RSS-Feed abonnieren
DOI: 10.1055/s-0031-1277005
Ernährung von Tumorpatienten
Nutrition in Cancer PatientsPublikationsverlauf
Publikationsdatum:
11. April 2012 (online)

Zusammenfassung
Bei Patienten mit aktiver Tumorerkrankung entwickelt sich sehr häufig eine Mangelernährung. Der Gewichtsverlust ist mit einer reduzierten Lebensqualität und Leistungsfähigkeit sowie mit einer eingeschränkten Toleranz für antitumorale Therapien assoziiert. Gastrointestinale Störungen, quälende Schmerzzustände, psychosoziale Belastungen sowie Änderungen des metabolischen Milieus mit einer oft nachweisbaren tumorassoziierten systemischen Inflammationsreaktion führen zu Appetitverlust, verminderter Nahrungs- und Energieaufnahme, Fatigue, reduzierter Mobilität und weiterem Muskel- und Gewichtsverlust. Zentrale Ziele einer Stoffwechsel- und Ernährungsbetreuung onkologischer Patienten sind eine differenzierte Erfassung der Problemsituation, die gezielte Behandlung aller Faktoren, die die Nahrungsaufnahme und -verwertung stören, die Sicherung des erforderlichen Energie- und Nährstoffbedarfs, ein begleitendes Muskeltraining sowie antiinflammatorische und antikatabole Behandlungsansätze.
Abstract
Malnutrition develops frequently in cancer patients. Weight loss in these patients is associated with impaired quality of life and physical performance and a reduced tolerance of anticancer treatments. Gastrointestinal defects, chronic pain, psycho-social tensions and tumor-associated inflammatory reactions, all contribute to appetite loss, reduced intake of nutrients and energy, fatigue, diminished mobility and further loss of weight and muscles. Major aims of the nutritional and metabolic care of oncologic patients are the following: the careful assessment of the relevant problems; the targeted treatment of all factors interfering with nutritional intake and utilization; ensuring the required supply of nutrients and energy; exercise training; as well as anti-inflammatory and anti-catabolic strategies.
Schlüsselwörter
Tumor - Ernährung - Mangelernährung - Kachexie - Inflammation - Muskel - Krebs
Keywords
tumor - cancer - nutrition - malnutrition - cachexia - inflammation - muscle
Literatur
- 1
Dewys W D, Begg C, Lavin P T et al.
Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern
Cooperative Oncology Group.
Am J Med.
1980;
69
491-497
Reference Ris Wihthout Link
- 2
Andreyev H J, Norman A R, Oates J et al.
Why do patients with weight loss have a worse outcome when undergoing chemotherapy
for gastrointestinal malignancies?.
Eur J Cancer.
1998;
34
503-509
Reference Ris Wihthout Link
- 3
Ross P J, Ashley S, Norton A et al.
Do patients with weight loss have a worse outcome when undergoing chemotherapy for
lung cancers?.
Br J Cancer.
2004;
90
1905-1911
Reference Ris Wihthout Link
- 4
Ravasco P, Monteiro-Grillo I, Vidal P M et al.
Cancer: disease and nutrition are key determinants of patients’ quality of life.
Support Care Cancer.
2004;
12
246-252
Reference Ris Wihthout Link
- 5
Good R A, West A, Day N K et al.
Effects of undernutrition of host cell and organ function.
Cancer Res.
1982;
42
(S 02)
737s-746s
Reference Ris Wihthout Link
- 6
Skipworth R JE, Stewart G D, Dejong C HC et al.
Pathophysiology of cancer cachexia: much more than host-tumour interaction?.
Clin Nutr.
2007;
26
667-676
Reference Ris Wihthout Link
- 7
Montazeri A.
Quality of life data as prognostic indicators of survival in cancer patients: an overview
of the literature from 1982 to 2008.
Health Qual Life Outcomes.
2009;
7
102
Reference Ris Wihthout Link
- 8
Arends J.
Mangelernährung bei Tumorpatienten.
Onkologe.
2008;
14
9-14
Reference Ris Wihthout Link
- 9
Evans W J, Morley J E, Argilés J et al.
Cachexia: a new definition.
Clin Nutr.
2008;
27
793-799
Reference Ris Wihthout Link
- 10
Shizgal H M.
The effect of malnutrition on body composition.
Surg Gynecol Obstet.
1981;
152
22-26
Reference Ris Wihthout Link
- 11
Cahill G F.
Fuel metabolism in starvation.
Annu Rev Nutr.
2006;
26
1-22
Reference Ris Wihthout Link
- 12
Lundholm K, Holm G, Scherstén T.
Insulin resistance in patients with cancer.
Cancer Res.
1978;
38
4665-4670
Reference Ris Wihthout Link
- 13
Pajak B, Orzechowska S, Pijet B et al.
Crossroads of cytokine signaling – the chase to stop muscle cachexia.
J Physiol Pharmacol.
2008;
59
(S 09)
251-264
Reference Ris Wihthout Link
- 14 Norman K, Stobäus N, Zocher D et al. Cutoff percentiles of bioelectrical phase angle predict functionality, quality of
life, and mortality in patients with cancer (14.07.2010). Im Internet: http://www.ncbi.nlm.nih.gov/pubmed/20631202 Stand: 20.07.2010
Reference Ris Wihthout Link
- 15
Prado C MM, Baracos V E, McCargar L J et al.
Body composition as an independent determinant of 5-fluorouracil-based chemotherapy
toxicity.
Clin Cancer Res.
2007;
13
3264-3268
Reference Ris Wihthout Link
- 16
Prado C MM, Lieffers J R, McCargar L J et al.
Prevalence and clinical implications of sarcopenic obesity in patients with solid
tumours of the respiratory and gastrointestinal tracts: a population-based study.
Lancet Oncol.
2008;
7
629-635
Reference Ris Wihthout Link
- 17
Dempsey D T, Feurer I D, Knox L S et al.
Energy expenditure in malnourished gastrointestinal cancer patients.
Cancer.
1984;
53
1265-1273
Reference Ris Wihthout Link
- 18
Arends J, Bodoky G, Bozzetti F et al.
ESPEN Guidelines on Enteral Nutrition: Non-surgical oncology.
Clin Nutr.
2006;
2
245-259
Reference Ris Wihthout Link
- 19
Kalm L M, Semba R D.
They starved so that others be better fed: remembering Ancel Keys and the Minnesota
experiment.
J Nutr.
2005;
135
1347-1352
Reference Ris Wihthout Link
- 20
Kotler D P, Tierney A R, Culpepper-Morgan J A et al.
Effect of home total parenteral nutrition on body composition in patients with acquired
immunodeficiency syndrome.
JPEN J Parenter Enteral Nutr.
1990;
14
454-458
Reference Ris Wihthout Link
- 21
Bozzetti F, Arends J, Lundholm K et al.
ESPEN Guidelines on Parenteral Nutrition: non-surgical oncology.
Clin Nutr.
2009;
28
445-454
Reference Ris Wihthout Link
- 22
Thibault R, Goujon N, Le Gallic E et al.
Use of 10-point analogue scales to estimate dietary intake: a prospective study in
patients nutritionally at-risk.
Clin Nutr.
2009;
28
134-140
Reference Ris Wihthout Link
- 23
Oken M M, Creech R H, Tormey D C et al.
Toxicity and response criteria of the Eastern Cooperative Oncology Group.
Am J Clin Oncol.
1982;
5
649-655
Reference Ris Wihthout Link
- 24
Jensen G L, Mirtallo J, Compher C et al.
Adult starvation and disease-related malnutrition: a proposal for etiology-based diagnosis
in the clinical practice setting from the International Consensus Guideline Committee.
JPEN J Parenter Enteral Nutr.
2010;
34
156-159
Reference Ris Wihthout Link
- 25
Dulloo A G.
Regulation of body composition during weight recovery: integrating the control of
energy partitioning and thermogenesis.
Clin Nutr.
1997;
16
(S 01)
25-35
Reference Ris Wihthout Link
- 26
Streat S J, Beddoe A H, Hill G L.
Aggressive nutritional support does not prevent protein loss despite fat gain in septic
intensive care patients.
J Trauma.
1987;
27
262-266
Reference Ris Wihthout Link
- 27
Holm E, Kämmerer U.
Fette und Kohlenhydrate in Ernährungskonzepten für Tumorpatienten.
Aktuel Ernahrungsmed.
2011;
36
286-298
Reference Ris Wihthout Link
- 28
Bruera E, Roca E, Cedaro L et al.
Action of oral methylprednisolone in terminal cancer patients: a prospective randomized
double-blind study.
Cancer Treat Rep.
1985;
69
751-754
Reference Ris Wihthout Link
- 29
Maltoni M, Nanni O, Scarpi E et al.
High-dose progestins for the treatment of cancer anorexia-cachexia syndrome: a systematic
review of randomised clinical trials.
Ann Oncol.
2001;
12
289-300
Reference Ris Wihthout Link
- 30
Jatoi A, Windschitl H E, Loprinzi C L et al.
Dronabinol versus megestrol acetate versus combination therapy for cancer-associated
anorexia: a North Central Cancer Treatment Group study.
J Clin Oncol.
2002;
20
567-573
Reference Ris Wihthout Link
- 31
Lundholm K, Daneryd P, Bosaeus I et al.
Palliative nutritional intervention in addition to cyclooxygenase and erythropoietin
treatment for patients with malignant disease: Effects on survival, metabolism, and
function.
Cancer.
2004;
100
1967-1977
Reference Ris Wihthout Link
- 32
Lundholm K, Daneryd P, Körner U et al.
Evidence that long-term COX-treatment improves energy homeostasis and body composition
in cancer patients with progressive cachexia.
Int J Oncol.
2004;
24
505-512
Reference Ris Wihthout Link
- 33
Lundholm K, Gelin J, Hyltander A et al.
Anti-inflammatory treatment may prolong survival in undernourished patients with metastatic
solid tumors.
Cancer Res.
1994;
54
5602-5606
Reference Ris Wihthout Link
- 34
Colomer R, Moreno-Nogueira J M, García-Luna P P et al.
N-3 fatty acids, cancer and cachexia: a systematic review of the literature.
Br J Nutr.
2007;
97
823-831
Reference Ris Wihthout Link
- 35
van der Meij B S, Langius J AE, Smit E F et al.
Oral nutritional supplements containing (n-3) polyunsaturated fatty acids affect the
nutritional status of patients with stage III non-small cell lung cancer during multimodality
treatment.
J Nutr.
2010;
140
1774-1780
Reference Ris Wihthout Link
- 36
Murphy R A, Mourtzakis M, Chu Q SC et al.
Nutritional intervention with fish oil provides a benefit over standard of care for
weight and skeletal muscle mass in patients with nonsmall cell lung cancer receiving
chemotherapy.
Cancer.
2011;
117
1775-1782
Reference Ris Wihthout Link
- 37
Murphy R A, Mourtzakis M, Chu Q SC et al.
Supplementation with fish oil increases first-line chemotherapy efficacy in patients
with advanced nonsmall cell lung cancer.
Cancer.
2011;
117
3774-3780
Reference Ris Wihthout Link
- 38
Adachi S, Takiguchi S, Okada K et al.
Effects of ghrelin administration after total gastrectomy: a prospective, randomized,
placebo-controlled phase II study.
Gastroenterology.
2010;
138
1312-1320
Reference Ris Wihthout Link
- 39
Biesalski H K.
Mikronährstoffsupplemente bei onkologischen Patienten: Gibt es rationale Gründe?.
Aktuel Ernahrungsmed.
2011;
36
282-285
Reference Ris Wihthout Link
- 40
Arends J.
Metabolism in cancer patients.
Anticancer Res.
2010;
30
1863-1868
Reference Ris Wihthout Link
- 41
Na H-K, Oliynyk S.
Effects of physical activity on cancer prevention.
Ann N Y Acad Sci.
2011;
1229
176-183
Reference Ris Wihthout Link
- 42
Holmes M D, Chen W Y, Feskanich D et al.
Physical activity and survival after breast cancer diagnosis.
JAMA.
2005;
293
2479-2486
Reference Ris Wihthout Link
- 43
Meyerhardt J A, Giovannucci E L, Holmes M D et al.
Physical activity and survival after colorectal cancer diagnosis.
J Clin Oncol.
2006;
24
3527-3534
Reference Ris Wihthout Link
- 44
Meyerhardt J A, Heseltine D, Niedzwiecki D et al.
Impact of physical activity on cancer recurrence and survival in patients with stage
III colon cancer: findings from CALGB 89803.
J Clin Oncol.
2006;
24
3535-3541
Reference Ris Wihthout Link
- 45
McCann R M, Hall W J, Groth-Juncker A.
Comfort care for terminally ill patients. The appropriate use of nutrition and hydration.
JAMA.
1994;
272
1263-1266
Reference Ris Wihthout Link
Dr. med. Jann Arends
Klinik für Tumorbiologie an der Albert-Ludwigs-Universität Freiburg
Breisacher Straße 117
79106 Freiburg
eMail: arends@tumorbio.uni-freiburg.de