Changes in nutritional status associated with unresectable pancreatic cancer

Abstract

Summary Weight loss is common in patients with pancreatic cancer; however, the nature and progress of their nutritional depletion are not well documented. In this study, pre-illness weight and duration of weight loss were recorded in 20 patients with histologically confirmed unresectable cancer of the pancreas. Patients then underwent nutritional analysis at monthly intervals until death. The median period of assessment was 27 weeks (interquartile range 22.5-38.0 weeks). At the time of diagnosis, all patients had lost weight [median 14.2%(10.0-20.0%) of pre-illness stable weight], and this weight loss was progressive, increasing to a median of 24.5% by the time of the last assessment (P =0.0004). Body mass index was significantly reduced from a pre-illness median value of 24.9 kg m-2 (22.4-27.4 kg m-2) to 20.7 kg m-2 (19.5-23.6 kg m-2) at the time of diagnosis and further to 17.7 kg m-2 (16.6-23.1 kg m-2) just before death (P =0.0003). Further evidence of tissue depletion was evident from the significant reductions in lean body mass [43.4 kg (36.9-53.0 kg) to 40.1 kg (33.5-50.7 kg) P =0.008] and fat mass [12.5 kg (8.9-17.8 kg) to 9.6 kg (6.3-15.1 kg) P =0.03). This study confirms that the majority of patients with unresectable pancreatic cancer have already undergone significant weight loss by the time of diagnosis and that the natural history of this process is one of inexorable progression. These results highlight the need for selective non-toxic therapeutic intervention to attenuate cachexia and indicate that such interventions should be instituted early in the course of the disease.

Use of the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in patients with cancer

“…Malnourished cancer patients may have a BMI within the healthy or overweight range, with body fat masking loss of lean body mass. Wigmore et al (1997) found that the median BMI of 20 pancreatic cancer patients at diagnosis was 20.7 (range 19.5 -23.6) kg=m 2 despite a median weight loss of 14.2 (range 10 -20%) in the previous 6 months.…”

Symptoms in advanced pancreatic cancer are of importance for energy intake

“…More than 80 % of patients with pancreatic cancer (PC) suffer from significant weight loss at the time of diagnosis [1]. The aetiology of this prominent feature may be multi-factorial and is not fully understood.…”

Żywienie drogą przewodu pokarmowego (żywienie dojelitowe)

“…Co ważne, nie ma żadnych wiarygodnych danych wskazujących na to, że leczenie żywieniowe ma wpływ na pobudzanie wzrostu nowotworu, czyli przyspieszenie rozwoju choroby, chociaż nie można wykluczyć stymulującego wpływu niektórych składników odżywczych na wzrost nowotworu [2]. Z kolei niedobór składników odżywczych w sposób oczywisty nie tylko nie hamuje rozwoju nowotworu, ale także istotnie pogarsza stan chorego, zmniejsza tolerancję leczenia onkologicznego, zwiększa ryzyko wystąpienia powikłań i może prowadzić do przerwania leczenia przeciwnowotworowego, a w skrajnych przypadkach nawet do zgonu [5][6][7][8][9]. Niedożywienie jest także niezależnym negatywnym czynnikiem prognostycznym i zwiększa ryzyko wystąpienia toksyczności leczenia przyczynowego [10][11][12].…”