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Haug M, Schwappacher R, Pollmann C, Ritter P, Michael M, Hermann HJ, Grützmann R, Mittelstädt A, Neurath MF, Zopf Y, Friedrich O. Effects of Adjuvant Exercise and Nutrition Therapy on Muscle Fibre Biomechanics in Gastrointestinal Cancer Patients. Cancers (Basel) 2024; 16:1608. [PMID: 38672689 PMCID: PMC11049604 DOI: 10.3390/cancers16081608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
Patients with aggressive cancer, e.g., gastrointestinal cancer, are prone (≥50% chance) to developing cancer cachexia (CC). Little is known about the effects of CC on the biomechanical function of muscle. A promising prevention strategy was found in the form of a multi-modal therapy combining mild resistance exercise (e.g., whole-body electro-myostimulation, WB-EMS) and a protein-rich diet. In a previous study of ours, this was effective in counteracting the loss of muscle mass, yet a systematic and comprehensive assessment of active and passive single muscle fibre functions was so far absent. This pilot study investigated the biomechanical function of single muscle fibres (rectus abdominis) from the biopsies of conventionally treated (pre-)cachectic cancer ((pre-)CC) patients (m = 9), those receiving the multi-modal therapy comprising WB-EMS training and protein-rich nutrition (m = 3), and a control group (m = 5). Our findings not only align with previous findings showing the absolute force loss in CC that is accelerated by atrophy but also speak in favour of a different, potentially energy- and Ca2+-homeostasis-related effect that compromises muscle contraction (F ~0.9 mN vs. F ~0.6 mN in control patients). However, myofibrillar Ca2+ sensitivity and the quality of contraction were unaltered (pCa50: 5.6-5.8). Single fibres from the (pre-)CC patients receiving WB-EMS training and protein supplementation were significantly more compliant (p < 0.001 at ≥130% of resting length L0). Those fibres displayed a similar softness to the ones from the control patients (axial compliance ~15 m/N at ≥130% L0), while single fibres from the patients with (developing) cachexia were significantly stiffer (axial compliance ~7 m/N, p < 0.001 at ≥130% L0). Adjuvant multi-modal therapy (WB-EMS training and nutritional support) contributes to maintaining the axial compliance of single fibres and potentially improves the quality of life for patients at risk of developing CC.
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Affiliation(s)
- Michael Haug
- Institute of Medical Biotechnology (MBT), Department of Chemical and Biological Engineering, Friedrich-Alexander-University Erlangen-Nürnberg, Paul-Gordan-Str. 3, 91052 Erlangen, Germany; (C.P.); (P.R.); (M.M.); (O.F.)
- Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander-University Erlangen-Nürnberg, Paul-Gordan-Str. 6, 91052 Erlangen, Germany
| | - Raphaela Schwappacher
- Hector-Centre for Nutrition, Exercise and Sports, Medical Department 1, Friedrich-Alexander-University Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany; (R.S.); (H.J.H.); (Y.Z.)
- Medical Department 1, Friedrich-Alexander-University Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany;
| | - Charlotte Pollmann
- Institute of Medical Biotechnology (MBT), Department of Chemical and Biological Engineering, Friedrich-Alexander-University Erlangen-Nürnberg, Paul-Gordan-Str. 3, 91052 Erlangen, Germany; (C.P.); (P.R.); (M.M.); (O.F.)
| | - Paul Ritter
- Institute of Medical Biotechnology (MBT), Department of Chemical and Biological Engineering, Friedrich-Alexander-University Erlangen-Nürnberg, Paul-Gordan-Str. 3, 91052 Erlangen, Germany; (C.P.); (P.R.); (M.M.); (O.F.)
- Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander-University Erlangen-Nürnberg, Paul-Gordan-Str. 6, 91052 Erlangen, Germany
| | - Mena Michael
- Institute of Medical Biotechnology (MBT), Department of Chemical and Biological Engineering, Friedrich-Alexander-University Erlangen-Nürnberg, Paul-Gordan-Str. 3, 91052 Erlangen, Germany; (C.P.); (P.R.); (M.M.); (O.F.)
- Medical Department 1, Friedrich-Alexander-University Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany;
| | - Hans Joachim Hermann
- Hector-Centre for Nutrition, Exercise and Sports, Medical Department 1, Friedrich-Alexander-University Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany; (R.S.); (H.J.H.); (Y.Z.)
- Medical Department 1, Friedrich-Alexander-University Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany;
| | - Robert Grützmann
- Department of General and Visceral Surgery, Friedrich-Alexander-University Erlangen-Nürnberg, Krankenhausstr. 12, 91054 Erlangen, Germany; (R.G.); (A.M.)
| | - Anke Mittelstädt
- Department of General and Visceral Surgery, Friedrich-Alexander-University Erlangen-Nürnberg, Krankenhausstr. 12, 91054 Erlangen, Germany; (R.G.); (A.M.)
| | - Markus Friedrich Neurath
- Medical Department 1, Friedrich-Alexander-University Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany;
| | - Yurdagül Zopf
- Hector-Centre for Nutrition, Exercise and Sports, Medical Department 1, Friedrich-Alexander-University Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany; (R.S.); (H.J.H.); (Y.Z.)
- Medical Department 1, Friedrich-Alexander-University Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany;
| | - Oliver Friedrich
- Institute of Medical Biotechnology (MBT), Department of Chemical and Biological Engineering, Friedrich-Alexander-University Erlangen-Nürnberg, Paul-Gordan-Str. 3, 91052 Erlangen, Germany; (C.P.); (P.R.); (M.M.); (O.F.)
- Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander-University Erlangen-Nürnberg, Paul-Gordan-Str. 6, 91052 Erlangen, Germany
- School of Biomedical Sciences, University of New South Wales, Wallace Wurth Building, 18 High St, Sydney, NSW 2052, Australia
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Mehler-Klamt AC, Naegele M, Lippach K. [Assessments in the initial nursing consultation-starting point for interprofessional cooperation in oncology]. Urologie 2024; 63:288-294. [PMID: 38416169 DOI: 10.1007/s00120-024-02299-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Most oncology patients are not adequately screened for symptoms during the admission process. As a result, their needs are not properly assessed and included in their treatment. OBJECTIVE To investigate which assessments are already used by different nursing, medical, and social services at oncology centers and how these could be centralized in order to include the different services involved in the care of patients in a bundled way. MATERIALS AND METHODS Interviews were conducted with nursing, medical, and social services of an oncology center. Hereby, a main focus was put on their individual screenings. Furthermore, the special features of the services for oncological patients were elaborated. RESULTS AND CONCLUSION Symptom assessments are currently only performed if the nursing, medical, or social service concerned is actively involved in the care of the patient. This usually happens only once a problem arises. This could be counteracted by a needs and requirements analysis integrated into the admission process, in which the assessments are used in a bundled manner. In this way, a comprehensive picture of the individual could be created even before a problem arises. Based on the analysis by nursing experts, the various nursing, medical, and social services could then be involved in the care of the patient right at the start of treatment. This would significantly improve the quality of care for patients.
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Affiliation(s)
- A C Mehler-Klamt
- Institut für Pflegewissenschaft, LMU Klinikum München, Marchinoninistr. 15, 81377, München, Deutschland.
| | - M Naegele
- Netzwerk Onkologie, Kantonsspital St. Gallen, St. Gallen, Schweiz
- Zertifizierungs-AG der Konferenz onkologischer Krankenpflege (KOK), Berlin, Deutschland
| | - K Lippach
- Institut für Pflegewissenschaft, LMU Klinikum München, Marchinoninistr. 15, 81377, München, Deutschland
- Zertifizierungs-AG der Konferenz onkologischer Krankenpflege (KOK), Berlin, Deutschland
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Meissner C, Tiegges S, Broehl M, Otto R, Ridwelski K. International study on the prevalence of malnutrition in centralized care for colorectal cancer patients. Innov Surg Sci 2023; 8:83-92. [PMID: 38058781 PMCID: PMC10696944 DOI: 10.1515/iss-2023-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/24/2023] [Indexed: 12/08/2023] Open
Abstract
Objectives Patients with different diseases may show signs of malnutrition both before and during the hospital stay. The presence of malnutrition may impact the recovery and length of stay and consequently the costs. Early identification of malnutrition is thus a critical factor. The objective of this multicenter study is to determine the prevalence of malnutrition in colorectal cancer centers. Another objective is to investigate possible consequences, such as complications or length of stay. In addition, the study aims to demonstrate the relevance of nutrition management in colorectal cancer centers. At the same time, relevant requirements clearly demanded by the Certification Commission for Certified Colorectal Cancer Centers are met through implementation of the study. Methods Between 2019 and 2021, patients in colorectal cancer centers were examined in the preoperative phase. In addition to questions about patients' state of health and nutrition, the validated screening forms-Subjective Global Assessment (SGA) and Nutritional Risk Screening Tool 2002 (NRS 2002)-were used to assess malnutrition. The data were processed by univariate analysis. Results In total, data records of 3,102 patients were evaluated. The mean age of the participants was 68.5 ± 11.9 years, and their average body mass index (BMI) was 26.8 ± 5.3 kg/m2. The SGA questionnaire indicated that 23 % of the participants suffered from malnutrition and 38 % were at risk of malnutrition (NRS≥3). Malnutrition was found more frequently in patients with colorectal carcinomas than in patients with rectal carcinomas (53.1 vs. 32.1 %). The length of stay in hospital and the rate of complications were significantly higher when malnutrition was identified. Conclusions Approximately one in three to four patients with a colorectal carcinoma has an increased risk of malnutrition. The two screening methods calculated a different prevalence (23 and 38 %). Any malnutrition that is present demonstrably has a significant impact both on the rate of complications and the length of stay and may therefore have a decisive influence on the costs. The results of this multicenter study underscore the need for systematic screening for malnutrition and at the same time should increase clinics awareness of the importance of establishing a nutrition management policy.
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Affiliation(s)
- Carl Meissner
- An-Institut für Qualitätssicherung in der operativen Medizin gGmbH an der Otto-von-Guericke Universität Magdeburg, Magdeburg, Germany
- Medizinischen Versorgungszentrum „Im Altstadtquartier“ GmbH, Haus- und Facharztzentrum, Ambulantes Operationszentrum, Magdeburg, Germany
| | | | | | - Ronny Otto
- An-Institut für Qualitätssicherung in der operativen Medizin gGmbH an der Otto-von-Guericke Universität Magdeburg, Magdeburg, Germany
| | - Karsten Ridwelski
- Klinikum Magdeburg gGmbH, Klinik für Allgemein- und Viszeralchirurgie, Magdeburg, Germany
- An-Institut für Qualitätssicherung in der operativen Medizin gGmbH an der Otto-von-Guericke Universität Magdeburg, Magdeburg, Germany
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Bakaloudi DR, Papaemmanouil A, Vadarlis A, Makrakis D, Germanidis G, Timotheadou E, Chourdakis M. Critical evaluation and comparison of nutritional clinical practice guidelines for cancer patients. Clin Nutr 2023; 42:670-686. [PMID: 36944289 DOI: 10.1016/j.clnu.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 02/09/2023] [Accepted: 03/09/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND The growing incidence of cancer globally, and the importance of nutrition support for these patients, emphasize the need for the development of nutritional clinical practice guidelines and consensus papers (CPGs) in the field. Numerous relevant CPGs have been published by several organizations worldwide. The aim of this systematic review was to compare the content of the existing CPGs and evaluate the quality of their development using the AGREE-II tool. METHODS A systematic literature search in PubMed, Embase and Web of Science databases was conducted for the identification of relevant CPGs and consensus papers. Eligible CPGs was blindly evaluated by four appraisers according to the Appraisal of Guidelines for Research and Evaluation ΙΙ (AGREE-II) tool. RESULTS In total 15 CPGs were identified and were evaluated. All but one set of CPGs underlined the importance of nutritional screening and assessment, whereas recommendations on nutritional interventions, supplements, management of complications and nutritional follow-up were also reported by several organizations. AGREE-II results showed that two CPGs were characterized as high, eight as moderate and five as low regarding their quality of development. CONCLUSIONS Variety on recommendations could be observed between CPGs that should be considered when applied into clinical practice. Limitations of the existing CPGs could be the fact that they are non-specific and only a minority of them are focused to specific cancer types. Frequent updates for CPGs and inclusion of more nutritional topics should be considered for some CPGs. Improvement of the quality of the CPGs development should also be pursued in future.
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Affiliation(s)
- Dimitra Rafailia Bakaloudi
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece; Department of Medical Oncology, General Hospital of Thessaloniki "G. Papageorgiou", Aristotle University of Thessaloniki, Greece; Division of Medical Oncology, Department οf Medicine, University of Washington, Seattle, WA, USA
| | - Androniki Papaemmanouil
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Andreas Vadarlis
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece; Department of Gastroenterology and Hepatology, General Hospital of Thessaloniki ''G. Papanikolaou", Greece
| | - Dimitrios Makrakis
- Department of Medicine, Jacobi Medical Center-Albert Einstein College of Medicine, Bronx, NY, USA
| | - Georgios Germanidis
- Division of Gastroenterology and Hepatology, 1st Department of Internal Medicine, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Eleni Timotheadou
- Department of Medical Oncology, General Hospital of Thessaloniki "G. Papageorgiou", Aristotle University of Thessaloniki, Greece
| | - Michail Chourdakis
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece.
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Klassen D, Strauch C, Alteheld B, Lingohr P, Matthaei H, Vilz T, Gonzalez-Carmona MA, Hausen A, Gräßler M, Sharma A, Strassburg C, Kalff JC, Schmidt-Wolf IGH. Assessing the Effects of a Perioperative Nutritional Support and Counseling in Gastrointestinal Cancer Patients: A Retrospective Comparative Study with Historical Controls. Biomedicines 2023; 11. [PMID: 36831145 DOI: 10.3390/biomedicines11020609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023] Open
Abstract
The aim of this study was to investigate the effects of perioperative nutritional therapy care in gastrointestinal (esophageal, gastric, gastroesophageal) cancer patients on nutritional status and disease progression (complications, hospitalization, mortality). We considered 62 gastrointestinal cancer patients treated at the Center for Integrated Oncology (CIO), University Hospital Bonn, Germany (August 2017-July 2019). Of these, 42 patients (as intervention group: IG) received pre- and postoperative nutritional support with counseling, while 20 patients (as historical control group CG) received only postoperative nutritional therapy. Several clinical parameters, such as Body Mass Index (BMI), nutritional risk screening (NRS), phase angle, postoperative complications, length of hospital stay, and mortality, were determined. There were significantly fewer patients with gastric cancer/CDH1 gene mutation and more with esophageal cancer in IG (p = 0.001). Significantly more patients received neoadjuvant therapy in IG (p = 0.036). No significant differences were found between the groups regarding BMI, NRS, complications, length of hospital stay, and mortality. However, the comparison of post- and preoperative parameters in IG showed a tendency to lose 1.74 kg of weight (p = 0.046), a decrease in phase angle by 0.59° (p = 0.004), and an increase in NRS of 1.34 points (p < 0.001). Contrary to prior reports, we found no significant effect of perioperative nutritional therapy care in gastrointestinal cancer patients; however, the small cohort size and infrequent standardization in nutritional status may possibly account for the variance. Considering that oncological pathways and metabolic nutritional pathways are interrelated, dividing patients into subgroups to provide a personalized nutritional approach may help in improving their treatment.
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Ostermann J, Smollich M. Ernährungsmedizinischer Bedarf und reale Versorgung von Brustkrebspatientinnen. Geburtshilfe Frauenheilkd 2023. [DOI: 10.1055/a-1954-9788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Schmidt L, Mathies V, von Grundherr J. [Practice-relevant dietary recommendations in uro-oncology]. Urologie 2023; 62:17-22. [PMID: 36459207 DOI: 10.1007/s00120-022-01984-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND A healthy lifestyle is recommended for prevention, during therapy and in the survivorship of various medical conditions. OBJECTIVES This article aims to give an overview of the current dietary recommendations and currently discussed topics which are useful for patient counseling. METHODS The literature with a focus on uro-oncology, on prevention, during cancer therapy and survivorship was reviewed for healthy lifestyle recommendations. In addition, issues perceived in practice were researched, discussed with examples, and critically evaluated. RESULTS The current recommendations of the professional associations are intended to encourage all healthy or already ill patients to adopt a healthy lifestyle that includes a balanced diet, physical activity and healthy body weight. Consistent with current evidence, neither general supplementation of dietary supplements nor avoidance of entire food groups (such as meat or dairy products) is recommended. CONCLUSIONS In the counseling situation, patients should be encouraged in a healthy lifestyle or supported in an appropriate change of behavior. Any perceived uncertainty or questions from patient's perspective should be clarified and, if necessary, referred to a dietician, oecotrophologist or nutritionist.
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Burkhard-Meier A, Rémi C, Lindner LH, von Bergwelt-Baildon M. Cannabis in der Onkologie – viel Rauch um nichts? Laryngorhinootologie 2022. [PMID: 36543223 DOI: 10.1055/a-1949-3296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
ZusammenfassungDie medizinische Verwendung von Cannabis hat in den letzten Jahren in Europa und Nordamerika an Popularität gewonnen. Cannabinoide sind sowohl als Fertigarzneimittel als auch in Blüten- und Extraktform verfügbar. Der vorliegende Artikel legt den Fokus auf die supportive Therapie onkologischer Patienten. Mögliche Indikationen sind Schmerzen, Chemotherapie-bedingte Übelkeit und Erbrechen, Appetitlosigkeit und Geschmacksveränderungen. Trotz des enormen Hypes um Cannabis als Medizin ist die Evidenz für dessen Anwendung bei onkologischen Patienten unzureichend. Palliativpatienten mit refraktären Symptomen könnten jedoch geeignete Kandidaten für einen Therapieversuch darstellen. Der entscheidende Parameter für die Auswahl eines Cannabis-Arzneimittels ist die THC/CBD-Ratio. Orale Einnahmeformen bieten sich gerade für Cannabis-naive und ältere Patienten an. Psychische und kardiovaskuläre Nebenwirkungen sind nicht zu unterschätzen.
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Affiliation(s)
- Anton Burkhard-Meier
- Klinikum Grosshadern: Klinikum der Universitat Munchen Standort Grosshadern, München, GERMANY
| | - Constanze Rémi
- Klinik und Poliklinik für Palliativmedizin am Klinikum der LMU München, GERMANY
| | - Lars H. Lindner
- Medizinische Klinik und Poliklinik III am Klinikum der LMU München, GERMANY
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Wendt S, Meißner C. Präoperatives Ernährungsmanagement in der
großen Tumorchirurgie des Bauchraumes an deutschen Kliniken. Eine
explorative Strukturanalyse. Aktuelle Ernährungsmedizin 2022. [DOI: 10.1055/a-1894-6339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
ZusammenfassungBis zu 80% der PatientInnen vor Tumorresektionen des oberen
Gastrointestinaltrakts sind mangelernährt. Dabei hat schon der
präoperative Ernährungszustand einen signifikanten Einfluss auf
den perioperativen Verlauf. Ein adäquater präoperativer
Ernährungszustand, der unter anderem die Komplikationsrate und die
Krankenhausliegedauer reduzieren kann, ist daher erstrebenswert. Zwar empfehlen
einschlägige Leitlinien Maßnahmen zur Erkennung und Behandlung
einer Mangelernährung, jedoch fehlt es bislang an Vorschlägen
zur Planung eines strukturieren präoperativen
Ernährungsmanagements auf die BehandlerInnen zurückgreifen
können. Innerhalb dieser Arbeit wurden 40 Krankenhäuser in
Deutschland deshalb zu individuell vorhandenen Strukturen und Maßnahmen
zum präoperativen Ernährungsmanagement von PatientInnen vor
Tumorresektionen des oberen Gastrointestinaltrakts befragt. Die Befragungen
zeigen, dass Maßnahmen zur Erkennung und Therapie einer
präoperativen Mangelernährung mehrheitlich bekannt und
akzeptiert sind. So befürworten 35 der 40 TeilnehmerInnen eine
präoperative Ernährungstherapie bei mangelernährten
PatientInnen, 26 TeilnehmerInnen erwägen hierfür sogar einen
Aufschub der Operation. Eine flächendeckende Umsetzung an den Kliniken
scheitere jedoch häufig an Hinderungsgründen, wie fehlender
Sichtbarkeit der Ernährung als Therapiebaustein unter BehandlerInnen,
labilen Verantwortlichkeiten sowie unzureichenden finanziellen und personellen
Ressourcen. Mögliche Lösungsvorschläge zum Abbau der
Hindernisse reichen von Refinanzierungsmöglichkeiten der klinischen
Ernährungstherapie bis hin zu Forderungen auf gesundheitspolitischer
Ebene. Aus den Erkenntnissen aktueller Studien und Leitlinien, sowie den
Ergebnissen der Befragung, unterbreitet diese Arbeit einen Vorschlag zur
Implementierung eines präoperativen Ernährungsmanagements.
Dessen Umsetzbarkeit im klinischen Alltag sollte dabei durch wissenschaftliche
Verfahren begleitet werden.
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Affiliation(s)
- Saskia Wendt
- Ernährung, Israelitisches Krankenhaus Hamburg, Hamburg,
Germany
| | - Carl Meißner
- Facharztzentrum – Praxisklinik – Ambulantes
Operationszentrum, Medizinisches Versorgungszentrum „Im
Altstadtquartier“ GmbH, Magdenburg, Germany
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Zhao J, Kan Y, Wu X, Yang S, Wang G, Bao Y, Li J. Nutrition management for patients with head and neck cancer during peri-radiotherapy: A systematic review and quality appraisal of clinical practice guidelines using the AGREE II instrument. Front Oncol 2022; 12:974059. [DOI: 10.3389/fonc.2022.974059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 11/07/2022] [Indexed: 11/30/2022] Open
Abstract
ObjectiveTo evaluate the quality of clinical practice guidelines (CPGs) for nutrition management of patients with head and neck cancer (HNC) during peri-radiotherapy, as well as to summarize the nutrition recommendations fitting the subject.MethodsCPGs published in English, Chinese and German were identified from databases, guideline networks, and websites of nutritional associations from the databases’ inception to March 8, 2022. Three independent appraisers used the Appraisal of Guidelines for Research and Evaluation II (AGREE II) Instrument to assess the quality of CPGs. The intraclass correlation coefficient (ICC) was used to calculate appraiser agreement.Results769 records were identified. After removing duplicates, 470 articles were screened. 12 CPGs were identified with nutrition-specific recommendations. 67% of CPGs were rated as high quality, and 33% as low quality. Recommendations were categorized into nutritional risk screening, nutrition assessment, nutrition counseling, nutrition interventions, nutrition intake, swallowing function management, weight management, exercise, multidisciplinary team, post-discharge care, nutrients, and pharmacologic interventions.ConclusionWe found discrepant recommendations in existing CPGs, including nutrition screening, nutrition assessment, nutrition intake, and nutrients. We also reported the absence of essential parts of CPGs, including the views of its target users, the statement of external review, the method to formulate the recommendations, strategies to improve uptake, and resource implications of applying the CPGs. CPGs with low quality should be improved in future updates based on currently available guideline development tools. Specialized CPGs on nutrition management for HNC patients during peri-radiotherapy should be developed.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/index.php, identifier CRD42022320322.
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Jendretzki J, Henniger D, Schiffmann L, Wolz C, Kollikowski A, Meining A, Einsele H, Winkler M, Löffler C. Every fifth patient suffered a high nutritional risk—Results of a prospective patient survey in an oncological outpatient center. Front Nutr 2022; 9:1033265. [PMID: 36386917 PMCID: PMC9659884 DOI: 10.3389/fnut.2022.1033265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/11/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Malnutrition in cancer patients often remains undetected and underestimated in clinical practice despite studies revealing prevalences from 20 to 70%. Therefore, this study aimed to identify patient groups exposed to an increased nutritional risk in a university oncological outpatient center. Methods Between May 2017 and January 2018 we screened oncological patients there using the malnutrition universal screening tool (MUST). Qualitative data were collected by a questionnaire to learn about patients’ individual information needs and changes in patients’ diets and stressful personal nutrition restrictions. Results We included 311 patients with various cancers. 20.3% (n = 63) were found to be at high risk of malnutrition, 16.4% (n = 51) at moderate risk despite a mean body mass index (BMI) of 26.5 ± 4.7 kg/m2. The average age was 62.7 (± 11.8) with equal gender distribution (52% women, n = 162). In 94.8% (n = 295) unintended weight loss led to MUST scoring. Patients with gastrointestinal tumors (25%, n = 78) and patients >65 years (22%, n = 68) were at higher risk. Furthermore, there was a significant association between surgery or chemotherapy within six months before survey and a MUST score ≥2 (OR = 3.6). Taste changes, dysphagia, and appetite loss were also particular risk factors (OR = 2.3–3.2). Young, female and normal-weight patients showed most interest in nutrition in cancer. However, only 38% (n = 118) had a nutritional counseling. Conclusion This study confirms that using the MUST score is a valid screening procedure to identify outpatients at risk of developing malnutrition. Here one in five was at high risk, but only 1% would have been detected by BMI alone. Therefore, an ongoing screening procedure with meaningful parameters should be urgently implemented into the clinical routine of cancer outpatients as recommended in international guidelines.
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Affiliation(s)
- Julia Jendretzki
- Comprehensive Cancer Center, University Hospital Würzburg, Würzburg, Germany
- Klinik Hallerwiese-Cnopf’sche Kinderklinik, Neonatologie und Pädiatrie, Nuremberg, Germany
| | - Dorothea Henniger
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
- *Correspondence: Dorothea Henniger,
| | - Lisa Schiffmann
- Comprehensive Cancer Center, University Hospital Würzburg, Würzburg, Germany
| | - Constanze Wolz
- Comprehensive Cancer Center, University Hospital Würzburg, Würzburg, Germany
| | - Anne Kollikowski
- Comprehensive Cancer Center, University Hospital Würzburg, Würzburg, Germany
| | - Alexander Meining
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Hermann Einsele
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | | | - Claudia Löffler
- Comprehensive Cancer Center, University Hospital Würzburg, Würzburg, Germany
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
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12
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Burkhard-Meier A, Rémi C, Lindner LH, von Bergwelt-Baildon M. [Cannabis in oncology - much ado about nothing?]. Dtsch Med Wochenschr 2022; 147:916-922. [PMID: 35868317 DOI: 10.1055/a-1872-2749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The medical use of Cannabis has gained popularity in Europe and Northern America in recent years. Cannabinoids are available as finished pharmaceuticals, flowers and extracts. This article focuses on supportive medicine for oncological patients. Possible indications are pain, chemotherapy-induced nausea and vomiting, loss of appetite and altered taste perception. Despite the enormous cannabis hype in medicine, the evidence for its use in oncology patients is insufficient. However, palliative patients with refractory symptoms could be candidates for a therapeutic trial. The key parameter for choosing a cannabis medicinal product is the THC/CBD ratio. Oral forms of administration are particularly suitable for cannabis-naive and older patients. Mental and cardiovascular side effects should not be underestimated.
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Affiliation(s)
| | - Constanze Rémi
- Klinik und Poliklinik für Palliativmedizin am Klinikum der LMU München
| | - Lars H Lindner
- Medizinische Klinik und Poliklinik III am Klinikum der LMU München
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13
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Steindorf K, Clauss D, Rötzer I, Tjaden C, Hackert T, Wiskemann J. Nutrition Intake and Nutrition Status of Pancreatic Cancer Patients: Cross-Sectional and Longitudinal Analysis of a Randomized Controlled Exercise Intervention Study. Nutr Cancer 2022; 74:3492-3500. [PMID: 35608567 DOI: 10.1080/01635581.2022.2077382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Pancreatic cancer patients often present with an inadequate nutritional intake. At the same time, there are no standardized recommendations for nutrition intake during and after cancer treatment. In a prospective analysis of a randomized controlled trial analyzing the effects of a 6-month resistance training in pancreatic cancer patients, we assessed the nutritional intake and the impact of a 6-month supervised resistance training or home-based resistance training vs. usual care control on the nutritional intake of the patients. Nutritional intake was assessed by 24-h recall before and after the 6-month resistance training period. At baseline low protein intake (<1 g/kg body weight) was found in 33.9% of the 59 patients and low energy intake (<25 kcal/kg body weight) was found in 39.0% of the patients. In all, 35.6% of the patients were classified with a risk of malnutrition (NRS ≥ 3). In the total of 46 patients who finished the 6-month intervention period, there was no difference in nutritional intake over time between resistance training and usual care control. In conclusion, it appears that the majority of our study population had an adequate protein and energy intake. A resistance training seems to have no influence on the nutritional intake of the patients.
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Affiliation(s)
- Karen Steindorf
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center, National Center for Tumor Diseases, Heidelberg, Germany
| | - Dorothea Clauss
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center, National Center for Tumor Diseases, Heidelberg, Germany.,Department of Molecular and Cellular Sport Medicine, German Sport University, Cologne, Germany
| | - Ingeborg Rötzer
- Division of Medical Oncology, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Christine Tjaden
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Thilo Hackert
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Joachim Wiskemann
- Division of Medical Oncology, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
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14
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Emanuel A, Krampitz J, Rosenberger F, Kind S, Rötzer I. Nutritional Interventions in Pancreatic Cancer: A Systematic Review. Cancers (Basel) 2022; 14:2212. [PMID: 35565341 DOI: 10.3390/cancers14092212] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/24/2022] [Accepted: 04/27/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary This systematic review investigates the impact of nutritional interventions on cachexia, malnutrition and weight loss in patients with pancreatic cancer. In total, 26 studies were included. Parenteral nutrition is associated with a higher incidence of complications. Enteral nutrition shows positive effects on length of stay in hospital, complications, weight loss and cytokines. Dietary supplements enriched with omega-3 fatty acids improve body weight and lean body mass. Considering the heterogeneous study situation as well as the high bias potential of the included RCTs, a recommendation for enteral nutrition and dietary supplements with omega-3 fatty acids can be given. Abstract (1) Background: Pancreatic cancer (PaCa) is directly related to malnutrition, cachexia and weight loss. Nutritional interventions (NI) are used in addition to standard therapy. The aim of this systematic review is to provide an overview of the types of NI and their effects. (2) Methods: We included RCTs with at least one intervention group receiving an NI and compared them with a control group with no NI, placebo or alternative treatment on cachexia, malnutrition or weight loss in patients with PaCa. Any available literature until 12 August 2021 was searched in the Pubmed and Cochrane databases. RCTs were sorted according to NI (parenteral nutrition, enteral nutrition, dietary supplements and mixed or special forms). (3) Results: Finally, 26 studies with a total of 2720 patients were included. The potential for bias was mostly moderate to high. Parenteral nutrition is associated with a higher incidence of complications. Enteral nutrition is associated with shorter length of stay in hospital, lower rate and development of complications, positive effects on cytokine rates and lower weight loss. Dietary supplements enriched with omega-3 fatty acids lead to higher body weight and lean body mass. (4) Conclusions: Enteral nutrition and dietary supplements with omega-3 fatty acids should be preferred in nutritional therapy of PaCa patients.
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15
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Sawicki J, Berner R, Löser T, Schöll E. Modeling Tumor Disease and Sepsis by Networks of Adaptively Coupled Phase Oscillators. Front Netw Physiol 2022; 1:730385. [PMID: 36925568 PMCID: PMC10013027 DOI: 10.3389/fnetp.2021.730385] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 11/19/2021] [Indexed: 06/18/2023]
Abstract
In this study, we provide a dynamical systems perspective to the modelling of pathological states induced by tumors or infection. A unified disease model is established using the innate immune system as the reference point. We propose a two-layer network model for carcinogenesis and sepsis based upon the interaction of parenchymal cells and immune cells via cytokines, and the co-evolutionary dynamics of parenchymal, immune cells, and cytokines. Our aim is to show that the complex cellular cooperation between parenchyma and stroma (immune layer) in the physiological and pathological case can be qualitatively and functionally described by a simple paradigmatic model of phase oscillators. By this, we explain carcinogenesis, tumor progression, and sepsis by destabilization of the healthy homeostatic state (frequency synchronized), and emergence of a pathological state (desynchronized or multifrequency cluster). The coupled dynamics of parenchymal cells (metabolism) and nonspecific immune cells (reaction of innate immune system) are represented by nodes of a duplex layer. The cytokine interaction is modeled by adaptive coupling weights between the nodes representing the immune cells (with fast adaptation time scale) and the parenchymal cells (slow adaptation time scale) and between the pairs of parenchymal and immune cells in the duplex network (fixed bidirectional coupling). Thereby, carcinogenesis, organ dysfunction in sepsis, and recurrence risk can be described in a correct functional context.
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Affiliation(s)
- Jakub Sawicki
- Potsdam Institute for Climate Impact Research, Potsdam, Germany
| | - Rico Berner
- Institut für Mathematik, Technische Universität Berlin, Berlin, Germany
- Institut für Theoretische Physik, Technische Universität Berlin, Berlin, Germany
| | | | - Eckehard Schöll
- Potsdam Institute for Climate Impact Research, Potsdam, Germany
- Institut für Theoretische Physik, Technische Universität Berlin, Berlin, Germany
- Bernstein Center for Computational Neuroscience Berlin, Humboldt-Universität, Berlin, Germany
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16
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Keaver L, Houlihan C, O'Callaghan N, LaVertu AE, Ding X, Zhang FF. Evidence-based nutrition guidelines for cancer survivors in Europe: a call for action. Eur J Clin Nutr 2021; 76:819-826. [PMID: 34716363 DOI: 10.1038/s41430-021-01036-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 10/06/2021] [Accepted: 10/14/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND/OBJECTIVES The aims of this study were to (1) document currently available guidelines aimed at healthcare professionals and including some information on the nutritional management of cancer survivors in Europe; (2) assess the quality of these guidelines and (3) document the nutrition recommendations promoted. METHODS Four search strategies were implemented in 2018 and updated in 2021 to locate guidelines. Papers were included if they described a European guideline or recommendation for cancer survivors that contained nutrition guidance and there were no language restrictions. Two reviewers independently assessed guideline quality using the AGREE II instrument and nutrition content was extracted and summarised. RESULTS Five guidelines (of 593 documents located through the searches) met the inclusion criteria. The ESPEN guidelines were deemed to have the highest methodological quality. Limited information on nutrition was available in these guidelines with the majority of focus being on the promotion of fruit, vegetables and wholegrains and reducing fat, red meat and alcohol. Weight management was mentioned by all five guidelines. There was no detailed information available for cancer survivors or their healthcare team and no practical strategies for the implementation of recommendations. CONCLUSIONS There is a need for nutrition guidelines specific for cancer survivors in a European setting. Current guidelines are limited and focus on broad recommendations, while lacking in practical strategies for implementation. There is also a tendency to recommend cancer prevention guidelines be used for cancer survivors rather than developing specific guidance for this group.
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Affiliation(s)
- Laura Keaver
- Department of Health and Nutritional Science, Institute of Technology Sligo, Sligo, F91 YW50, Ireland. .,Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, 02111, USA.
| | - Christine Houlihan
- Department of Health and Nutritional Science, Institute of Technology Sligo, Sligo, F91 YW50, Ireland
| | - Niamh O'Callaghan
- Department of Health and Nutritional Science, Institute of Technology Sligo, Sligo, F91 YW50, Ireland
| | - Amy E LaVertu
- Hirsh Health Sciences Library, Tufts University, Boston, MA, 02111, USA
| | - Xinge Ding
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, 02111, USA
| | - Fang Fang Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, 02111, USA
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17
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Hausen A, Henschel D, Heuser R, Harnischmacher M, Kloeß C, Pröbstl A, Schmidt-Wolf I, Strassburg CP, Kalff JC, von Websky M. [Development and Implementation of a Nutrition Medicine Strategy to optimize Medical Service for Malnourished Patients at a Tertiary Referral Centre]. Zentralbl Chir 2021; 146:283-295. [PMID: 34154010 DOI: 10.1055/a-1481-9227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Malnutrition in hospitalised patients is an important and underestimated problem, with a negative impact on outcome and survival - not only in surgical patients. There is a discrepancy between optimal treatment as defined in relevant guidelines on clinical nutrition and the clinical reality. The Main reason for this discrepancy is the lack of established structures for nutrition medicine as an integral part of clinical routines. The necessary structural development is impaired mainly by the lack of resources, but in isolated cases also by the lack of appreciation of the problem. Therefore, practicability and feasibility with regard to local conditions are pivotal for sustainable improvement in a nutrition strategy in hospitalised patients. METHODS We describe the institutional and procedural measures taken at a tertiary referral centre to implement a nutrition medicine strategy. The underlying nutrition medicine methodology and definitions are introduced and practical implementation at our centre is illustrated by four examples of ongoing projects. RESULTS Using the described systematics, structural changes were implemented at our centre within one year that allowed malnutrition screening, the treatment of patients with complex nutritional care and improvements in the nutritive status of hospitalised patients by ongoing and future project initiatives. SUMMARY The successfully implemented structural change at the University Hospital of Bonn described here may serve as a modular example for other hospitals striving to improve clinical nutrition and outcome in hospitalised patients.
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Affiliation(s)
- Annekristin Hausen
- Medizinische Klinik und Poliklinik I - Allgemeine Innere Medizin, Universitätsklinikum Bonn, Deutschland
| | - Diana Henschel
- Abteilung für Integrierte Onkologie, CIO Bonn, Universitätsklinikum Bonn, Deutschland
| | - Regina Heuser
- Abteilung für Integrierte Onkologie, CIO Bonn, Universitätsklinikum Bonn, Deutschland
| | - Marie Harnischmacher
- Abteilung für Integrierte Onkologie, CIO Bonn, Universitätsklinikum Bonn, Deutschland
| | | | | | - Ingo Schmidt-Wolf
- Abteilung für Integrierte Onkologie, CIO Bonn, Universitätsklinikum Bonn, Deutschland
| | - Christian P Strassburg
- Medizinische Klinik und Poliklinik I - Allgemeine Innere Medizin, Universitätsklinikum Bonn, Deutschland
| | - Jörg C Kalff
- Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Deutschland
| | - Martin von Websky
- Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Deutschland
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18
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Reckefuß N. [Medical nutrition therapy in intensive care medicine : Summary of the updated DGEM guideline]. Med Klin Intensivmed Notfmed 2020; 115:437-46. [PMID: 32399612 DOI: 10.1007/s00063-020-00690-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/29/2020] [Accepted: 04/09/2020] [Indexed: 10/24/2022]
Abstract
The course of a critical illness is divided into several phases (early and late acute phase, post-acute phase) in which different metabolic processes take place. Accordingly, the medical nutrition therapy needs to be adapted to the patient's metabolic tolerance in each phase. When indicated, it should be started within 24 h. If oral administration is not possible, an enteral diet should be used. In individuals with contraindications, parenteral nutrition should be started. The target values for the diet of nonobese patients in the late acute phase are 24 kcal and 1.0 g protein (or 1.2 g amino acid) per kilogram bodyweight. The individual metabolic tolerance can be estimated based on the extent of insulin resistance and serum phosphate levels, and the nutrition therapy is adjusted accordingly.
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19
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Schink K, Reljic D, Herrmann HJ, Meyer J, Mackensen A, Neurath MF, Zopf Y. Whole-Body Electromyostimulation Combined With Individualized Nutritional Support Improves Body Composition in Patients With Hematological Malignancies - A Pilot Study. Front Physiol 2018; 9:1808. [PMID: 30618820 PMCID: PMC6305403 DOI: 10.3389/fphys.2018.01808] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 11/30/2018] [Indexed: 12/22/2022] Open
Abstract
Patients undergoing the complex treatment for hematological malignancies are exposed to a high physiological and psychological distress inducing fatigue and physical inactivity. In line with cancer-related metabolic changes patients are predisposed for skeletal muscle mass loss that leads to a functional decline, affects therapeutic success, and quality of life. Benefits of physical exercise and nutritional interventions on muscle maintenance are observed in solid cancer patients, but marginally investigated in patients with hematological cancer. We here studied the effects of a combined supportive exercise and nutrition intervention using whole-body electromyostimulation (WB-EMS) training and individualized nutritional support in patients actively treated for hematological malignancy. In a controlled pilot trial, 31 patients (67.7% male; 58.0 ± 16.7 years) with various hematological cancers were allocated to a control group (n = 9) receiving nutritional support of usual care regarding a high protein intake (>1.0 g/kg/d) or to a physical exercise group (n = 22) additionally performing WB-EMS training twice weekly for 12 weeks. Bodyweight and body composition assessed by bioelectrical impedance analysis were measured every 4 weeks. Physical function, blood parameters, quality of life and fatigue were assessed at baseline and after 12 weeks. No WB-EMS-related adverse effects occurred. Patients attending the exercise program presented a higher skeletal muscle mass than controls after 12-weeks (1.51 kg [0.41, 2.60]; p = 0.008). In contrast, patients of the control group showed a higher fat mass percentage than patients of the WB-EMS group (-4.46% [-7.15, -1.77]; p = 0.001) that was accompanied by an increase in serum triglycerides in contrast to a decrease in the WB-EMS group (change ± SD, control 36.3 ± 50.6 mg/dl; WB-EMS -31.8 ± 68.7 mg/dl; p = 0.064). No significant group differences for lower limb strength, quality of life, and fatigue were detected. However, compared to controls the WB-EMS group significantly improved in physical functioning indicated by a higher increase in the 6-min-walking distance (p = 0.046). A combined therapeutic intervention of WB-EMS and protein-rich nutritional support seems to be safe and effective in improving skeletal muscle mass and body composition in hematological cancer patients during active oncological treatment. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02293239.
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Affiliation(s)
- Kristin Schink
- Hector-Center for Nutrition, Exercise and Sports, Department of Medicine 1, University Hospital Erlangen, Friedrich–Alexander University Erlangen–Nürnberg, Erlangen, Germany
| | - Dejan Reljic
- Hector-Center for Nutrition, Exercise and Sports, Department of Medicine 1, University Hospital Erlangen, Friedrich–Alexander University Erlangen–Nürnberg, Erlangen, Germany
| | - Hans J. Herrmann
- Hector-Center for Nutrition, Exercise and Sports, Department of Medicine 1, University Hospital Erlangen, Friedrich–Alexander University Erlangen–Nürnberg, Erlangen, Germany
| | - Julia Meyer
- Hector-Center for Nutrition, Exercise and Sports, Department of Medicine 1, University Hospital Erlangen, Friedrich–Alexander University Erlangen–Nürnberg, Erlangen, Germany
| | - Andreas Mackensen
- Department of Medicine 5 – Haematology and Oncology, University Hospital Erlangen, Friedrich–Alexander University Erlangen–Nürnberg, Erlangen, Germany
| | - Markus F. Neurath
- Department of Medicine 1 – Gastroenterology, Pneumology and Endocrinology, University Hospital Erlangen, Friedrich–Alexander University Erlangen–Nürnberg, Erlangen, Germany
| | - Yurdagül Zopf
- Hector-Center for Nutrition, Exercise and Sports, Department of Medicine 1, University Hospital Erlangen, Friedrich–Alexander University Erlangen–Nürnberg, Erlangen, Germany
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20
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Schink K, Herrmann HJ, Schwappacher R, Meyer J, Orlemann T, Waldmann E, Wullich B, Kahlmeyer A, Fietkau R, Lubgan D, Beckmann MW, Hack C, Kemmler W, Siebler J, Neurath MF, Zopf Y. Effects of whole-body electromyostimulation combined with individualized nutritional support on body composition in patients with advanced cancer: a controlled pilot trial. BMC Cancer 2018; 18:886. [PMID: 30208857 PMCID: PMC6134788 DOI: 10.1186/s12885-018-4790-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 09/03/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Physical 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. METHODS In 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. RESULTS Twenty-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. CONCLUSIONS Supervised 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 REGISTRATION ClinicalTrials.gov NCT02293239 (Date: November 18, 2014).
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Affiliation(s)
- Kristin Schink
- Department of Medicine 1 – Gastroenterology, Pneumology and Endocrinology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Ulmenweg 18, 91054 Erlangen, Germany
| | - Hans J. Herrmann
- Department of Medicine 1 – Gastroenterology, Pneumology and Endocrinology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Ulmenweg 18, 91054 Erlangen, Germany
| | - Raphaela Schwappacher
- Department of Medicine 1 – Gastroenterology, Pneumology and Endocrinology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Ulmenweg 18, 91054 Erlangen, Germany
| | - Julia Meyer
- Department of Medicine 1 – Gastroenterology, Pneumology and Endocrinology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Ulmenweg 18, 91054 Erlangen, Germany
| | - Till Orlemann
- Department of Medicine 1 – Gastroenterology, Pneumology and Endocrinology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Ulmenweg 18, 91054 Erlangen, Germany
| | - Elisabeth Waldmann
- Institute of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsstraße 22, 91054 Erlangen, Germany
| | - Bernd Wullich
- Department of Urology and Pediatric Urology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Rathsberger Straße 57, 91054 Erlangen, Germany
| | - Andreas Kahlmeyer
- Department of Urology and Pediatric Urology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Rathsberger Straße 57, 91054 Erlangen, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Universitätsstraße 27, 91054 Erlangen, Germany
| | - Dorota Lubgan
- Department of Radiation Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Universitätsstraße 27, 91054 Erlangen, Germany
| | - Matthias W. Beckmann
- Department of Obstetrics and Gynaecology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Universitätsstraße 21/23, 91054 Erlangen, Germany
| | - Carolin Hack
- Department of Obstetrics and Gynaecology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Universitätsstraße 21/23, 91054 Erlangen, Germany
| | - Wolfgang Kemmler
- Institute of Medical Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Henkestraße 91, 91052 Erlangen, Germany
| | - Jürgen Siebler
- Department of Medicine 1 – Gastroenterology, Pneumology and Endocrinology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Ulmenweg 18, 91054 Erlangen, Germany
| | - Markus F. Neurath
- Department of Medicine 1 – Gastroenterology, Pneumology and Endocrinology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Ulmenweg 18, 91054 Erlangen, Germany
| | - Yurdagül Zopf
- Department of Medicine 1 – Gastroenterology, Pneumology and Endocrinology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Ulmenweg 18, 91054 Erlangen, Germany
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Kufeldt J, Viehrig M, Schweikert D, Fritsche A, Bamberg M, Adolph M. Treatment of malnutrition decreases complication rates and shortens the length of hospital stays in a radiation oncology department. Strahlenther Onkol 2018; 194:1049-1059. [DOI: 10.1007/s00066-018-1360-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 08/17/2018] [Indexed: 01/16/2023]
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Erickson N, Paradies K, Buchholz D, Huebner J. Nutrition care of cancer patients-A survey among physicians and nurses. Eur J Cancer Care (Engl) 2018; 27:e12855. [DOI: 10.1111/ecc.12855] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2018] [Indexed: 11/28/2022]
Affiliation(s)
- N. Erickson
- Comprehensive Cancer Center; Ludwig-Maximilian-University Munich (CCC LMU); Munich Germany
| | - K. Paradies
- Working Group KOK (Conference of Oncological Nurses of the German Cancer Society); Berlin Germany
| | - D. Buchholz
- School for Dietetics; University Medical Center of the Johannes Gutenberg University Mainz; Mainz Germany
| | - J. Huebner
- Medizinische Klinik II; Universitätsklinikum Jena; Jena Germany
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Abstract
BACKGROUND Cachexia is a multifactorial and complex syndrome characterized by progressive functional impairment and ongoing loss in quality of life, which lead to a deterioration of the prognosis for affected patients. The prevalence of cachexia can be very high and is up to 80 % in patients with malignant tumors. OBJECTIVE The aim of the study was to assess the relevance of exercise and nutrition in the prevention and therapy of cachexia. METHODS An evaluation of the current literature on exercise and nutritional therapy in patients with cachexia or with advanced stage diseases where a high prevalence of cachexia is probable, was carried out. RESULTS There is a lack of scientific evidence for the benefits of exercise in cachexia. A major problem of relevant studies was that cachexia was frequently not defined according to valid criteria; however, data indicate a benefit of exercise training in patients with advanced diseases associated with a high prevalence of cachexia. A solely nutritional intervention and dietary counselling seem to be of minimal benefit. The administration of omega 3 fatty acids is controversially discussed. CONCLUSION Although there is a lack of data on the effects of exercise and nutritional therapy in cachexia, there is evidence for the benefits. The present data indicate the necessity for the use of a multimodal treatment including exercise, nutritional and pharmacological therapy in cachexia. There is a great necessity for prospective studies.
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Affiliation(s)
- B Wilms
- Medizinische Klinik I, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - S M Schmid
- Medizinische Klinik I, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
| | - K Luley
- Medizinische Klinik I, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - J Wiskemann
- Medizinische Onkologie, Nationales Centrum für Tumorerkrankungen, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - H Lehnert
- Medizinische Klinik I, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
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Rosania R, Chiapponi C, Malfertheiner P, Venerito M. Nutrition in Patients with Gastric Cancer: An Update. Gastrointest Tumors 2016; 2:178-87. [PMID: 27403412 DOI: 10.1159/000445188] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 03/03/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Nutritional management of patients with gastric cancer (GC) represents a challenge. SUMMARY This review provides an overview of the present evidence on nutritional support in patients with GC undergoing surgery as well as in those with advanced disease. KEY MESSAGE For patients undergoing surgery, the preoperative nutritional condition directly affects postoperative prognosis, overall survival and disease-specific survival. Perioperative nutritional support enriched with immune-stimulating nutrients reduces overall complications and hospital stay but not mortality after major elective gastrointestinal surgery. Early enteral nutrition after surgery improves early and long-term postoperative nutritional status and reduces the length of hospitalization as well. Vitamin B12 and iron deficiency are common metabolic sequelae after gastrectomy and warrant appropriate replacement. In malnourished patients with advanced GC, short-term home complementary parenteral nutrition improves the quality of life, nutritional status and functional status. Total home parenteral nutrition represents the only modality of caloric intake for patients with advanced GC who are unable to take oral or enteral nutrition. PRACTICAL IMPLICATIONS Early evaluations of nutritional status and nutritional support represent key aspects in the management of GC patients with both operable and advanced disease.
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Affiliation(s)
- Rosa Rosania
- Departments of Gastroenterology, Hepatology and Infectious Diseases, Magdeburg, Germany
| | - Costanza Chiapponi
- Departments of General, Visceral and Vascular Surgery, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Peter Malfertheiner
- Departments of Gastroenterology, Hepatology and Infectious Diseases, Magdeburg, Germany
| | - Marino Venerito
- Departments of Gastroenterology, Hepatology and Infectious Diseases, Magdeburg, Germany
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