Options for artificial nutrition of cancer patients.

BACKGROUND: Until today, 25 to 50% of ill or severely disabled patients show qualitative or quantitative nutritional deficits which can lead to a disease aggravation and thus may be a limiting factor in oncologic treatment strategies. Therefore the various options for artificial nutrition should be used according to strict indications. These are whenever the patient is not able to eat (e.g. acute mucositis), does not want to eat (e.g. nausea Grade 3 to 4) or is not allowed to eat (e.g. pancreatitis).
METHODS: The principle is to apply as much as possible enteral feeding because of its advantages. Enteral nutrition is more physiological, safer and more reasonable. A prerequisite for an adequate feeding is the optimal nutrient composition and detection of patient's individual nutritional status. Numerous options for the adequate application technique of nutritional support are available: 1. oral diets with commercially available supplement drinks; 2. the pump-assisted application by using nasal or percutaneous probes bears many advantages when some important basic rules are not neglected to guarantee a complication free course, e.g. the choice of right nutrients for the right indications, the control of the tube-position and a smooth build-up of the application; 3. peripheral or central venous application is necessary if contraindications prevent the use of enteral nutrition (e.g. ileus, pancreatitis). The following parameters have to be taken into account when generating a parenteral nutrition programme: diagnosis, the present status of the patient's disease, the actual body weight and ideal weight, the laboratory test results, the need of total energy of nutrients in detail and of fluid and electrolytes.
CONCLUSIONS: The prevention of malnutrition by adequate therapies for patients with anorexia or cachexia may contribute to a reduction of morbidity and mortality in cancer therapy. There is also a substantial impact of malnutrition on the outcome of anti cancer therapies. Finally a large decrease in health care costs may result from a prevention of cachexia.