Terapia nutricional em pacientes com câncer do aparelho digestivo

Lilia Tomaz Godoi, Sandra Lucia Fernandes

Abstract


O estado nutricional é um determinante crítico do sucesso do tratamento e qualidade de vida dos
pacientes com câncer. As terapias contra o câncer, incluindo cirurgia, quimioterapia e radioterapia
estão associadas à desnutrição, além do que, as drogas utilizadas no tratamento para combater o
câncer muitas vezes resultam em vômitos, mucosite, diarréia e disfagia. Esta pesquisa tem como
objetivo principal compreender o efeito das intervenções nutricionais em pacientes com câncer no trato
digestivo, analisando diversos estudos. Para a realização deste estudo foi utilizado o método de revisão
da bibliografia, pesquisando-se artigos científicos das bases de dados PubMed, Bireme e Google
acadêmico. Os resultados mostraram que a caquexia neoplásica é uma manifestação clínica muito
comum em pacientes com câncer no trato gastrointestinal. A terapia nutricional precoce proporciona
resultados benéficos em termos de minimizar a perda de peso, reduzir a deterioração do estado
nutricional e da função física. Sempre que possível a primeira escolha deve ser a via oral. Porém,
pacientes desnutridos ou que não conseguem ingerir a oferta calórica e proteica calculada por via
oral, podem ser candidatos à nutrição enteral (NE) ou nutrição parenteral (NP). Estudos recentes têm
sugerido a associação das terapias enteral e parenteral na redução das complicações pós-operatórias
e na diminuição da permanência hospitalar.


Keywords


Enteral. Parenteral. Terapia Nutricional. Câncer. Sistema digestivo.

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References


Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers

C, Rebelo M, Parkin DM, Forman D, Bray F. Cancer

incidence and mortality worldwide: sources, methods

and major patterns in GLOBOCAN 2012. Int J Cancer.

;136:E359–86.

Santarpia L, Contaldo F, Pasanisi F. Nutritional screening

and early treatment of malnutrition in cancer patients. J

Cachexia Sarcopenia Muscle. 2011;2:27–35.

Macciò A, Madeddu C, Gramignano G, Mulas C, Floris C,

Sanna E, Cau MC, Panzone F, Mantovani G. A randomized

phase III clinical trial of a combined treatment for cachexia

in patients with gynecological cancers: evaluating the

impact on metabolic and inflammatory profiles and quality

of life. Gynecol Oncol. 2012;124:417–425.

Caccialanza R, Pedrazzoli P, Cereda E, Gavazzi C, Pinto

C, Paccagnella A, Beretta GD, Nardi M, Laviano A, Zagonel

V. Nutritional support in cancer patients: a position paper

from the Italian Society of Medical Oncology (AIOM) and

the Italian Society of Artificial Nutrition and Metabolism

(SINPE) J Cancer. 2016;7:131–135.

Nicolini A, Ferrari P, Masoni MC, Fini M, Pagani S,

Giampietro O, Carpi A. Malnutrition, anorexia and cachexia

in cancer patients: A mini-review on pathogenesis and

treatment. Biomed Pharmacother. 2013;67:807–817.

Haverkort EB, Binnekade JM, Busch OR, van Berge

Henegouwen MI, de Haan RJ, Gouma DJ. Presence

and persistence of nutrition-related symptoms during

the first year following esophagectomy with gastric tube

reconstruction in clinically disease-free patients. World J

Surg. 2010;34:2844–2852.

Faria C, Li X, Nagl N, McBride A. Outcomes associated

with 5-HT3-RA therapy selection in patients with

chemotherapy-induced nausea and vomiting: a

retrospective claims analysis. Am Health Drug Benefits.

;7:50–58.

Maranzano E, De Angelis V, Pergolizzi S, Lupattelli M,

Frata P, Spagnesi S, Frisio ML, Mandoliti G, Malinverni G,

Trippa F, Fabbietti L, Parisi S, Di Palma A, De Vecchi P,

De Renzis C, Giorgetti C, Bergami T, Orecchia R, Portaluri

M, Signor M, Di Gennaro D, Italian Group for Antiemetic

Research in Radiotherapy - IGARR A prospective

observational trial on emesis in radiotherapy: analysis of

patients recruited in 45 Italian radiation oncology

centres. Radiother Oncol. 2010;94:36–41.

Yang ZH and Li GN. Clinical Analysis of Perioperative

Enteral Nutrition in Patients with Gastrointestinal Tumor.

App J Gen Prac 2008; 6: 483-484.

Ahn HS, Yook JH, Park CH, Park YK, Yu W, Lee MS,

Sang-Uk H, Ryu KW, Sohn TS, Kim HH, Choi SH, Noh

SH, Hiki N, Sano T and Yang HK. General perioperative

management of gastric cancer patients at high-volume

centers. Gastric Cancer 2011; 14: 178-182.

Lassen K, Dejong CH, Ljungqvist O, Fearon K, Andersen

J, Hannemann P, von Meyenfeldt MF, Hausel J, Nygren J

and Revhaug A. Nutritional support and oral intake after

gastric resection in five northern European countries. Dig

Surg 2005; 22: 346-352; discussion 352.

Klein S, Koretz RL. Nutrition support in patients with

cancer: what do the data really show? Nutr Clin Pract

;9:91-100.

Altintas ND, Aydin K, Türkoğlu MA, et al. Effect of enteral

versus parenteral nutrition on outcome of medical

patients requiring mechanical ventilation. Nutr Clin Pract

;26:322-9.

Peterson, Sarah J., and Marisa Mozer. “Differentiating

Sarcopenia and Cachexia Among Patients With Cancer.”

Nutrition in Clinical Practice 32.1 (2017): 30-39.

Bevan R, Young C, Holmes P, Fortunato L, Slack R,

Rushton L. British Occupational Cancer Burden Study

Group. Occupational cancer in Britain. Gastrointestinal

cancers: liver, oesophagus, pancreas and stomach. Br J

Cancer. 2012;107(Suppl 1):S33–40.

Reid J, McKenna HP, Fitzsimons D, McCance TV.

An exploration of the experience of cancer cachexia:

what patients and their families want from healthcare

professionals. Eur J Cancer Care. 2010;19:682–9.

SUN, Li-Chu et al. Randomized, controlled study of

branched chain amino acid-enriched total parenteral

nutrition in malnourished patients with gastrointestinal

cancer undergoing surgery. The American Surgeon, v. 74,

n. 3, p. 237-242, 2008.

Bozzetti F, Mariani L. Defining and classifying cancer

cachexia: a proposal by the SCRINIOWorking Group.

JPEN Journal of Parenteral and Enteral Nutrition

;33(4):361–7.

Weimann, A., Braga, M., Carli, F., Higashiguchi, T.,

Hübner, M., Klek, S., ... & Waitzberg, D. (2017). ESPEN

guideline: Clinical nutrition in surgery. Clinical Nutrition.

Bozzetti F, Arends J, Lundholm K, et al. ESPEN guidelines

on parenteral nutrition: non-surgical oncology. Clin Nutr.

; 28: 445-54.

Arends J, Bodoky G, Bozzetti F, et al. ESPEN guidelines

on enteral nutrition: non-surgical oncology. Clin Nutr.

; 25: 245–259.

August DA, Huhmann MB; American Society for Parenteral

and Enteral Nutrition (ASPEN) Board of Directors. ASPEN

clinical guidelines: nutrition support therapy during

adult anticancer treatment and in hematopoietic cell

transplantation. JPEN. 2009; 33:472-500.

French Speaking Society of Clinical Nutrition and

Metabolism (SFNEP). Clinical nutrition guidelines of

the French Speaking Society of Clinical Nutrition and

Metabolism (SFNEP): Summary of recommendations for

adults undergoing non-surgical anticancer treatment. Dig

Liver Dis. 2014 46:667-74.

Weimann A, Braga M, Harsanyi L et al. ESPEN

Guidelines on Enteral Nutrition: surgery including organ

transplantation. Clin Nutr. 2006; 25: 224-44.

SHILS, Maurice E.; SHIKE, Moshe; ROSS, A. Catharine;

CABALLERO, Benjamin, COUSINS, Robert J. Nutrição

moderna na saúde e na doença. 11ª edição, São Paulo:

Manole, 2016.

Bozzetti F. Nutritional support of the oncology patient. Crit

Rev Oncol Hematol. 2013; 87: 172-200.

Bossola M. Nutritional intervention in head and neck

cancer patients undergoing chemoradiotherapy: a

narrative review. Nutrients. 2015; 7: 265-76.

Cao DX, Wu GH, Zhang B, et al. Resting energy

expenditure and body composition in patients with newly

detected cancer. Clinical Nutrition 2010;29:72–7.

Fredrix EW, Soeters PB, Wouters EF, Deerenberg IM,

von Meyenfeldt MF, Saris WH. Effect of different tumor

types on resting energy expenditure. Cancer Research

;51:6138–41.

Arends, Jann et al. ESPEN guidelines on nutrition in

cancer patients. Clinical Nutrition, 2016.

Shaw JH, Holdaway CM. Protein-sparing effect of

substrate infusion in surgical patients is governed by

the clinical state, and not by the individual substrate

infused. JPEN Journal of Parenteral and Enteral Nutrition

;12:433–40.

G. Zürcher, U. Gola, H.K. Biesalski. Antioxidanzien bei

Krebs. Schweiz Z für Ernährungsmedizin, 4 (2007), pp.

–19.

H.A. Norman, R.R. Butrum, E. Feldman, D. Heber, D.

Nixon, M.F. Picciano, et al. The role of dietary supplements

during cancer therapy. J Nutr, 133 (Suppl. 11) (2003), pp.

S3794–S3799.

Silva, Juliana de Aguiar Pastore, Maria Emilia de Souza

Fabre, Dan Linetzky Waitzberg. Omega-3 supplements

for patients in chemotherapy and/or radiotherapy: A

systematic review. Clinical Nutrition 34.3 (2015): 359-366.

Deans DA, Tan BH, Wigmore SJ, Ross JA, de Beaux AC,

Paterson-Brown S, Fearon KC. The influence of systemic

inflammation, dietary intake and stage of disease on rate

of weight loss in patients with gastro-oesophageal cancer.

Br J Cancer. 2009;100:63–9.

Deans DA, Tan BH, Wigmore SJ, Ross JA, de Beaux AC,

PatersonBrown S, Fearon KC. The influence of systemic

inflammation, dietary intake and stage of disease on rate

of weight loss in patients with gastro-oesophageal cancer.

Br J Cancer 2009; 100: 63-9.

Churm D, Andrew IM, Holden K, Hildreth AJ, Hawkins C.

A questionnaire study of the approach to the anorexiacachexia

syndrome in patients with cancer by staff in a

district general hospital. Support Care Cancer 2009; 17:

-7.

Wu Q, Yu JC, Kang WM, Ma ZQ. Short-term effects

of supplementary feeding with enteral nutrition via

jejunostomy catheter on postgastrectomy gastric cancer

patients. Chin Med J 2011; 124: 3297- 301.

Jeong O, Ryu SY, Jung MR, Choi WW and Park YK. The

safety and feasibility of early postoperative oral nutrition

on the first postoperative day after gastrectomy for gastric

carcinoma. Gastric Cancer 2014; 17: 324-331.

HUANG, Dongping et al. Early enteral nutrition in

combination with parenteral nutrition in elderly patients

after surgery due to gastrointestinal cancer. International

journal of clinical and experimental medicine, v. 8, n. 8, p.

, 2015.

Elamin E. Dietary and pharmacological management of

severe catabolic conditions. Am J Med Sci 2011; 342:

-8.

Moses AW, Slater C, Preston T, Barber MD, Fearon

KC. Reduced total energy expenditure and physical

activity in cachectic patients with pancreatic cancer

can be modulated by an energy and protein dense oral

supplement enriched with n-3 fatty acids. British Journal

of Cancer 2004;90(5):996–1002.

DUDRICK, S. J. et al. Long-term total parenteral nutrition

with growth, development and positive nitrogen balance.

Surgery 1968. 64: 134-142. Nutr. Hosp, v. 16, n. 6, p. 286-

, 2001.

Reid J, Mills M, Cantwell M, Cardwell CR, Murray LJ,

Donnelly M. Thalidomide for managing cancer cachexia.

Cochrane Database Syst Rev 2012; 4: CD008664.




DOI: http://dx.doi.org/10.22565/ijn.v10i4.325

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