BackgroundPhysical exercise and nutritional treatment are promising measures to prevent muscle wasting that is frequently observed in advanced-stage cancer patients. However, conventional exercise is not always suitable for these patients due to physical weakness and therapeutic side effects. In this pilot study, we examined the effect of a combined approach of the novel training method whole-body electromyostimulation (WB-EMS) and individualized nutritional support on body composition with primary focus on skeletal muscle mass in advanced cancer patients under oncological treatment.MethodsIn a non-randomized controlled trial design patients (56.5% male; 59.9 ± 12.7 years) with advanced solid tumors (UICC III/IV, N = 131) undergoing anti-cancer therapy were allocated to a usual care control group (n = 35) receiving individualized nutritional support or to an intervention group (n = 96) that additionally performed a supervised physical exercise program in form of 20 min WB-EMS sessions (bipolar, 85 Hz) 2×/week for 12 weeks. The primary outcome of skeletal muscle mass and secondary outcomes of body composition, body weight and hand grip strength were measured at baseline, in weeks 4, 8 and 12 by bioelectrical impedance analysis and hand dynamometer. Effects of WB-EMS were estimated by linear mixed models. Secondary outcomes of physical function, hematological and blood chemistry parameters, quality of life and fatigue were assessed at baseline and week 12. Changes were analyzed by t-tests, Wilcoxon signed-rank or Mann-Whitney-U-tests.ResultsTwenty-four patients of the control and 58 of the WB-EMS group completed the 12-week trial. Patients of the WB-EMS group had a significantly higher skeletal muscle mass (0.53 kg [0.08, 0.98]; p = 0.022) and body weight (1.02 kg [0.05, 1.98]; p = 0.039) compared to controls at the end of intervention. WB-EMS also significantly improved physical function and performance status (p < 0.05). No significant differences of changes in quality of life, fatigue and blood parameters were detected between the study groups after 12 weeks.ConclusionsSupervised WB-EMS training is a safe strength training method and combined with nutritional support it shows promising effects against muscle wasting and on physical function in advanced-stage cancer patients undergoing treatment.Trial registrationClinicalTrials.gov NCT02293239 (Date: November 18, 2014).

Zusammenfassung Fragestellung: Bei Tumorpatienten f?hren sowohl erkrankungs- als auch therapieassoziierte Belastungen h?ufig zu einer Mangelern?hrung. Zentrale klinische Probleme sind eine unzureichende Nahrungsaufnahme, eine Einschr?nkung der k?rperlichen Aktivit?t und Mobilit?t sowie katabole metabolische Ver?nderungen im Sinne einer systemischen Inflammationsreaktion, die oft gemeinsam vorliegen. Diese Leitlinie soll evidenzbasierte Empfehlungen zur Erkennung und ggf. multimodalen Behandlung von Ern?hrungs- und Stoffwechselst?rungen bei Tumorpatienten geben. Methodik: Es wurden eine systematische Literaturrecherche sowie eine Handsuche zu Literatur ?ber Ern?hrungs- und Stoffwechelst?rungen bei Tumorpatienten durchgef?hrt. Die Ergebnisse wurden in einer interdisziplin?ren Arbeitsgruppe aus ?rzten, Ern?hrungswissenschaftlern und Di?tassistenten diskutiert und bewertet. Auf dieser Basis wurden von der Arbeitsgruppe Empfehlungen erarbeitet, die auf der Konsensuskonferenz am 18. und 19. Oktober 2013 vorgestellt, diskutiert, z.?T. modifiziert und verabschiedet wurden. Ergebnisse: Die Leitlinie enth?lt 48 Empfehlungen zur klinischen Ern?hrung in der Onkologie. Zur fr?hzeitigen Erfassung von Ern?hrungsst?rungen sollen valide Screeningverfahren eingesetzt und bei Auff?lligkeiten im Screening durch ein gezieltes Assessment erg?nzt werden. Grunds?tzlich soll eine ausreichende Energie- und Eiwei?zufuhr gesichert werden. Hierzu eignen sich die Linderung ern?hrungsrelevanter Symptome sowie ein der individuellen Situation angemessener Einsatz professioneller Ern?hrungsberatung inkl. oraler bilanzierter Di?ten (Trinknahrungen), Sondenern?hrung bzw. intraven?ser Ern?hrung. Jede Ern?hrungsbetreuung sollte zum Aufbau der Muskelmasse von bewegungstherapeutischen Ma?nahmen begleitet werden. Bei Patienten mit fortgeschrittener Erkrankung k?nnen medikament?se Substanzen zur Steigerung des Appetits, zur Vergr??erung der Muskelmasse und zur Minderung der Inflammationsreaktion erwogen werden. W?hrend einer Bestrahlung im Kopf-Hals-Bereich ist fr?hzeitig der Einsatz von Trinknahrungen und ggf. einer Sondenern?hrung in Betracht zu ziehen, um den Energiebedarf zu sichern und eine Unterbrechung der Bestrahlung zu verhindern. W?hrend einer medikament?sen Tumorbehandlung gilt analog, dass eine ausreichende Nahrungszufuhr gesichert werden soll, ggf. unter Anwendung einer enteralen und/oder parenteralen Nahrungszufuhr. Nach kurativer Tumorbehandlung werden regelm??ige k?rperliche Aktivit?t sowie eine die Bedarfsdeckung nicht ?bersteigende Energiezufuhr empfohlen. Abh?ngig von der Erkrankungsprognose sollte auch bei unheilbar kranken Tumorpatienten auf eine ausreichende Nahrungsaufnahme geachtet werden, w?hrend in der Sterbephase die Zufuhr von Nahrung und Fl?ssigkeit allein symptomorientiert erfolgen soll. Schlussfolgerung: Durchgehende Aufmerksamkeit f?r m?gliche Ern?hrungsst?rungen sowie eine der jeweiligen Situation angemessene Ern?hrungsbehandlung sollen Teil der Supportivbetreuung jedes Tumorpatienten sein, um die K?rperreserven, die ...

BackgroundMalnutrition is an under-recognized problem in hospitalized patients. Despite systematic screening, the prevalence of malnutrition in the hospital did not decrease in the last few decades. The aim of our study was to evaluate the prevalence of malnutrition and to determine the explicit daily calorie intake of hospitalized patients, to identify the risk factors of developing malnutrition during hospitalization and the effect on the financial reimbursement according to the German DRG-system.Material/Methods815 hospitalized patients were included in this study. The detection of malnutrition was based on the nutritional-risk-screening (NRS) and subjective-global-assessment (SGA) scores. A trained investigator recorded the daily calorie and fluid intake of each patient. Furthermore, clinical parameters, and the financial reimbursement were evaluated.ResultsThe prevalence of malnutrition was 53.6% according to the SGA and 44.6% according the NRS. During hospitalization, patients received on average 759.9±546.8 kcal/day. The prevalence of malnutrition was increased in patients with hepatic and gastrointestinal disease and with depression or dementia. The most important risk factors for malnutrition were bed rest and immobility (OR=5.88, 95% CI 2.25–15.4). In 84.5% of patient records, malnutrition was not correctly coded, leading to increased financial losses according to the DRG-system (94.908 Euros).ConclusionsHospitalized patients suffer from inadequate nutritional therapy and the risk for developing malnutrition rises during the hospital stay. The early screening of patients for malnutrition would not only improve management of nutritional therapy but also, with adequate coding, improve financial reimbursement according to the DRG-system.

Objective Gait is a sensitive marker for functional declines commonly seen in patients treated for advanced cancer. We tested the effect of a combined exercise and nutrition programme on gait parameters of advanced‐stage cancer patients using a novel wearable gait analysis system. Methods Eighty patients were allocated to a control group with nutritional support or to an intervention group additionally receiving whole‐body electromyostimulation (WB‐EMS) training (2×/week). At baseline and after 12 weeks, physical function was assessed by a biosensor‐based gait analysis during a six‐minute walk test, a 30‐s sit‐to‐stand test, a hand grip strength test, the Karnofsky Index and EORTC QLQ–C30 questionnaire. Body composition was measured by bioelectrical impedance analysis and inflammation by blood analysis. Results Final analysis included 41 patients (56.1% male; 60.0 ± 13.0 years). After 12 weeks, the WB‐EMS group showed higher stride length, gait velocity (p < .05), six‐minute walking distance (p < .01), bodyweight and skeletal muscle mass, and emotional functioning (p < .05) compared with controls. Correlations between changes in gait and in body composition, physical function and inflammation were detected. Conclusion Whole‐body electromyostimulation combined with nutrition may help to improve gait and functional status of cancer patients. Sensor‐based mobile gait analysis objectively reflects patients’ physical status and could support treatment decisions.