Is there a place for nutrition in palliative care?
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REVIEW ARTICLE
Is there a place for nutrition in palliative care? Federico Bozzetti 1 Received: 18 January 2020 / Accepted: 27 April 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Although nutritional interventions are becoming widely used in cancer patients, purposes and results of such treatment are not always well-defined. This is because nutrition is traditionally considered a palliative treatment to be confined to the area of palliative cares, whereas the modern approach includes nutrition as an early supplemental support to improve compliance of patients with the oncologic therapies and total parenteral nutrition may be recommended in patients who would be destined to succumb prior from starvation-malnutrition than from tumour progression. Purpose of this paper if to define the potential as well as the limitations of nutritional interventions on both the survival and the quality of life of the advanced cancer patients. Recent findings Some RCT on the use of oral, enteral and supplemental parenteral nutrition in patients on oncologic therapy show some benefit on compliance with therapy and in some domains of quality of life. Some malnourished (hypo)aphagic incurable cancer patients may survive longer thanks to parenteral nutrition, while few data suggest that quality of life may be maintained for a limited period of time. Summary With a few exceptions, oncology and nutrition have till recently travelled on parallel tracks without talking each other. The oncologist who knows the natural history of the patients should understand which risk of complication and of poor tolerance to the treatment can malnourished patients carry and which is the potential of parenteral nutrition in hypophagic incurable patients. Keywords Oral nutritional supplements . Enteral feeding . Supplemental parenteral nutrition . Total parenteral nutrition . Home nutrition . Cancer cachexia
Introduction The title of this paper conceals two ambiguities: on one side, the classic statement of the WHO defines palliative care “an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, Key points • Malnourished patients poorly tolerate the oncologic therapies • Nutritional status and compliance with chemo/radiation therapy can improve thanks to nutritional interventions • Nutritional interventions can be “supplemental” that is adjunctive to a reduced oral intake of nutrients or exclusive (i.e. total parenteral nutrition) • Nutrition may be supplemental and is indicated in malnourished (or at risk of malnutrition) patients on oncologic therapy or total (i.e. parenteral nutrition) in incurable hypophagic patients. • Aim of the supplemental nutrition is to potentiate the effects of the oncologic therapy while that of total parenteral nutrition is prolonging survival of incurable patients * Federico Bozzetti [email protected] 1
Residenza Querce, Milanodue, 20090 Segrate, Italy
through the prevention and relief of suffering b
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