ISSN:0148-6071    

DOI:10.1177/014860719201600191

出版商:SAGE Publications    

年代:1992

数据来源: WILEY

ISSN:0148-6071    

DOI:10.1177/014860719201600192

出版商:SAGE Publications    

年代:1992

数据来源: WILEY

摘要:

The clinical outcome for 1362 patients with active cancer managed on home parenteral nutrition (HPN) is compared with that of 122 patients with radiation enteritis (“cured” cancer) and 416 patients with Crohn's disease. This longitudinal clinical information was reported to the North American Home Parenteral and Enteral Nutrition Registry (Oley Foundation/A.S.P.E.N. joint project) between 1985 and 1989. The data shows that the number of active cancer patients on this therapy is increasing 13% per year. The annual survival rate is 25% for patients with active cancer, as compared with 88% for patients with radiation enteritis and 95% for patients with Crohn's disease. Although 50% of all active cancer patients starting HPN are dead within 6 to 9 months, the prognosis is somewhat better in children, and 20% of these active cancer patients appear to do well, returning to full oral nutrition and experiencing complete rehabilitation. These are presumed to be patients with a potentially curable cancer requiring super‐aggressive treatment, which causes temporary severe gastrointestinal dysfunction. Adult active cancer patients have the same rehospitalization rate for HPN complications (once per year) as radiation enteritis and Crohn's disease patients. However, their rehospitalization rate for non‐HPN complications is four times higher. This article reviews the factors that may explain the growth of HPN in active cancer patients and discusses some of the unanswered clinical questions that urgently need to be addressed to more effectively determine the appropriateness or inappropriateness of HPN management in the active cancer setting. (Journal of Parenteral and Enteral Nutrition16:93S‐99S, 1992)

ISSN:0148-6071    

DOI:10.1177/014860719201600611

出版商:SAGE Publications    

年代:1992

数据来源: WILEY

ISSN:0148-6071    

DOI:10.1177/014860719201600195

出版商:SAGE Publications    

年代:1992

数据来源: WILEY

ISSN:0148-6071    

DOI:10.1177/014860719201600131

出版商:SAGE Publications    

年代:1992

数据来源: WILEY

摘要:

Cancer patients have the highest incidence of protein‐calorie malnutrition seen in hospitalized patients, with significant malnutrition occurring in more than 30% of cancer patients undergoing major upper gastrointestinal procedures. Clinically significant malnutrition occurs as a result of diminished nutrient intake, increased nutrient losses, and tumor‐induced derangements in host metabolism. In the absence of adequate exogenous nutrients, the body utilizes endogenous substrates to satisfy the ongoing requirements of both host and tumor for energy and protein. In those patients with malignant obstruction of the gastrointestinal tract, the tumor itself may induce diminished nutrient intake. Present day treatment modalities including gastrointestinal resection, chemotherapy, and radiotherapy compound these metabolic derangements, further increasing the risk of postoperative morbidity and death. The presence of malnutrition in cancer patients has prognostic importance. In a review of more than 3000 cancer patients, DeWys and colleagues identified significantly improved survival in those patients without weight loss compared with those had lost 6% of their body weight (Am J Med 69:491–497, 1980). Other investigators have noted increased postoperative morbidity and mortality associated with malnutrition. Early hypotheses suggested that reversal of weight loss would improve survival. The development and refinements of enteral and parenteral nutrition have provided the opportunity for studying the relationship between nutritional supplementation and postoperative prognosis. Nutrition support is therefore often instituted to improve nutritional status and thereby reduce the risks of postoperative complications. This article addresses the beneficial role of preoperative nutrition therapy in cancer patients. (Journal of Parenteral and Enteral Nutrition16:100S‐105S, 1992)

ISSN:0148-6071    

DOI:10.1177/014860719201600612

出版商:SAGE Publications    

年代:1992

数据来源: WILEY

摘要:

Nutrition interventions with cancer patients may produce benefits beyond those typically evaluated, such as increased appetite, food intake, and weight gain. Other benefits include enhanced mood, improved sense of well‐being, and increased socialization because of an increased ability to eat in public or with family. Along with the target benefits of nutrition interventions, these “untargeted” benefits have come to be clustered under the general rubric of health‐related quality of life. All medical treatments, including nutrition interventions, can be evaluated in terms of their total effect upon health‐related quality of life. However, demonstrating health outcome benefits of nutrition interventions can be very difficult. This difficulty is at two levels: conceptual and practical. Conceptual difficulties can be overcome by refining and clarifying the definition and measurement of health‐related quality of life. Practical difficulties are more diverse and must be tackled on a point‐by‐point basis, depending upon the unique characteristics of the disease being treated, the intervention being tested, and the context of the trial. This paper offers some guidelines and recommendations for overcoming many of the more commonly confronted barriers to successful demonstration of health outcome benefits from clinical nutrition trials with cancer patients. (Journal of Parenteral and Enteral Nutrition16:106S‐111S, 1992)

ISSN:0148-6071    

DOI:10.1177/014860719201600613

出版商:SAGE Publications    

年代:1992

数据来源: WILEY

摘要:

Many studies have assessed the benefits of nutrition support in cancer patients. Except for studies directed at the treatment of severe malnutrition, most clinical trials have failed. Although prospective randomized controlled clinical trials (Phase III) remain the most reliable means of evaluating the efficacy of therapy, the available literature reports only results from small trials (Phase II to III), most of which appear to be contradictory and none of which conclusively answer the question being considered. To address this gap in knowledge, tools such as meta‐analysis have been adapted from the field of statistics. Meta‐analysis involves pooling results across several studies and provides a more precise estimate of treatment effect than can each individual study. However, clinical trials selected for meta‐analysis, although broadly similar, can differ significantly in terms of therapies used and clinical populations studied. Major cancer types with differing effects on food intake and malnutrition (eg, the mechanical obstruction in head and neck cancer vs the cytokine‐induced metastases associated with lung, ovarian, colon, and breast cancer) cannot be subject to the same analytic criteria. In this paper, the current state of clinical outcome trials in nutrition and cancer is examined, and the desired design for future studies is proposed. Research priorities include the conduct of Phase II clinical trials that use as outcome measures quality of life, performance status, and survival to identify optimal cancer‐specific and patient‐specific nutrition support. The next round of Phase III efficacy studies should establish the appropriate use of nutrition support in cancer therapy. (Journal of Parenteral and Enteral Nutrition16: 112S‐116S, 1992)

ISSN:0148-6071    

DOI:10.1177/014860719201600614

出版商:SAGE Publications    

年代:1992

数据来源: WILEY

ISSN:0148-6071    

DOI:10.1177/014860719201600601

出版商:SAGE Publications    

年代:1992

数据来源: WILEY