The nutritional status of cancer patients can be evaluated as an independent prognostic factor.

Professor Shim Seon-jin (Department of Oncology, Gachon University Gil Hospital)

Nutritional status is very important for cancer patients. However, according to reports, the prevalence of malnutrition in cancer patients reaches 40-80%.1) In a domestic study, about 61% of hospitalized cancer patients were malnourished.2) Malnutrition accounts for about 20-50% of deaths among cancer patients.3) However, the reality is that the nutrition problem is overlooked because it is difficult for clinicians who are constantly suffering from a shortage of manpower to focus on the treatment of the disease itself.

The main cause of malnutrition in cancer patients can be found in the cancer cells themselves. Cancer cells increase nutrient requirements due to changes in carbohydrate, fat, and protein metabolism, and also cause abnormalities in acid-base balance, electrolyte concentration, and vitamin or mineral concentration. In addition, dysesthesias of taste and smell due to tumor metabolites and anorexia due to psychological problems may occur. Treatment methods such as surgery, chemotherapy, and radiation therapy also directly or indirectly affect nutritional status, leading to malnutrition.3)

Chemotherapy, which is one of the cancer treatment methods, specifically destroys cells that are actively growing and dividing in the human body, so cells in the gastrointestinal tract, which divide rapidly, can also be severely damaged. This can cause nausea and vomiting, leading to insufficient food intake and worsening nutritional status, leading to a state in which treatment cannot be continued. In a domestic study of patients receiving chemotherapy, food intake decreased by 330 cc from 1,450 cc before chemotherapy to 1,120 cc after administration (P<0.000). In addition, body weight decreased by about 1 kg before and after administration (P<0.033), and in the case of BMI, it was confirmed that it significantly decreased from 22.08 before administration to 21.26 after administration and 21.33 after re-hospitalization (P<0.037). Of the total subjects, 79.6% of the subjects were prescribed antiemetics, but only 6.1% of the patients were prescribed nutritional infusions. showed the effect of chemotherapy on nutritional status.4)

Malnutrition can make it difficult for patients to tolerate chemotherapy or radiation therapy, reducing the effectiveness of treatment. They become more susceptible to infection and are also associated with increased morbidity, mortality, length of hospital stay and health care costs.5) In addition, protein, fat, water, and mineral depletion can lead to cancer cachexia, which clinically causes weight loss, muscle wasting, taste changes, and loss of appetite, resulting in deterioration of physical and mental functions. have a devastating effect on life.3)

Therefore, nutritional status in cancer patients can be said to be an independent prognostic factor. In a study published in the Journal of Clinical Oncology, 2,693 cancer patients were classified as cachexia severity by considering BMI and %WL (weight loss (%)). And as a result of comparing the median survival values ​​according to the grades, the median survival values ​​according to the cachexia grade were 20.9 months for grade 0 and 4.3 months for grade 4, showing a 4.9-fold difference between grades 0 and 4. This shows that BMI and %WL can function as significant predictors of survival rate, and it was confirmed that regular observation and management of patient BMI as well as weight loss rate are necessary.6)

It is very important to conduct nutritional counseling, treat symptoms that interfere with food intake, and supplement nutritional deficiencies for patients at risk of malnutrition or malnutrition through regular observation. Cancer patients need 25-30 kcal/kg/day of energy and 1-1.5 g/kg/day of protein.7) It is also recommended to administer fat to increase energy density to provide sufficient nutrition and to supply essential fatty acids that are easily deficient in cancer patients. If necessary, more aggressive nutrition should be provided through Oral Nutritional Supplements (ONS) with EN or Supplemental Parenteral Nutrition (SPN) with EN plus PN. application can be considered.

Furthermore, when chemotherapy or outpatient visits are made, it is also worth considering intravenous nutritional treatment by utilizing the time spent in the hospital. In patients with severe nausea and vomiting, intravenous nutrition may provide comfort. Currently, most are prescribing amino acid or lipid single drug solution, but it is said that a low-dose product that can be administered within 2 hours of 3-chamber TPN, which was difficult to prescribe due to limitations in administration time and cost, is being developed. Therefore, if you use this part, you can make a multifaceted and active effort to improve nutrition.

Most oncologists are wary of weight loss in cancer patients and work to correct it. However, in many cases, it is not realistic to pay as much attention to nutritional treatment as to cancer treatment, which is an underlying disease. According to a paper published in Clinical & Translational Oncology, among the many causes of malnutrition in cancer patients, the factors attributed to medical staff include inadequate nutritional evaluation, lack of knowledge and training to identify malnutrition, and appropriate administration of EN or PN. I heard you miss the start time.8) In Korea, since the number of intensive nutrition treatment by the Nutrition Intensive Support Team (NST) in 2014, professional nutrition interventions by the Intensive Nutrition Support Team have been increasing. It may reduce blind spots in uncontrolled cancer patients and improve nutritional status as an independent prognostic factor.

[Reference]
1) Nutrition support in cancer patients JPEN, 26 (suppl) (2002), pp. S63-S71
2) According to GA et al. Nutrition. 2010 Mar;26(3):263-8.
3) Hanyang Medical Reviews Vol. 31 No. 4, 2011
4) Journal of the Korean Society of Nursing, June 30, 2000, No. 3
5) Nutrition. 2010 Mar;26(3):263-8.
6) J Clin Oncol. 2015 Jan 1;33(1):90-9.
7) Clinical Nutrition 40 (2021) 2898-2913
8) Clin Transl Oncol 2018 20(5) 619-629.

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