La importancia del estado nutricional para el paciente oncológico

Ivonne Chon Rivas, Daysi Chi Ramírez, Roberto León González, Jesús Blanco Bouza, Iván Cuevas Véliz, Alicia Rodríguez Abascal, Nuria Mederos Alfonso, Carlos Roca Muchuli

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Resumen

La incapacidad para mantener un adecuado estado nutricional es un problema frecuente en el paciente oncológico. La propia enfermedad, así como las diferentes variedades de tratamiento oncoespecíficos, puede conducir a la desnutrición energético-nutrimental, que  puede ser grave, con implicaciones pronósticas, debido a la escasa tolerancia y respuesta a la terapéutica citorreductora. En este artículo se reseña brevemente la fisiopatología de la caquexia tumoral, los efectos locales y sistémicos del propio tumor, así como la repercusión de la terapéutica citorreductora sobre el estado nutricional del enfermo. El apoyo nutricional en el paciente con cáncer continúa siendo controversial. Sin embargo, se constata actualmente una mejor apreciación de la necesidad de la evaluación nutricional temprana, oportuna y regular del paciente oncológico; así como el apoyo nutricional, con los principales objetivos de mejorar la respuesta al tratamiento onco-hematológico, disminuir las complicaciones que puedan originarse de la conducción de los mismos, y permitirle al enfermo una mejor calidad de vida.

Palabras clave

Cáncer; Desnutrición; Apoyo nutricional; Evaluación nutricional

Referencias

Nixon DW. Nutrition and cancer. J Med Assoc Ga 1991;80:141-3.

Klimczak A, Malinowska K, Kubiak K. Tumour illnesses and nutrition. Pol Merkur Lekarski 2009;27:242-4.

Deeter PJ. Nutritional problems in patients with advanced cancer. Adv Exp Med Biol 1994;354:227.

von Meyenfeldt M. Cancer-associated malnutrition: an introduction. Eur J Oncol Nurs. 2005;9 Suppl 2:S35-8.

Sala A, Rossi E, Antillon F. Nutritional status at diagnosis in children and adolescents with cancer in the Asociacion de Hemato-Oncologia Pediatrica de Centro America (AHOPCA) countries: preliminary results from Guatemala. Pediatr Blood Cancer 2008;50(2 Suppl):499-501.

Kern KA, Norton JA. Cancer cachexia. JPEN J Parenter Enteral Nutr 1988;2:286-298.

Puccio M. The cancer cachexia syndrome. Semin Oncol 1997;24:277-87.

Tan BH, Fearon KC. Cachexia: prevalence and impact in medicine. Curr Opin Clin Nutr Metab Care 2008;11:400-7.

Laviano A. Nutritional issues in cancer management. Nutrition 1996;12:358-71.

Fletcher AL, Marks DL. Central mechanisms controlling appetite and food intake in a cancer setting: An update. Curr Opin Support Palliat Care 2007;1:306-11.

Dionigi G, Rovera F, Boni L, Carrafiello G, Mangini M, Dionigi R. The surgeon's approach to preoperative evaluation of esophageal cancer: Recent developments. Rays 2005;30:351-6.

Cid Conde L, Fernández López T, Neira Blanco P, Arias Delgado J, Varela Correa JJ, Gómez Lorenzo FF. Hyponutrition prevalence among patients with digestive neoplasm before surgery. Nutr Hosp [España] 2008; 23:46-53.

Davis MP, Walsh D, Lagman R, Yavuzsen T. Early satiety in cancer patients: A common and important but underrecognized symptom. Support Care Cancer 2006;14:693-8.

Hong JH, Omur-Ozbek P, Stanek BT, Dietrich AM, Duncan SE, Lee YW, Lesser G. Taste and odor abnormalities in cancer patients. J Support Oncol 2009;7:58-65.

Ashby D, Choi P, Bloom S. Gut hormones and the treatment of disease cachexia. Proc Nutr Soc 2008;67:263-9.

Tisdale MJ. Mechanisms of cancer cachexia. Physiol Rev 2009;89:381-410.

Seretis EC, Agnantis NJ, Golematis VC, Voloudakis-Balatzis IE. Electron immunocytochemical demonstration of serotonin, vasoactive intestinal polypeptide, bombesin, somatostatin and glucagon in mirror biopsies from primary colorectal adenocarcinoma. J Exp Clin Cancer Res 2004;23:477-84.

Takahashi M, Terashima M, Takagane A, Oyama K, Fujiwara H, Wakabayashi G. Ghrelin and leptin levels in cachectic patients with cancer of the digestive organs. Int J Clin Oncol 2009;14:315-20.

Tisdale MJ. Catabolic mediators of cancer cachexia. Curr Opin Support Palliat Care;2:256-61.

Asp ML, Tian M, Wendel AA, Belury MA.Evidence for the contribution of insulin resistance to the development of cachexia in tumor-bearing mice. Int J Cancer 2009. Epub ahead of print. 24 de Julio del 2009.

Mullingan HD, Tisdale MJ. Metabolic substrate utilization by tumor and host tissues in cancer cachexia. Biochem J 1991;277:321-6.

DeBerardinis RJ. Is cancer a disease of abnormal cellular metabolism? New angles on an old idea. Genet Med 2008;10:767-77.

Dills WL Jr. Nutritional and physiological consequences of tumour glycolysis. Parasitology 1993;107 (Suppl):S177-S186.

Sola-Penna M. Metabolic regulation by lactate. IUBMB Life 2008;60:605-8.

Pedersen PL. Warburg, me and Hexokinase 2: Multiple discoveries of key molecular events underlying one of cancers' most common phenotypes, the "Warburg Effect", i.e., elevated glycolysis in the presence of oxygen. J Bioenerg Biomembr 2007;39:211-22.

Cravo ML, Glória LM, Claro I. Metabolic responses to tumour disease and progression: Tumour-host interaction. Clin Nutr 2000;19:459-65.

Nuutinen J, Minn H, Bergman J, Haaparanta M, Ruotasalainen U, Laine H, Knuuti J. Uncoupling of fatty acid and glucose metabolism in malignant lymphoma: A PET study. Br J Cancer 1999;80:513-8.

Baracos VE, Mackienze ML. Investigations of branched-chain amino acids and their metabolites in animal models of cancer. J Nutr 2006;136(1 Suppl): 237S-242S.

Melstrom LG, Melstrom KA Jr, Ding XZ, Adrian TE. Mechanisms of skeletal muscle degradation and its therapy in cancer cachexia. Histol Histopathol 2007;22:805-14.

Pajak B, Orzechowska S, Pijet B, Pijet M, Pogorzelska A, Gajkowska B, Orzechowski A. Crossroads of cytokine signaling--the chase to stop muscle cachexia. J Physiol Pharmacol 2008; 59(Suppl 9):251-64.

Moldawer LL, Copeland EM. Proinflammatory cytokines, nutritional support, and the cachexia syndrome. Interactions and therapeutic options. Cancer 1997;79:1828-39.

Balkwill F, Osborne R. Evidence for tumor necrosis factor/cachectin produc-tion in cancer. Lancet 1987;2:1229.

Hundsberger H, Verin A, Wiesner C, Pflüger M, Dulebo A, Schütt W, Lasters I, Männel DN, Wendel A, Lucas R. TNF: A moonlighting protein at the interface between cancer and infection. Front Biosci 2008;13:5374-86.

Heikkilä K, Ebrahim S, Lawlor DA. A systematic review of the association between circulating concentrations of C reactive protein and cancer. J Epidemiol Community Health 2007;61:824-33.

Durham WJ, Dillon EL, Sheffield-Moore M. Inflammatory burden and amino acid metabolism in cancer cachexia. Curr Opin Clin Nutr Metab Care 2009;12:72-7.

McMillan DC. Systemic inflammation, nutritional status and survival in patients with cancer. Curr Opin Clin Nutr Metab Care 2009;12:223-6.

Stephens NA, Skipworth RJ, Fearon KC. Cachexia, survival and the acute phase response. Curr Opin Support Palliat Care 2008;2:267-74.

McKay CJ, Glen P, McMillan DC. Chronic inflammation and pancreatic cancer. Best Pract Res Clin Gastroenterol 2008;22:65-73.

Todorov P, Cariuk P, Mc Devitt T. Characterization of a cancer cachectic factor. Nature 1996;379:739-47.

Wang LH, Liu CF. Activities of daily living, quality of life and related factors in cachectic gastrointestinal cancer patients. Hu Li Za Zhi 2007;54:33-42.

Couch M, Lai V, Cannon T, Guttridge D, Zanation A, George J, Hayes DN, Zeisel S, Shores C. Cancer cachexia syndrome in head and neck cancer patients: Part I. Diagnosis, impact on quality of life and survival, and treatment. Head Neck 2007;29:401-11.

George J, Cannon T, Lai V, Richey L, Zanation A, Hayes DN, Shores C, Guttridge D, Couch M. Cancer cachexia syndrome in head and neck cancer patients: Part II. Pathophysiology. Head Neck 2007;29:497-507.

Narayanan P, Nobbenhuis M, Reynolds KM, Sahdev A, Reznek RH, Rockall AG. Fistulas in malignant gynecologic disease: etiology, imaging, and management. Radiographics 2009;29: 1073-83.

Pedrazzani C, Marrelli D, Rampone B, De Stefano A, Corso G, Fotia G, Pinto E, Roviello F. Postoperative complications and functional results after subtotal gastrectomy with Billroth II reconstruction for primary gastric cancer. Dig Dis Sci 2007;52:1757-63.

Hines OJ, Reber HA. Pancreatic surgery. Curr Opin Gastroenterol 2009;25:460-5.

Davila M, Bresalier RS. Gastrointestinal complications of oncologic therapy. Nat Clin Pract Gastroenterol Hepatol 2008; 5:682-96.

Scarpa R. Surgical management of head and neck carcinoma. Semin Oncol Nurs 2009;25:172-82.

Mahdavi R, Faramarzi E, Mohammad-Zadeh M, Ghaeammaghami J, Jabbari MV. Consequences of radiotherapy on nutritional status, dietary intake, serum zinc and copper levels in patients with gastrointestinal tract and head and neck cancer. Saudi Med J 2007;28:435-40.

Theis VS, Sripadam R, Ramani V, Lal S. Chronic radiation enteritis. Clin Oncol (R Coll Radiol) 2009. Epub ahead of print. 6 de Noviembre del 2009.

Murphy BA, Gilbert J. Dysphagia in head and neck cancer patients treated with radiation: Assessment, sequelae, and rehabilitation. Semin Radiat Oncol 2009; 19:35-42.

Alterio D, Jereczek-Fossa BA, Fiore MR, Piperno G, Ansarin M, Orecchia R. Cancer treatment-induced oral mucositis. Anticancer Res 2007;27:1105-25.

Gudny Geirsdottir O, Thorsdottir I. Nutritional status of cancer patients in chemotherapy; dietary intake, nitrogen balance and screening. Food Nutr Res 2008;52. Disponible en: htpp://doi.10.3402/fnr.v52i0.1856.

Santana Porbén S. ¿Cómo saber que el paciente quirúrgico está desnutrido? Nutrición Clínica [México] 2004;7: 240-50.

Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelson RA, Jeejeebhoy KN. What is Subjective Global Assessment of Nutricional Status? JPEN Journal of Parenteral and Enteral Nutrition. 1987; 11:8-13.

Espinosa Borrás A, Martínez González C, Barreto Penié J, Santana Porbén S. Evaluación antropométrica del paciente hospitalizado. RCAN Rev Cub Aliment Nutr 2007;17:72-89.

Santana Porbén S, Espinosa Borrás A. Composición corporal. Acta Médica del Hospital Ameijeiras 2003:11:45-48.

Lorefält B, Wissing U, Unosson M. Smaller but energy and protein-enriched meals improve energy and nutrient intakes in elderly patients. J Nutr Health Aging 2005;9:243-7.

Urquhart Fewell A. Training the hospital dietitian. American J Nurs 1916;16: 970-4.

Sánz Ortiz J. Anorexia treatment in the oncological patient. Rev Clin Esp 2004; 204:542-4.

Adams LA, Shepard N, Caruso RA, Norling MJ, Belansky H, Cunningham RS. Putting evidence into practice: evidence-based interventions to prevent and manage anorexia. Clin J Oncol Nurs 2009;13:95-102.

Martínez González C, Santana Porbén S, Barreto Penié J. Diseño e implementación de un esquema intrahospitalario de Nutrición enteral. RCAN Rev Cub Aliment Nutr 2001; 15:130-8.

Cady J. Nutritional support during radiotherapy for head and neck cancer: the role of prophylactic feeding tube placement. Clin J Oncol Nurs 2007; 11:875-80.

Raykher A, Russo L, Schattner M, Schwartz L, Scott B, Shike M. Enteral nutrition support of head and neck cancer patients. Nutr Clin Pract 2007; 22:68-73.

Santana Porbén S, Barreto Penié J, Martínez González C, Espinosa Borrás A. Diseño e implementación de un esquema intrahospitalario de Nutrición Parenteral. I. Nutrición Parenteral Periférica. RCAN Rev Cub Aliment Nutr 2007;17:186-208.

Santana Porbén S, Barreto Penié J, Martínez González C, Espinosa Borrás A. Diseño e implementación de un esquema intrahospitalario de Nutrición Parenteral. II. Nutrición Parenteral Periférica. RCAN Rev Cub Aliment Nutr 2008;18:94-126.

Behl D, Jatoi A. Pharmacological options for advanced cancer patients with loss of appetite and weight. Expert Opin Pharmacother 2007;8:1085-90.

Orrevall Y, Tishelman C, Permert J, Cederholm T. The use of artificial nutrition among cancer patients enrolled in palliative home care services. Palliat Med 2009;23:556-64.

Gutman M, Singer P, Gimmon Z. Is there an indication for parenteral nutrition support in the terminally ill cancer patient? Harefuah 2008;147:224-8, 278, 277.

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