Nutritional support in patients with oesophageal cancer
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Obesity and overweight are risk factors for developing an oesophageal cancer, especially the adenocarcinoma in the distal oesophagus or at the gastroesophageal junction, and many patients still are overweight at the clinical presentation even if they are losing weight. Main mechanisms involved in weight loss are a decreased nutrients’ intake and an alteration in metabolism due to a cytokine-driven inflammatory status. Malnutrition is a risk factor for a poor compliance to chemotherapy and radiation therapy and finally for the oncologic outcome. There is scientific evidence that frequently both conditions exist but in the advanced stages of disease metabolic alterations play a major role and are responsible for the poor response to nutritional support.
The literature about the nutritional support in patients with cancer of the oesophagus has been reviewed with special emphasis on randomised clinical trials whenever available. In surgical patients, both overweight and weight loss increase the risk of postoperative complications.
In non-dysphagic patients receiving a neo-adjuvant oncologic treatment, the simple use of oral nutritional supplements is little effective in ameliorating the nutritional status, in contrast, an intensive dietetic surveillance associated with oral supplements can lead to better nutritional status, improved quality of life and better compliance with therapy. In dysphagic patients, many comparative non-randomised clinical studies have shown clinical benefits from tube feeding on the nutritional status and compliance with therapy. There is no apparent difference on the metabolic efficacy of the enteral versus parenteral nutrition. Studies on peri-operative nutrition in oesophagectomy patients were often underpowered and, hence, inconclusive, but the large experience on the nutritional support in patients with gastrointestinal cancer undergoing major abdominal surgery has clearly shown the benefits of the enteral nutrition. Both the American and the European Society for Parenteral and Enteral Nutrition have recognised a grade A recommendation for the nutritional support of malnourished gastrointestinal cancer patients undergoing major surgery.
In patients with oesophageal cancer on chemotherapy and/or radiation therapy, enteral nutrition (oral supplements ± intensive counselling or tube feeding) is nutritionally and clinically beneficial. In surgical patients, a broad experience in major abdominal surgery supports the peri-operative use of enteral nutrition and especially of immune-enteral nutrition.
KeywordsNutritional support in cancer of the oesophagus Oral nutritional supplements in cancer of the oesophagus Enteral nutrition in cancer of the oesophagus Parenteral nutrition in cancer of the oesophagus Tube feeding in cancer of the oesophagus
- 13.Braga A, Ljungqvist O, Soeters PB, Fearon K, et al (2009) ESPEN Guidelines on Parenteral Nutrition: Surgery. Clin Nutr (in press).Google Scholar
- 15.Burt ME, Gorschboth CM, Brennan MF (1982) A controlled, prospective, randomized trial evaluating the metabolic effects of enteral and parenteral nutrition in the cancer patient. Cancer 49:1092–1105. doi: 10.1002/1097-0142(19820315) 49:6<1092::AID-CNCR2820490606>3.0.CO;2-9 CrossRefPubMedGoogle Scholar
- 20.Conti S, West J, Fitzpatrick HF (1997) Mortality and morbidity after esophagogastrectomy for cancer of the esophagus and cardia. Am Surg 43:92–96Google Scholar
- 21.Crumley ABC, McMillan M, McKennan M et al (2006) Evaluation of an inflammation-based prognostic score in patients with inoperable gastro-oesophageal cancer. Br J Cancer 94:437–441Google Scholar
- 26.Dempsey DT, Feurer ID, Knox LS, Crosby LO et al (1984) Energy expenditure in malnourished gastrointestinal cancer patients. Cancer 53:1265–1273. doi: 10.1002/1097-0142(19840315) 53:6<1265::AID-CNCR2820530609>3.0.CO;2-2 CrossRefPubMedGoogle Scholar
- 28.Dietitians Association of Australia Evidence Based Practice Guidelines for the Nutritional Management of Patients Receiving Radiation therapy (2008). Nutr&Diet 65 (Suppl 1) S1-S2Google Scholar
- 29.DiFiore F, Lecleire S, Pop D, Rigal O et al (2007) Baseline nutritional status is predictive of response to treatment and survival in patients treated by definitive chemoradiotherapy for a locally advanced esophageal cancer. Am J Gastroenterol 102:2557–2563. doi: 10.1111/j.1572-0241.2007.01437.x CrossRefGoogle Scholar
- 32.Fietkau R, Iro H, Sailer D, Sauer R (1991) Percutaneous endoscopically guided gastrostomy in patients with head and neck cancer. Rec Res Cancer Res 121:269–282Google Scholar
- 44.Jeevanandam M, Horowitz GD, Lowry SF et al (1985) Cancer cachexia: effect of total parenteral nutrition on whole body protein kinetics in man. JPEN J Parenter Enteral Nutr 9:10Google Scholar
- 47.Lagergen J, Bergstrom R, Nyren O (1999) Association between body mass index and adenocarcinoma of the esophagus and gastric cardia. Ann Intern Med 130:883–890Google Scholar
- 53.McWhirther JP, Pennington CR (1994) Incidence and ecognition of malnutrition in hospital. BMJ 308:945–948Google Scholar
- 54.Mekhail TM, Adelstein D, Rybicki LA et al (2001) Enteral nutrition during the treatment of head and neck carcinoma:is a percutaneous endoscopic gastrostomy tube preferable to a nasogastric tube? Cancer 91:1785–1790. doi: 10.1002/1097-0142(20010501) 91:9<1785::AID-CNCR1197>3.0.CO;2-1 CrossRefPubMedGoogle Scholar
- 56.Moloney M, Mortarty M, Daly L (1983) Controlled studies of nutritional intake in patients with malignant disease undergoing treatment. Hum Nutr Appl Nutr 37A:30–35Google Scholar
- 57.Nayel H, el-Ghoneimy E, el-Saddah S (1992) Impact of the nutritional supplementation on treatment delay and morbidity in patients with head and neck tumour treated with irradiation. Nutrition 18:13–18Google Scholar
- 61.Paccagnella A, Mauri A, Berto R et al (2007) Biopsychosocial approach to home enteral nutrition: measure of subjective satisfaction and quality of life. Minerva Med 38:5–17Google Scholar
- 62.Padilla GV, Grant MM (1985) Psychosocial aspects of artificial feeding. Cancer 55:301–304. doi: 10.1002/1097-0142(19850101) 55:1+<301::AID-CNCR2820551316>3.0.CO;2-B CrossRefPubMedGoogle Scholar
- 73.Ryan AM, Reynolds JV, Healy L, Byrne M, Moore J, Brannelly N, McHugh A, McCormack D, Flood P (2009) Enteral nutrition enriched with eicosapentaenoic acid (EPA) preserves lean body mass following oesophageal cancer surgery: results of a double-blinded randomized controlled trial. Ann Surg 249:355–363. doi: 10.1097/SLA.0b013e3181983231 CrossRefPubMedGoogle Scholar
- 74.Sakurai Y, Masui T, Yoshida I, Tonomura S et al (2007) Randomised clinical trial on the effects of perioperative use of immune-enhancing enteral formula on the metabolic and immunologic status of patients undergoing esophagectomy. World J Surg 31:2150–2157. doi: 10.1007/s00268-007-9170-8 CrossRefPubMedGoogle Scholar
- 76.Scottish Intercollegiate Guidelines Network SIGN guidelines- an introduction to SIGN methodology for the development of evidence-based clinical guidelines. Edinburgh, SIGN Publication No.39, SIGN Secretariat, Royal College of Physicians of Edinburgh, 1999Google Scholar
- 80.Simms JM, Olliver E, Smith JAR (1980) A study of total parenteral nutrition (TPN) in major gastric and esophageal resection for neoplasia. JPEN J Parenter Enteral Nutr 4:422Google Scholar
- 86.Thiel HJ, Fietkau R, Sauer R (1988) Malnutrition and the role of nutritional support for radiation therapy patients. Rec Res Cancer Res 108:205–226Google Scholar
- 88.Van Bokhoerst_De-Van Der Schurer MAE, Quak JJ, Von Blomberg-Van Der Flier BME (2001) Effect of perioperative nutrition with and without arginine supplementation on nutritional status, immune function, postoperative morbidity and survival in severely malnourished head and neck cancer patients. Am J Clin Nutr 73:323–332Google Scholar