Bei sehr weit fortgeschrittener Tumorerkrankung und erkennbarem Eintritt in die letzten Lebenswoc... more Bei sehr weit fortgeschrittener Tumorerkrankung und erkennbarem Eintritt in die letzten Lebenswochen und -tage steht das Stillen von Hunger und Durst im Vordergrund. In allen anderen Fallen ist die Behandlung auf eine Verbesserung der korperlichen, psychischen und prognostischen Situation ausgerichtet: So zielt jede Ernahrungstherapie auf eine Verlangsamung oder – noch gunstiger – auf eine Umkehr eines anhaltenden Gewichtsverlusts. Indirekt kann sich so die subjektive Lebensqualitat verbessern, denn bei besserem Ernahrungszustand treten unerwunschte Wirkungen antitumoraler Therapien seltener und weniger heftig auf. Ebenso wird erwartet, dass eine Verbesserung der Ernahrungssituation das bei Mangelernahrung und Kachexie hohe Infektionsrisiko vermindert. Aus diesen Grunden sollte eine Ernahrungsberatung fruhzeitig und regelmasig angeboten werden, spatestens aber beim Auftreten von Ernahrungsstorungen.
TPS7086 Background: Approximately 50% of all cancer subjects suffer from cancer anorexia-cachexia... more TPS7086 Background: Approximately 50% of all cancer subjects suffer from cancer anorexia-cachexia syndrome accompanied by an inadequate food intake and predicting mortality, poor therapeutic response, diminished functional capacity, and reduced QoL. Especially in the advanced stages, parenteral nutrition (PN) is often required and accompanied by an increased risk of blood stream infections associated with increased mortality and other serious medical conditions such as sepsis. Furthermore, the switch from oral food intake to PN changes the patient’s everyday life leading to reduced autonomy and flexibility (e.g. due to dependency on home nursing services). This study aims at evaluating the incidence of catheter-related infections (CRI) and the frequency of self-administered parenteral nutrition at home (HPN) in patients receiving standard PN via A) traditional two- or three-chamber bags (often requiring addition of vitamins and/or medications by home care service) or B). the multi-c...
Viele Tumorpatienten entwickeln im Verlauf ihrer Erkrankung Ernährungsprobleme bis hin zur Kachex... more Viele Tumorpatienten entwickeln im Verlauf ihrer Erkrankung Ernährungsprobleme bis hin zur Kachexie, manche sterben gar kachexiebedingt. Und nicht nur dies: Eine eingeschränkte Ernährungssituation ist relevant für die Verträglichkeit der onkologischen Therapie und eng mit einer schlechteren Prognose assoziiert. Trotz dieses negativen Zusammenhangs werden eine mögliche Mangelernährung und ihre Therapie bei onkologischen Patienten immer noch unzureichend bedacht. Dabei könnte die Ernährungsbetreuung zu einer essenziellen Komponente der Supportivbehandlung werden und so dazu beitragen, die Tumorbehandlung zu optimieren.
Cancer cachexia is a multi-factorial syndrome, which negatively affects quality of life, responsi... more Cancer cachexia is a multi-factorial syndrome, which negatively affects quality of life, responsiveness to chemotherapy, and survival in advanced cancer patients. Our understanding of cachexia has grown greatly in recent years and the roles of many tumor-derived and host-derived compounds have been elucidated as mediators of cancer cachexia. However, cancer cachexia remains an unmet medical need and attempts towards a standard treatment guideline have been unsuccessful. This review covers the diagnosis, assessment, and treatment of cancer cachexia; the elements impeding the formulation of a standard management guideline; and future directions of research for the improvement and standardization of current treatment procedures.
Clinical nutrition (Edinburgh, Scotland), Jan 9, 2018
We recommend that intestinal failure associated liver disease (IFALD) should be diagnosed by the ... more We recommend that intestinal failure associated liver disease (IFALD) should be diagnosed by the presence of abnormal liver function tests and/or evidence of radiological and/or histological liver abnormalities occurring in an individual with IF, in the absence of another primary parenchymal liver pathology (e.g. viral or autoimmune hepatitis), other hepatotoxic factors (e.g. alcohol/medication) or biliary obstruction. The presence or absence of sepsis should be noted, along with the duration of PN administration. Abnormal liver histology is not mandatory for a diagnosis of IFALD and the decision to perform a liver biopsy should be made on a case-by-case basis, but should be particularly considered in those with a persistent abnormal conjugated bilirubin in the absence of intra or extra-hepatic cholestasis on radiological imaging and/or persistent or worsening hyperbilirubinaemia despite resolution of any underlying sepsis and/or any clinical or radiological features of chronic live...
Nutritional effects on cancer occurrence and on treatment outcome in cancer patients may depend o... more Nutritional effects on cancer occurrence and on treatment outcome in cancer patients may depend on food preferences and on the quantity of foods supplied. However, it has been difficult to reliably show beneficial effects of specific dietary concepts on cancer incidence. On the other hand, obesity as a result of chronic overfeeding has been linked firmly to an increased risk of a number of cancers as well as on cancer recurrence after treatment. Metabolic consequences of obesity and other components of the metabolic syndrome may be responsible for inducing and/or promoting cancer growth and should be antagonized by regular moderate physical activity in healthy subjects and in cancer survivors. During cancer treatment and in patients with advanced disease, inadequate food intake and physical inactivity may lead to malnutrition, while recurrent and chronic systemic inflammatory reactions induce chronic catabolism with a preferential loss of muscle and cell mass, condition referred to ...
Clinical nutrition (Edinburgh, Scotland), Jan 19, 2017
The aim of the study was to evaluate the applicability of the ESPEN 16-category clinical classifi... more The aim of the study was to evaluate the applicability of the ESPEN 16-category clinical classification of chronic intestinal failure, based on patients' intravenous supplementation (IVS) requirements for energy and fluids, and to evaluate factors associated with those requirements. ESPEN members were invited to participate through ESPEN Council representatives. Participating centers enrolled adult patients requiring home parenteral nutrition for chronic intestinal failure on March 1st 2015. The following patient data were recorded though a structured database: sex, age, body weight and height, intestinal failure mechanism, underlying disease, IVS volume and energy need. Sixty-five centers from 22 countries enrolled 2919 patients with benign disease. One half of the patients were distributed in 3 categories of the ESPEN clinical classification. 9% of patients required only fluid and electrolyte supplementation. IVS requirement varied considerably according to the pathophysiologi...
Cancer cachexia is a metabolic syndrome that can be present even in the absence of weight loss (&... more Cancer cachexia is a metabolic syndrome that can be present even in the absence of weight loss ('precachexia'). Cachexia is often compounded by pre-existing muscle loss, and is exacerbated by cancer therapy. Furthermore, cachexia is frequently obscured by obesity, leading to under-diagnosis and excess mortality. Muscle wasting (the signal event in cachexia) is associated not only with reduced quality of life, but also markedly increased toxicity from chemotherapy. Many of the primary events driving cachexia are likely mediated via the central nervous system and include inflammation-related anorexia and hypoanabolism or hypercatabolism. Treatment of cachexia should be initiated early. In addition to active management of secondary causes of anorexia (such as pain and nausea), therapy should target reduced food intake (nutritional support), inflammation-related metabolic change (anti-inflammatory drugs or nutrients) and reduced physical activity (resistance exercise). Advances ...
Today still only 50% of newly diagnosed cancers can be cured. While molecular mechanisms of cell ... more Today still only 50% of newly diagnosed cancers can be cured. While molecular mechanisms of cell proliferation are being studied intensively, comparably little research energy, however, has been spent on unravelling metabolic interactions of cancer and host tissues. Evidence is accumulating that systemic as well as local metabolic patterns have considerable impact on tumour growth, as well as on body composition and organ functions. This may lead to new treatments in oncology. Cancer development - and recurrence - may be inhibited by physical activity, as well as by avoiding obesity, the metabolic syndrome and insulin resistance. Antineoplastic treatments induce reductions in nutritional intake and require individually tailored nutritional support. New concepts are being considered to metabolically starve or reprogram cancer cells. During palliative treatment of progressive tumours, it should be good clinical practice to avoid or treat malnutrition and chronic inflammatory states. A...
Bei sehr weit fortgeschrittener Tumorerkrankung und erkennbarem Eintritt in die letzten Lebenswoc... more Bei sehr weit fortgeschrittener Tumorerkrankung und erkennbarem Eintritt in die letzten Lebenswochen und -tage steht das Stillen von Hunger und Durst im Vordergrund. In allen anderen Fallen ist die Behandlung auf eine Verbesserung der korperlichen, psychischen und prognostischen Situation ausgerichtet: So zielt jede Ernahrungstherapie auf eine Verlangsamung oder – noch gunstiger – auf eine Umkehr eines anhaltenden Gewichtsverlusts. Indirekt kann sich so die subjektive Lebensqualitat verbessern, denn bei besserem Ernahrungszustand treten unerwunschte Wirkungen antitumoraler Therapien seltener und weniger heftig auf. Ebenso wird erwartet, dass eine Verbesserung der Ernahrungssituation das bei Mangelernahrung und Kachexie hohe Infektionsrisiko vermindert. Aus diesen Grunden sollte eine Ernahrungsberatung fruhzeitig und regelmasig angeboten werden, spatestens aber beim Auftreten von Ernahrungsstorungen.
TPS7086 Background: Approximately 50% of all cancer subjects suffer from cancer anorexia-cachexia... more TPS7086 Background: Approximately 50% of all cancer subjects suffer from cancer anorexia-cachexia syndrome accompanied by an inadequate food intake and predicting mortality, poor therapeutic response, diminished functional capacity, and reduced QoL. Especially in the advanced stages, parenteral nutrition (PN) is often required and accompanied by an increased risk of blood stream infections associated with increased mortality and other serious medical conditions such as sepsis. Furthermore, the switch from oral food intake to PN changes the patient’s everyday life leading to reduced autonomy and flexibility (e.g. due to dependency on home nursing services). This study aims at evaluating the incidence of catheter-related infections (CRI) and the frequency of self-administered parenteral nutrition at home (HPN) in patients receiving standard PN via A) traditional two- or three-chamber bags (often requiring addition of vitamins and/or medications by home care service) or B). the multi-c...
Viele Tumorpatienten entwickeln im Verlauf ihrer Erkrankung Ernährungsprobleme bis hin zur Kachex... more Viele Tumorpatienten entwickeln im Verlauf ihrer Erkrankung Ernährungsprobleme bis hin zur Kachexie, manche sterben gar kachexiebedingt. Und nicht nur dies: Eine eingeschränkte Ernährungssituation ist relevant für die Verträglichkeit der onkologischen Therapie und eng mit einer schlechteren Prognose assoziiert. Trotz dieses negativen Zusammenhangs werden eine mögliche Mangelernährung und ihre Therapie bei onkologischen Patienten immer noch unzureichend bedacht. Dabei könnte die Ernährungsbetreuung zu einer essenziellen Komponente der Supportivbehandlung werden und so dazu beitragen, die Tumorbehandlung zu optimieren.
Cancer cachexia is a multi-factorial syndrome, which negatively affects quality of life, responsi... more Cancer cachexia is a multi-factorial syndrome, which negatively affects quality of life, responsiveness to chemotherapy, and survival in advanced cancer patients. Our understanding of cachexia has grown greatly in recent years and the roles of many tumor-derived and host-derived compounds have been elucidated as mediators of cancer cachexia. However, cancer cachexia remains an unmet medical need and attempts towards a standard treatment guideline have been unsuccessful. This review covers the diagnosis, assessment, and treatment of cancer cachexia; the elements impeding the formulation of a standard management guideline; and future directions of research for the improvement and standardization of current treatment procedures.
Clinical nutrition (Edinburgh, Scotland), Jan 9, 2018
We recommend that intestinal failure associated liver disease (IFALD) should be diagnosed by the ... more We recommend that intestinal failure associated liver disease (IFALD) should be diagnosed by the presence of abnormal liver function tests and/or evidence of radiological and/or histological liver abnormalities occurring in an individual with IF, in the absence of another primary parenchymal liver pathology (e.g. viral or autoimmune hepatitis), other hepatotoxic factors (e.g. alcohol/medication) or biliary obstruction. The presence or absence of sepsis should be noted, along with the duration of PN administration. Abnormal liver histology is not mandatory for a diagnosis of IFALD and the decision to perform a liver biopsy should be made on a case-by-case basis, but should be particularly considered in those with a persistent abnormal conjugated bilirubin in the absence of intra or extra-hepatic cholestasis on radiological imaging and/or persistent or worsening hyperbilirubinaemia despite resolution of any underlying sepsis and/or any clinical or radiological features of chronic live...
Nutritional effects on cancer occurrence and on treatment outcome in cancer patients may depend o... more Nutritional effects on cancer occurrence and on treatment outcome in cancer patients may depend on food preferences and on the quantity of foods supplied. However, it has been difficult to reliably show beneficial effects of specific dietary concepts on cancer incidence. On the other hand, obesity as a result of chronic overfeeding has been linked firmly to an increased risk of a number of cancers as well as on cancer recurrence after treatment. Metabolic consequences of obesity and other components of the metabolic syndrome may be responsible for inducing and/or promoting cancer growth and should be antagonized by regular moderate physical activity in healthy subjects and in cancer survivors. During cancer treatment and in patients with advanced disease, inadequate food intake and physical inactivity may lead to malnutrition, while recurrent and chronic systemic inflammatory reactions induce chronic catabolism with a preferential loss of muscle and cell mass, condition referred to ...
Clinical nutrition (Edinburgh, Scotland), Jan 19, 2017
The aim of the study was to evaluate the applicability of the ESPEN 16-category clinical classifi... more The aim of the study was to evaluate the applicability of the ESPEN 16-category clinical classification of chronic intestinal failure, based on patients' intravenous supplementation (IVS) requirements for energy and fluids, and to evaluate factors associated with those requirements. ESPEN members were invited to participate through ESPEN Council representatives. Participating centers enrolled adult patients requiring home parenteral nutrition for chronic intestinal failure on March 1st 2015. The following patient data were recorded though a structured database: sex, age, body weight and height, intestinal failure mechanism, underlying disease, IVS volume and energy need. Sixty-five centers from 22 countries enrolled 2919 patients with benign disease. One half of the patients were distributed in 3 categories of the ESPEN clinical classification. 9% of patients required only fluid and electrolyte supplementation. IVS requirement varied considerably according to the pathophysiologi...
Cancer cachexia is a metabolic syndrome that can be present even in the absence of weight loss (&... more Cancer cachexia is a metabolic syndrome that can be present even in the absence of weight loss ('precachexia'). Cachexia is often compounded by pre-existing muscle loss, and is exacerbated by cancer therapy. Furthermore, cachexia is frequently obscured by obesity, leading to under-diagnosis and excess mortality. Muscle wasting (the signal event in cachexia) is associated not only with reduced quality of life, but also markedly increased toxicity from chemotherapy. Many of the primary events driving cachexia are likely mediated via the central nervous system and include inflammation-related anorexia and hypoanabolism or hypercatabolism. Treatment of cachexia should be initiated early. In addition to active management of secondary causes of anorexia (such as pain and nausea), therapy should target reduced food intake (nutritional support), inflammation-related metabolic change (anti-inflammatory drugs or nutrients) and reduced physical activity (resistance exercise). Advances ...
Today still only 50% of newly diagnosed cancers can be cured. While molecular mechanisms of cell ... more Today still only 50% of newly diagnosed cancers can be cured. While molecular mechanisms of cell proliferation are being studied intensively, comparably little research energy, however, has been spent on unravelling metabolic interactions of cancer and host tissues. Evidence is accumulating that systemic as well as local metabolic patterns have considerable impact on tumour growth, as well as on body composition and organ functions. This may lead to new treatments in oncology. Cancer development - and recurrence - may be inhibited by physical activity, as well as by avoiding obesity, the metabolic syndrome and insulin resistance. Antineoplastic treatments induce reductions in nutritional intake and require individually tailored nutritional support. New concepts are being considered to metabolically starve or reprogram cancer cells. During palliative treatment of progressive tumours, it should be good clinical practice to avoid or treat malnutrition and chronic inflammatory states. A...
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