Нутритивная поддержка в онкологии: место парентерального питания (обзор литературы)

Пасечник И.Н., Скобелев Е.И., Болдырева Т.С. Нутритивная поддержка в онкологии: место парентерального питания (обзор литературы). Современная Онкология. 2023;25(3):266–272.
DOI: 10.26442/18151434.2023.3.202261

© ООО «КОНСИЛИУМ МЕДИКУМ», 2023 г.

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Pasechnik IN, Skobelev EI, Boldyreva TS. Nutritional support in oncology: the place of parenteral nutrition (literature review). Journal of Modern Oncology. 2023;25(3):266–272. DOI: 10.26442/18151434.2023.3.202261

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Аннотация

В настоящее время нутритивная поддержка рассматривается как один из важнейших компонентов лечения онкологических больных. Это связано с позитивным влиянием коррекции пищевого статуса на течение основного заболевания, переносимость противоопухолевого лечения, реабилитационные мероприятия и качество жизни. Важнейшим принципом нутритивной поддержки является ее преемственность на всех этапах курации больного: поликлиническом, стационарном, реабилитационном. Цель работы – обсудить нутритивную поддержку онкологических больных с акцентом на парентеральное питание. Из более чем 120 первично отобранных источников литературы различных баз данных (Scopus, Web of Science, РИНЦ и др.) для анализа оставили 55 источников в основном за последние 5 лет, более ранние публикации использовались при сохранении их информативности для клиницистов. Современная концепция парентерального питания подразумевает назначение препаратов «три в одном». Парентеральное питание должно включать не только макронутриенты, но и микронутриенты: жиро- и водорастворимые витамины, ω-3 жирные кислоты. Установлено, что развитие инфекционных осложнений при нутритивной поддержке связано не с ее видом, а с калоражем питания. Разбираются вопросы дополнительного парентерального питания при недостаточности энтерального питания. Клиницист должен персонифицировать нутритивную поддержку с учетом типа опухолевого процесса, его стадии, особенностей пациента и выраженности нарушений питания. Во время лечения больных с онкологическими заболеваниями необходимо оценивать их пищевой статус и при необходимости проводить коррекцию. Врач обязан выбрать оптимальный способ обеспечения пациента энергией и пластическими материалами – пероральное дополнительное питание, энтеральное питание, парентеральное питание или их комбинация. Клиническая практика показывает, что отказ от парентерального питания сопровождается снижением качества нутритивной поддержки. Выбор вида нутритивной поддержки основывается на показаниях к ее проведению, которые подробно изложены в клинических рекомендациях. Следование алгоритму коррекции пищевого статуса в зависимости от стадии онкологического заболевания, состояния больного, вида противоопухолевой терапии позволит оптимизировать результаты лечения и повысить качество жизни.

Ключевые слова: онкология, нутритивная поддержка, парентеральное питание, нутритивная недостаточность

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Currently nutritional support is considered as one of the most important components of the treatment of cancer patients. This is due to the positive effect of correction of nutritional status on the course of the underlying disease, the tolerability of antitumor treatment, rehabilitation measures and quality of life. The most important principle of nutritional support is its continuity at all stages of the patient's curation: polyclinic, inpatient, rehabilitation. The purpose of the review was to discuss nutritional support for cancer patients with an emphasis on parenteral nutrition. Out of more than 120 initially selected literature sources from various databases (Scopus, Web of science, RSCI, etc.), 55 sources were left for analysis mainly over the past 5 years, earlier publications were used while maintaining their informativeness for clinicians. The modern concept of parenteral nutrition implies the appointment of drugs “three in one”. Parenteral nutrition should include not only macronutrients, but also micronutrients: fat- and water-soluble vitamins, ω-3 fatty acids. It has been established that the development of infectious complications with nutritional support is not related to its type, but to the calorie intake. The issues of additional parenteral nutrition with inadequate enteral nutrition are examined. The clinician should personalize nutritional support taking into account the type of tumor process, its stage, the characteristics of the patient and the severity of eating disorders. During the treatment of patients with oncological diseases, it is necessary to assess the state of their nutritional status and, if necessary, carry out correction. The doctor is obliged to choose the optimal way to provide the patient with energy and plastic materials – oral supplemental nutrition, enteral nutrition, parenteral nutrition or a combination of them. Clinical practice shows that the rejection of parenteral nutrition is accompanied by a decrease in the quality of nutritional support. The choice of the type of nutritional support is based on the indications for its implementation, which are detailed in the clinical recommendations. Strict adherence to the algorithm of correction of nutritional status depending on the stage of cancer, the patient's condition, the type of antitumor therapy will optimize the results of treatment and improve the quality of life.

Keywords: oncology, nutritional support, parenteral nutrition, nutritional deficiencies

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1. Bossi P, Delrio P, Mascheroni A, Zanetti M. The Spectrum of Malnutrition/Cachexia/Sarcopenia in Oncology According to Different Cancer Types and Settings: A Narrative Review. Nutrients. 2021;13(6):1980. DOI:10.3390/nu13061980
2. Muscaritoli M, Lucia S, Farcomeni A, et al. Prevalence of malnutrition in patients at first medical oncology visit: The PreMiO study. Oncotarget. 2017;8(45):79884‑96. DOI:10.18632/oncotarget.20168
3. Virizuela JA, Camblor-Álvarez M, Luengo-Pérez LM, et al. Nutritional support and parenteral nutrition in cancer patients: An expert consensus report. Clin Transl Oncol.
2018;20(5):619-29. DOI:10.1007/s12094-017-1757-4
4. Omlin A, Blum D, Wierecky J, et al. Nutrition impact symptoms in advanced cancer patients: Frequency and specific interventions, a case-control study. J Cachexia Sarcopenia Muscle. 2013;4(1):55-61. DOI:10.1007/s13539-012-0099-x
5. Escortell Sanchez R, Reig Garcıa-Galbis M. Nutricion enteral en el estadonutricional del cancer; revisionsistemaica. Nutr Hosp. 2015;32(4):1408‑16. DOI:10.3305/nh.2015.32.4.9227
6. Chow R, Bruera E, Chiu L, et al. Enteral and parenteral nutrition in cancer patients: a systematic review and meta-analysis. Ann Palliat Med. 2016;5(1):30‑41.
DOI:10.3978/j.issn.2224-5820.2016.01.01
7. Planas M, Alvarez-Hernandez J, Leon-Sanz M, et al. Prevalence of hospital malnutrition in cancer patients: a sub-analysis of the PREDyCES study. Support Care Cancer. 2016;24(1):429-35. DOI:10.1007/s00520-015-2813-7
8. Muscaritoli M, Arends J, Aapro M. From guidelines to clinical practice: a roadmap for oncologists for nutrition therapy for cancer patients. Ther Adv Med Oncol. 2019;11:1758835919880084. DOI:10.1177/1758835919880084
9. Martin L, Senesse P, Gioulbasanis I, et al. Diagnostic criteria for the classification of cancer-associated weight loss. J Clin Oncol. 2015;33(1):90-9. DOI:10.1200/JCO.2014.56.1894
10. 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(4):491-7. DOI:10.1016/s0149-2918(05)80001-3
11. Mantovani G, Madeddu C. Cancer cachexia: medical management. Support Care Cancer. 2010;18(1):1-9. DOI:10.1007/s00520-009-0722-3
12. Muscaritoli M, Arends J, Bachmann P, et al. ESPEN practical guideline: Clinical Nutrition in cancer. Clin Nutr. 2021;40(5):2898-913. DOI:10.1016/j.clnu.2021.02.005
13. Elia M. The «MUST» report. Nutritional screening of adults: a multidisciplinary responsibility. Redditch: BAPEN 2003.
14. Kondrup J, Rasmussen HH, Hamberg O, Stanga Z. Ad Hoc ESPEN Working Groupet. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr. 2003;22(3):321-36. DOI:10.1016/s0261-5614(02)00214-5
15. Cederholm T, Jensen GL, Correia MITD, et al. GLIM criteria for the diagnosis of malnutrition – A consensus report from the global clinical nutrition community. Clin Nutr.
2019;38(1):1-9. DOI:10.1016/j.clnu.2018.08.002
16. Peng D, Zong K, Yang H, et al. Malnutrition diagnosed by the Global Leadership Initiative on Malnutrition criteria predicting survival and clinical outcomes of patients with cancer: A systematic review and meta-analysis. Front Nutr. 2022;9:1053165. DOI:10.3389/fnut.2022.1053165
17. Xu J, Jie Y, Sun Y, et al. Association of Global Leadership Initiative on Malnutrition with survival outcomes in patients with cancer: A systematic review and meta-analysis. Clin Nutr. 2022;41(9):1874-80. DOI:10.1016/j.clnu.2022.07.007
18. Williams JD, Wischmeyer PE. Assessment of perioperative nutrition practices and attitudes – A national survey of colorectal and GI surgical oncology programs. Am J Surg. 2017;213(6):1010-8. DOI:10.1016/j.amjsurg.2016.10.008
19. Arends J, Bachmann P, Baracos V, al. ESPEN guidelines on nutrition in cancer patients. Clin Nutr. 2017;36(1):11-48. DOI:10.1016/j.clnu.2016.07.015
20. Durán-Poveda M, Suárez-de-la-Rica A, Minchot EC, et al. Knowledge and Practices of Digestive Surgeons concerning Specialized Nutritional Support in Cancer Patients: A Survey Study. Nutrients. 2022;14(22):4764. DOI:10.3390/nu14224764
21. Pasechnik IN, Gubaidullin RR, Borisov AIu. Osnovy nutritivnoi podderzhki bolnykh v kriticheskikh sostoianiiakh. Moscow: Colisey, 2012 (in Russian).
22. Bozzetti F, Arends J, Lundhom K, et al. ESPEN guidelines on parenteral nutrition: non-surgical oncology. Clin Nutr. 2009;28(4):445-54. DOI:10.1016/j.clnu.2009.04.011
23. Pasechnik IN. Parenteral nutrition: when, to whom and how much? Medicinskii vestnik MVD. 2022;1(116):29-35 (in Russian). DOI:10.52341/20738080_2022_116_1_29
24. Barnett MI, Pertkiewicz M, Cosslett AG, Muhlebach S. Basics in clinical nutrition: Parenteral nutrition admixture, how to prepare parenteral nutrition (PN) admixtures. e-SPEN. 2009;4(3):e114-6.
25. Emilio Alfonso J, Berlana D, Boullata J. Clinical, Ergonomic and Economic outcomes with multichamber bags compared with (Hospital) Pharmacy compounded bags and multibottle systems: A systemic Literature review. JPEN J Parenter Enteral Nutr. 2017;41(7):1162-77. DOI:10.1177/0148607116657541
26. Baras Z, Theilla M, Singer P. From compound to “ready to use” parenteral nutrition bags use in a tertiary medical center: An observational study. Clin Nutr. 2019;38:S270-1.
27. Itzhaki MH, Singer P. Advances in Medical Nutrition Therapy: Parenteral Nutrition. Nutrients. 2020;12(3):717. DOI:10.3390/nu12030717
28. Pasechnik IN. Nutritional Support for Critically Patients (Review). General Reanimatology. 2020;16(4):40‑59 (in Russian). DOI:10.15360/1813-9779-2020-4-40-59
29. Lochs H, Allison SP, Meier R, et al. Introductory to the ESPEN Guidelines on Enteral Nutrition: Terminology, Definitions and General Topics. Clin Nutr. 2006;25(2):180-6. DOI:10.1016/j.clnu.2006.02
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Авторы

И.Н. Пасечник¹, Е.И. Скобелев¹, Т.С. Болдырева*²

¹ФГБУ ДПО «Центральная государственная медицинская академия» Управления делами Президента РФ, Москва, Россия;
²ГБУЗ «Городская клиническая онкологическая больница №1» Департамента здравоохранения г. Москвы, Москва, Россия
*dikovatatyanasergeevna@gmail.com

________________________________________________

Igor N. Pasechnik¹, Evgeny I. Skobelev¹, Tatyana S. Boldyreva*²
¹Central State Medical Academy of Department of Presidential Affairs, Moscow, Russia;
²Moscow State Budgetary Healthcare Institution "Moscow City Oncological Hospital No.1, Moscow Healthcare Department", Moscow, Russia
*dikovatatyanasergeevna@gmail.com

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