004) Reduced total energy expenditure and physical activity in cachectic patients with pancreatic cancer can be modulated by an energy and protein dense oral supplement enriched with n-3 fatty acids. Br J Cancer 90: 996–1002

    Article  PubMed  CAS  Google Scholar 

  18. Ravasco P, Monteiro-Grillo I, Vidal PM, Camilo ME (2004) Cancer: disease and nutrition are key determinants of patients‘ quality of life. Support Care Cancer 12: 246–252

    Article  PubMed  Google Scholar 

  19. Ross PJ, Ashley S, Norton A et al. (2004) Do patients with weight loss have a worse outcome when undergoing chemotherapy for lung cancer? Br J Cancer 90: 1905–1911

    Article  PubMed  CAS  Google Scholar 

  20. Springer J, Haehling S von, Anker SD (2006) The need for a standardized definition for cachexia in chronic illness. Nat Clin Pract Endocrinol Metab 2: 416–417

    Article  PubMed  Google Scholar 

  21. Stratton RJ, King CL, Stroud MA et al. (2006) ‚Malnutrition Universal Screening Tool‘ predicts mortality and length of hospital stay in acutely ill elderly. Br J Nutr 95: 325–330

    Article  PubMed  CAS  Google Scholar 

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Arends, J. Mangelernährung bei Tumorpatienten. Onkologe 14, 9–14 (2008). https://doi.org/10.1007/s00761-007-1292-y

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  • DOI: https://doi.org/10.1007/s00761-007-1292-y

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