Nutrition and malignant disease: Implications for surgical practice

Abstract

Malignant disease is often associated with weight loss and malnutrition. Nutritional support is frequently provided to patients with cancer in an attempt to improve nutritional status and reverse weight loss, with the aim of reducing morbidity and mortality rates. This review evaluates the effect of supplemental nutrition on morbidity and mortality in patients with malignancy undergoing treatment with surgery, chemotherapy or radiotherapy. It also assesses the effect nutritional supplementation has on host defence mechanisms and how nutrients affect tumour cell growth. The evidence suggests that perioperative nutritional support, if given for at least 10 days, reduces morbidity and mortality in patients with biochemical evidence of severe malnutrition, manifest as a low serum albumin concentration and excessive weight loss. In contrast, there is no evidence that parenteral nutritional support benefits patients undergoing chemotherapy or radiotherapy, in terms of either an increased tumour response rate or prolongation of survival. Current research on malignant disease is highlighting the role of specific nutrients (amino acids, essential fatty acids and polyribonucleotides) as key regulators of both anticancer host defence mechanisms and the control of nitrogen metabolism and tumour growth. Arginine, essential fatty acids and ribonucleotides have all been demonstrated to stimulate antitumour host defence mechanisms and some also modulate tumour cell metabolism. Dietary manipulation offers exciting possibilities for the innovative management of malignant disease.

Is nutrition support related to a poor prognosis in head and neck cancer patients? Thoughts about the secondary analysis of RTOG trial 90‐03

“…I believe the authors overlook clinical trials demonstrating that nutritional support indeed improves clinical outcomes in patients with cancer and initiating the era of modern nutritional therapy. 2,3 The authors argue that information from their study comes from a randomized controlled trial and this strongly substantiates their results and conclusions. However, the Methods section clearly states that randomization was done for radiotherapy treatment and not for other treatments, such as nutritional support.…”

Flexible modeling improves assessment of prognostic value of C-reactive protein in advanced non-small cell lung cancer

“…Clinical observations suggested that low albumin might indicate an unfavourable prognosis, especially in the near future (Nixon et al, 1980;Hill, 1987;Heys et al, 1992). Still, our flexible spline-based model showed the statistical significance of time-dependent changes in the effect of albumin, and detected the dramatic effect of low baseline albumin on NSCL mortality in the next 3 -4 months.…”

Gastric outlet obstruction secondary to pancreatic cancer

“…The poor survival in this group of patients was probably related to their gross malnutrition at the time of surgery. Several studies have shown that malnutrition in surgical patients is a major cause for morbidity and mortality [1,5,8,10], therefore, the use of an enteral route for to provide nutrition in such critically ill patients is beneficial to their survival [4,6]. Preoperative malnutrition was often compounded by postoperative delayed gastric emptying and delayed institution of parenteral nutrition in gastroenterotomy patients.…”