Download PDF
Frauenheilkunde up2date 2013; 7(5): 331-346
DOI: 10.1055/s-0032-1325061
Allgemeine Gynäkologie und gynäkologische Onkologie
Georg Thieme Verlag KG Stuttgart · New York

Ernährung von Tumorpatienten

Mod. nach Erstpublikation Aktuel Ernahrungsmed 2012; 37: 91–106
Jann Arends
Further Information

Publication History

Publication Date:
16 October 2013 (online)

Also available at
    Permissions and Reprints All articles of this category
Kernaussagen

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.

  • Alle Tumorpatienten müssen regelmäßig auf einen drohenden Gewichtsverlust (Mangelernährung) sowie auf die Entwicklung einer prognostisch ungünstigen tumorassoziierten systemischen Inflammationsreaktion (Kachexie) untersucht werden.

  • Zu einer effektiven Ernährungsbetreuung gehört neben der kompetenten Behandlung gastrointestinaler Störungen, chronischer Schmerzen und psychosozialer Belastungen ein Trainingsprogramm zur Muskelstärkung.

  • Patienten mit aktiver Tumorerkrankung sollten regelmäßig und professionell zur Einnahme einer akzeptierten, verträglichen und bedarfsgerechten Kost beraten werden.

  • Medikamentöse Ansätze zur Appetitsteigerung (Steroide, Gestagene) sowie zur Dämpfung einer chronischen systemischen Inflammation (nicht steroidale Antirheumatika, n-3-Fettsäuren) können die Ernährungstherapie unterstützen.

  • Die individuell erforderliche Energie- und Nährstoffzufuhr sollte durchgehend sichergestellt werden, falls erforderlich mithilfe von Trinknahrungen und supplementären künstlichen Ernährungsformen über enterale Sonden und intravenöse Katheter (z. B. über ein liegendes Portsystem).

 

  • Literatur

  • 1 Dewys WD, Begg C, Lavin PT et al. Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern Cooperative Oncology Group. Am J Med 1980; 69: 491-497
    CrossrefGoogle Scholar
  • 2 Andreyev HJ, Norman AR, 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
    CrossrefGoogle Scholar
  • 3 Ross PJ, 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
    CrossrefGoogle Scholar
  • 4 Ravasco P, Monteiro-Grillo I, Vidal PM et al. Cancer: disease and nutrition are key determinants of patients quality of life. Support Care Cancer 2004; 12: 246-252
    CrossrefGoogle Scholar
  • 5 Good RA, West A, Day NK et al. Effects of undernutrition of host cell and organ function. Cancer Res 1982; 42 (Suppl. 02) 737s-746s
    Google Scholar
  • 6 Skipworth RJE, Stewart GD, Dejong CHC et al. Pathophysiology of cancer cachexia: much more than host-tumour interaction?. Clin Nutr 2007; 26: 667-676
    CrossrefGoogle Scholar
  • 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
    CrossrefGoogle Scholar
  • 8 Arends J. Mangelernährung bei Tumorpatienten. Onkologe 2008; 14: 9-14
    CrossrefGoogle Scholar
  • 9 Evans WJ, Morley JE, Argilés J et al. Cachexia: a new definition. Clin Nutr 2008; 27: 793-799
    CrossrefGoogle Scholar
  • 10 Shizgal HM. The effect of malnutrition on body composition. Surg Gynecol Obstet 1981; 152: 22-26
    Google Scholar
  • 11 Cahill GF. Fuel metabolism in starvation. Annu Rev Nutr 2006; 26: 1-22
    CrossrefGoogle Scholar
  • 12 Lundholm K, Holm G, Scherstén T. Insulin resistance in patients with cancer. Cancer Res 1978; 38: 4665-4670
    Google Scholar
  • 13 Pajak B, Orzechowska S, Pijet B et al. Crossroads of cytokine signaling — the chase to stop muscle cachexia. J Physiol Pharmacol 2008; 59 (Suppl. 09) 251-264
    Google Scholar
  • 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
    Google Scholar
  • 15 Prado CMM, Baracos VE, McCargar LJ et al. Body composition as an independent determinant of 5-fluorouracil-based chemotherapy toxicity. Clin Cancer Res 2007; 13: 3264-3268
    CrossrefPubMedGoogle Scholar
  • 16 Prado CMM, Lieffers JR, McCargar LJ 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
    Google Scholar
  • 17 Dempsey DT, Feurer ID, Knox LS et al. Energy expenditure in malnourished gastrointestinal cancer patients. Cancer 1984; 53: 1265-1273
    CrossrefGoogle Scholar
  • 18 Arends J, Bodoky G, Bozzetti F et al. ESPEN Guidelines on Enteral Nutrition: Non-surgical oncology. Clin Nutr 2006; 2: 245-259
    Google Scholar
  • 19 Kalm LM, Semba RD. They starved so that others be better fed: remembering Ancel Keys and the Minnesota experiment. J Nutr 2005; 135: 1347-1352
    Google Scholar
  • 20 Kotler DP, Tierney AR, Culpepper-Morgan JA et al. Effect of home total parenteral nutrition on body composition in patients with acquired immunodeficiency syndrome. J Parenter Enteral Nutr 1990; 14: 454-458
    CrossrefGoogle Scholar
  • 21 Bozzetti F, Arends J, Lundholm K et al. ESPEN Guidelines on Parenteral Nutrition: non-surgical oncology. Clin Nutr 2009; 28: 445-454
    CrossrefGoogle Scholar
  • 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
    CrossrefGoogle Scholar
  • 23 Oken MM, Creech RH, Tormey DC et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 1982; 5: 649-655
    CrossrefGoogle Scholar
  • 24 Jensen GL, 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. J Parenter Enteral Nutr 2010; 34: 156-159
    CrossrefGoogle Scholar
  • 25 Dulloo AG. Regulation of body composition during weight recovery: integrating the control of energy partitioning and thermogenesis. Clin Nutr 1997; 16 (Suppl. 01) 25-35
    Google Scholar
  • 26 Streat SJ, Beddoe AH, Hill GL. Aggressive nutritional support does not prevent protein loss despite fat gain in septic intensive care patients. J Trauma 1987; 27: 262-266
    CrossrefGoogle Scholar
  • 27 Holm E, Kämmerer U. Fette und Kohlenhydrate in Ernährungskonzepten für Tumorpatienten. Aktuel Ernahrungsmed 2011; 36: 286-298
    Article in Thieme ConnectGoogle Scholar
  • 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
    Google Scholar
  • 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
    CrossrefGoogle Scholar
  • 30 Jatoi A, Windschitl HE, Loprinzi CL 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
    CrossrefGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Google Scholar
  • 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
    Google Scholar
  • 34 Colomer R, Moreno-Nogueira JM, García-Luna PP et al. N-3 fatty acids, cancer and cachexia: a systematic review of the literature. Br J Nutr 2007; 97: 823-831
    CrossrefGoogle Scholar
  • 35 van der Meij BS, Langius JAE, Smit EF 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
    CrossrefGoogle Scholar
  • 36 Murphy RA, Mourtzakis M, Chu QSC 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
    CrossrefGoogle Scholar
  • 37 Murphy RA, Mourtzakis M, Chu QSC et al. Supplementation with fish oil increases first-line chemotherapy efficacy in patients with advanced nonsmall cell lung cancer. Cancer 2011; 117: 3774-3780
    CrossrefGoogle Scholar
  • 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
    CrossrefGoogle Scholar
  • 39 Biesalski HK. Mikronährstoffsupplemente bei onkologischen Patienten: Gibt es rationale Gründe?. Aktuel Ernahrungsmed 2011; 36: 282-285
    Article in Thieme ConnectGoogle Scholar
  • 40 Arends J. Metabolism in cancer patients. Anticancer Res 2010; 30: 1863-1868
    Google Scholar
  • 41 Na H-K, Oliynyk S. Effects of physical activity on cancer prevention. Ann N Y Acad Sci 2011; 1229: 176-183
    CrossrefGoogle Scholar
  • 42 Holmes MD, Chen WY, Feskanich D et al. Physical activity and survival after breast cancer diagnosis. J Am Med Assoc 2005; 293: 2479-2486
    CrossrefGoogle Scholar
  • 43 Meyerhardt JA, Giovannucci EL, Holmes MD et al. Physical activity and survival after colorectal cancer diagnosis. J Clin Oncol 2006; 24: 3527-3534
    CrossrefGoogle Scholar
  • 44 Meyerhardt JA, 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
    CrossrefGoogle Scholar
  • 45 McCann RM, Hall WJ, Groth-Juncker A. Comfort care for terminally ill patients. The appropriate use of nutrition and hydration. J Am Med Assoc 1994; 272: 1263-1266
    CrossrefGoogle Scholar