Abstract
In patients with cancer, severe malnutrition is associated with increased morbidity and mortality, reduction of treatment efficacy, and increased length of hospital stay. In order to avoid this, therefore, early individualized dietary counselling is mandatory. In this situation, oral nutritional supplements should be proposed according to their immunonutritional effects and indications. Indeed, while preoperative oral immunonutrition for patients with gastrointestinal neoplasm is associated with a 50% decrease in postoperative complications, the use of dietary antioxidant supplements during conventional chemotherapy and radiotherapy is controversial. In these conditions, continuing research on the use of concurrent supplemental antioxidants is warranted. As long as data about immunonutritional efficacy with randomized controlled trials is insufficient, then oral nutritional supplements without immune effects should be associated with dietary counselling.
Résumé
En cancérologie, la dénutrition sévère est associée à une augmentation de la morbimortalité, à une réduction de l’efficacité thérapeutique, de la qualité de vie et une augmentation des temps d’hospitalisation. La meilleure prévention de ces complications est, actuellement, un conseil diététique individualisé précoce. Dans cette situation, les compléments nutritionnels oraux avec ou sans immunonutriment devraient être proposés selon des indications thérapeutiques précises. En effet, s’il est démontré que l’immunonutrition réduit les complications post-opératoires de 50 % en chirurgie digestive carcinologique, l’utilisation de compléments enrichis en anti-oxydants est actuellement très controversée pour les patients en cours de radiothérapie ou chimiothérapie. Il est essentiel, dans cette situation, de développer des études cliniques randomisées avec évaluation de la survie. En pratique, il est essentiel de réserver les immunonutriments aux indications validées et les compléments nutritionnels oraux non enrichis aux autres cas en fonction du conseil diététique.
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Senesse, P., Janiszewski, C., Flori, N. et al. Utilisation et place des compléments nutritionnels oraux pour les malades cancéreux. Oncologie 11, 231–235 (2009). https://doi.org/10.1007/s10269-009-1047-z
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DOI: https://doi.org/10.1007/s10269-009-1047-z