营养治疗是肿瘤的一线治疗
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摘要
恶性肿瘤是我国居民第一死亡原因,而我国肿瘤患者的5年生存率显著低于发达国家,其原因是多方面的,轻视营养不良是主要原因之一。我国肿瘤患者的营养不良发病率高,但是治疗率低。由于营养宣教相对缺乏,许多营养误区得不到纠正和(或)引导。肿瘤患者的营养不良除了导致自身体重丢失、肌肉减少,还会增加医疗支出、增加社会的负担。肿瘤营养疗法是计划、实施、评价营养干预,以治疗肿瘤及其并发症或身体状况,从而改善肿瘤患者预后的过程,包括营养诊断(营养筛查、营养评估、综合评价3级诊断)、营养治疗、疗效评价(包括随访)3个阶段。实施营养治疗不仅能改善营养状况,更能提高临床效果,改善生活质量,延长生存时间,同时节约医疗费用。营养治疗是与手术、放疗、化疗、免疫治疗等肿瘤基本治疗方法并重的一个独立疗法,应该成为肿瘤患者的一线治疗。
Malignant tumor has become the No. 1 cause of death in China with a significantly lower 5-year survival rate than that of developed countries. Failure to intervene malnutrition among cancer patients is partially responsible for this phenomenon. Incidence of malnutrition is high,but its treatment rate is low in Chinese cancer patients. Clinicians and cancer patients are short of the awareness of nutrition treatment, yet full of misinformation due to lack of nutritional education. Besides causing weight loss and muscle loss among cancer patients, malnutrition would also increase medical costs and put a burden on society. Cancer nutrition therapy(CNT) is the process of planning, applying, and evaluating nutrition treatment for cancer patients. Aiming to treat cancer, improve body conditions, and improve prognosis, CNT involves three stages, including nutritional diagnosis(three levels composing of nutritional screening, nutritional assessment, and comprehensive evaluation), nutritional treatment, and efficacy evaluation(including follow-ups). Implementation of nutrition therapy assists in improving nutritional status, clinical efficacy and quality of life, extending survival time, and reducing costs. Nutrition therapy, as an independent therapy in addition to conventional anti-cancer treatments such as surgery, radiotherapy, chemotherapy, and immunotherapy, should be the first-line therapy for cancer patients.
Malignant tumor has become the No. 1 cause of death in China with a significantly lower 5-year survival rate than that of developed countries. Failure to intervene malnutrition among cancer patients is partially responsible for this phenomenon. Incidence of malnutrition is high,but its treatment rate is low in Chinese cancer patients. Clinicians and cancer patients are short of the awareness of nutrition treatment, yet full of misinformation due to lack of nutritional education. Besides causing weight loss and muscle loss among cancer patients, malnutrition would also increase medical costs and put a burden on society. Cancer nutrition therapy(CNT) is the process of planning, applying, and evaluating nutrition treatment for cancer patients. Aiming to treat cancer, improve body conditions, and improve prognosis, CNT involves three stages, including nutritional diagnosis(three levels composing of nutritional screening, nutritional assessment, and comprehensive evaluation), nutritional treatment, and efficacy evaluation(including follow-ups). Implementation of nutrition therapy assists in improving nutritional status, clinical efficacy and quality of life, extending survival time, and reducing costs. Nutrition therapy, as an independent therapy in addition to conventional anti-cancer treatments such as surgery, radiotherapy, chemotherapy, and immunotherapy, should be the first-line therapy for cancer patients.
引文
[1]郑荣寿,孙可欣,张思维,等.2015年中国恶性肿瘤流行情况分析[J].中华肿瘤杂志,2019,41(1):19-28.
[2] Zeng H,Chen W,Zheng R,et al. Changing cancer survival in China during 2003-15:a pooled analysis of 17 population-based cancer registries[J]. Lancet Glob Health, 2018, 6(5):e555-e567.
[3] Noone A M,Howlader N,Krapcho M,et al. SEER cancer statistics review, 1975-2015, National Cancer Institute[EB/OL].(2016-12-06)[2019-02-21]. https://seer. cancer. gov/csr/1975_2015/.
[4] Siegel R L,Miller K D,Jemal A. Cancer statistics,2019[J]. CA Cancer J Clin,2019,69(1):7-34.
[5]贺英,林欣,刘莉,等.重庆市某医院常见恶性肿瘤住院患者营养状况调查[J].肿瘤代谢与营养电子杂志,2017,4(1):45-50.
[6] Song C,Cao J, Zhang F,et al. Nutritional risk assessment by scored patient-generated subjective global assessment associated with demographic characteristics in 23 904 common malignant tumors patients[J]. Nutr Cancer,2019,71(1):50-60.
[7] Cong M,Wang J,Fang Y,et al. A multi-center survey on dietary knowledge and behavior among inpatients in oncology department[J]. Support Care Cancer,2018,26(7):2285-2292.
[8]张晓伟,李薇,陈公琰,等.中国肿瘤患者营养知识-态度-行为调查分析[J].肿瘤代谢与营养电子杂志,2015,2(4):4347.
[9]丛明华,王杰军,方玉,等.肿瘤内科住院患者膳食认知行为横断面多中心研究[J].肿瘤代谢与营养电子杂志,2017,4(1):39-44.
[10]张晓伟,李增宁,石汉平.医学生营养知识-态度-行为现状调查分析[J].中华普通外科学文献(电子版),2013,7(5):62-64.
[11]张晓伟,李薇,陈公琰,等.中国医务人员肿瘤营养知识-态度-行为调查分析[J].肿瘤代谢与营养电子杂志,2016,3(2):108-113.
[12] Ottery F D. Definition of standardized nutritional assessment and interventional pathways in oncology[J]. Nutrition, 1996,12(Suppl):S15-S19.
[13] Ryan A M,Power D G,Daly L,et al. Cancer-associated malnutrition,cachexia and sarcopenia:the skeleton in the hospital closet40 years later[J]. Proc Nutr Soc,2016,75(2):199-211.
[14] Cederholm T,Jensen G L,Correia M I T D,et al. GLIM criteria for the diagnosis of malnutrition:a consensus report from the global clinical nutrition community[J]. Clin Nutr,2019,38(1):1-9.
[15] Jensen G L,Cederholm T,Correia M I T D,et al. GLIM criteria for the diagnosis of malnutrition:a consensus report from the global clinical nutrition community[J]. J Parenter Enteral Nutr,2019,43(1):32-40.
[16] Bosaeus I,Daneryd P,Lundholm K. Dietary intake,resting energy expenditure, weight loss and survival in cancer patients[J]. J Nutr,2002,132(11 Suppl):S3465-S3466.
[17] Dewys W D, Begg C, Lavin P T, et al. Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern Cooperative Oncology Group[J]. Am J Med, 1980,69(4):491-497.
[18] Andreyev H J,Norman A R,Oates J,et al. Why do patients with weight loss have a worse outcome when undergoing chemotherapy for gastrointestinal malignancies[J]. Eur J Cancer, 1998,34(4):503-509.
[19] Peterson S J,Mozer M. Differentiating sarcopenia and cachexia among patients with cancer[J]. Nutr Clin Pract,2017,32(1):30-39.
[20] Salandini M C,Pecorelli N,De Nardi P,et al. Muscle loss in cancer patients:pathophysiology and impact on theoutcome[J]. J Nutr Oncol,2016,1(1):15-20.
[21] Schaap L A,van Schoor N M,Lips P,et al. Associations of sarcopenia definitions, and their components, with the incidence of recurrent falling and fractures:the longitudinal aging study Amsterdam[J].J Gerontol A Biol Sci Med Sci, 2018,73(9):1199-1204.
[22] Leong D P,Teo K K,Rangarajan S,et al. Prognostic value of grip strength:findings from the prospective urban rural epidemiology(PURE)study[J]. Lancet,2015,386(9990):266-273.
[23] Ibrahim K,May C R, Patel H P,et al. Implementation of grip strength measurement in medicine for older people wards as part of routine admission assessment:identifying facilitators and barriers using a theory-led intervention[J]. BMC Geriatr,2018,18(1):79.
[24] Shiroyama T,Nagatomo I,Koyama S,et al. Impact of sarcopeniain patients with advanced non-small cell lung cancer treated with PD-1 inhibitors:a preliminary retrospective study[J]. Sci Rep,2019,9(1):2447.
[25] Nakamura R, Inage Y,Tobita R,et al. Sarcopenia in Resected NSCLC:effect on postoperative outcomes[J]. J Thorac Oncol,2018,13(7):895-903.
[26] Goates S,Du K, Braunschweig C A,et al. Economic burden of disease-associated malnutrition at the state level[J]. PLoS One,2016,11(9):e0161833.
[27] Snider J T,Linthicum M T, Wu Y,et al. Economic burden of community-based disease-associated malnutrition in the United States[J]. JPEN J Parenter Enteral Nutr,2014,38(2 Suppl):S77-S85.
[28] Inotai A,Nuijten M,Roth E,et al. Modelling the burden of disease-associated malnutrition[J]. e-SPEN Journal,2012,7(5):e196-e204.
[29]石汉平.肿瘤营养疗法[J].中国肿瘤临床,2014,41(18):1141-1145.
[30]石汉平,赵青川,王昆华,等.营养不良的三级诊断[J].肿瘤代谢与营养电子杂志,2015,2(2):31-36.
[31] Hutton J L,Martin L,Field C J,et al. Dietary patterns in patients with advanced cancer:implications for anorexia-cachexia therapy[J]. Am J Clin Nutr,2006,84(5):1163-1170.
[32] Llop-Talaveron J M,Farran-Teixidor L,Badia-Tahull M B,et al.Artificial nutritional support in cancer patients after esophagectomy:11 years of experience[J]. Nutr Cancer,2014,66(6):1038-1046.
[33] Peng J,Cai J,Niu Z X,et al. Early enteral nutrition compared with parenteral nutrition for esophageal cancer patients after esophagectomy:a meta-analysis[J]. Dis Esophagus, 2016,29(4):333-341.
[34] Takesue T,Takeuchi H,Ogura M,et al. A prospective randomized trial of enteral nutrition after thoracoscopic esophagectomy for esophageal cancer[J]. Ann Surg Oncol,2016,23(Suppl 5):S1060-S1061.
[35] Wu W,Zhong M,Zhu D M,et al. Effect of early full-Calorie nutrition support following esophagectomy:arandomized controlled trial[J].JPEN J Parenter Enteral Nutr,2017,41(7):1146-1154.
[36] Adiamah A,Skorepa P,Weimann A,et al. The impact of preoperative immune modulating nutrition on outcomes in patients undergoing surgery for gastrointestinal cancer:asystematic review and meta-analysis[J]. Ann Surg,2019. DOI:10. 1097/SLA. 0000000000003256.
[37] Moya P, Miranda E, Soriano-Irigaray L,et al. Perioperative immunonutrition in normo-nourished patients undergoing laparo-scopic colorectal resection[J]. Surg Endosc, 2016,30(11)4946-4953.
[38] Sakurai Y. Nutritional management of cancer patients undergoing chemotherapy and chemoradiation therapy[J]. J Nutr Oncol,2016,1(1):10-14.
[39] Lundholm K,Daneryd P,Bosaeus I,et al. Palliative nutritional intervention in addition to cyclooxygenase and erythropoietin treatment for patients with malignant disease:effects on survival, metabolism, and function[J]. Cancer,2004,100(9):1967-1977.
[40] Khosravi A, Esfahani-Monfared Z, Seifi S, et al. Prospective randomized phase II parallel study of vinorelbine maintenance therapy versus best supportive care in advanced non-small cell lung cancer[J]. Tanaffos,2017,6(3):207-216.
[41] Yeh K Y,Hsia S,Chang P H,et al. Comprehensive nutrition intervention with omega-3 fatty acid, micronutrient and probioticenriched regimens improves malnutrition in patients with head and neck cancers[J]. J Nutri Oncol, 2016,1(1):44-45.
[42]石汉平,江华,李薇,等.中国肿瘤营养治疗指南[M].北京:人民卫生出版社,2015.
[43] Philipson T J,Snider J T,Lakdawalla D N,et al. Impact of oral nutritional supplementation on hospital outcomes[J]. Am J Manag Care,2013,19(2):121-128.
[44] Snider J T,Jena A B,Linthicum M T,et al. Effect of hospital use of oral nutritional supplementation on length of stay, hospital cost, and 30-day readmissions among medicare patients with COPD[J]. Chest,2015,147(6):1477-1484.
[45] Stratton R J,H6buterne X,Elia M. A systematic review and metaanalysis of the impact of oral nutritional supplements on hospital readmissions[J]. Ageing Res Rev,2013,12(4):884-897.
[46] Elia M, Normand C, Laviano A, et al. A systematic review of the cost and cost effectiveness of using standard oral nutritional supplements in community and care home settings[J]. Clin Nutr,2016,35(1):125-137.
[47] Sulo S, Feldstein J, Partridge J, et al. Budget impact of a comprehensive nutrition-focused quality improvement program for malnourished hospitalized patients[J]. Am Health Drug Benefits,2017,10(5);262-270.
[48]石汉平,陈伟,杨柳青,等.建设“无饿医院”[J].肿瘤代谢与营养电子杂志,2018,5(3):225-230.
[49]石汉平.整体营养疗法[J].肿瘤代谢与营养电子杂志,2017,4(2):130-135.
[50]石汉平.营养疗法应该成为肿瘤患者的基本治疗[J].中华结直肠疾病电子杂志,2013,2(3):99-101.
[51]石汉平.肿瘤营养[M].北京:科学技术文献出版社,2018.
[2] Zeng H,Chen W,Zheng R,et al. Changing cancer survival in China during 2003-15:a pooled analysis of 17 population-based cancer registries[J]. Lancet Glob Health, 2018, 6(5):e555-e567.
[3] Noone A M,Howlader N,Krapcho M,et al. SEER cancer statistics review, 1975-2015, National Cancer Institute[EB/OL].(2016-12-06)[2019-02-21]. https://seer. cancer. gov/csr/1975_2015/.
[4] Siegel R L,Miller K D,Jemal A. Cancer statistics,2019[J]. CA Cancer J Clin,2019,69(1):7-34.
[5]贺英,林欣,刘莉,等.重庆市某医院常见恶性肿瘤住院患者营养状况调查[J].肿瘤代谢与营养电子杂志,2017,4(1):45-50.
[6] Song C,Cao J, Zhang F,et al. Nutritional risk assessment by scored patient-generated subjective global assessment associated with demographic characteristics in 23 904 common malignant tumors patients[J]. Nutr Cancer,2019,71(1):50-60.
[7] Cong M,Wang J,Fang Y,et al. A multi-center survey on dietary knowledge and behavior among inpatients in oncology department[J]. Support Care Cancer,2018,26(7):2285-2292.
[8]张晓伟,李薇,陈公琰,等.中国肿瘤患者营养知识-态度-行为调查分析[J].肿瘤代谢与营养电子杂志,2015,2(4):4347.
[9]丛明华,王杰军,方玉,等.肿瘤内科住院患者膳食认知行为横断面多中心研究[J].肿瘤代谢与营养电子杂志,2017,4(1):39-44.
[10]张晓伟,李增宁,石汉平.医学生营养知识-态度-行为现状调查分析[J].中华普通外科学文献(电子版),2013,7(5):62-64.
[11]张晓伟,李薇,陈公琰,等.中国医务人员肿瘤营养知识-态度-行为调查分析[J].肿瘤代谢与营养电子杂志,2016,3(2):108-113.
[12] Ottery F D. Definition of standardized nutritional assessment and interventional pathways in oncology[J]. Nutrition, 1996,12(Suppl):S15-S19.
[13] Ryan A M,Power D G,Daly L,et al. Cancer-associated malnutrition,cachexia and sarcopenia:the skeleton in the hospital closet40 years later[J]. Proc Nutr Soc,2016,75(2):199-211.
[14] Cederholm T,Jensen G L,Correia M I T D,et al. GLIM criteria for the diagnosis of malnutrition:a consensus report from the global clinical nutrition community[J]. Clin Nutr,2019,38(1):1-9.
[15] Jensen G L,Cederholm T,Correia M I T D,et al. GLIM criteria for the diagnosis of malnutrition:a consensus report from the global clinical nutrition community[J]. J Parenter Enteral Nutr,2019,43(1):32-40.
[16] Bosaeus I,Daneryd P,Lundholm K. Dietary intake,resting energy expenditure, weight loss and survival in cancer patients[J]. J Nutr,2002,132(11 Suppl):S3465-S3466.
[17] Dewys W D, Begg C, Lavin P T, et al. Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern Cooperative Oncology Group[J]. Am J Med, 1980,69(4):491-497.
[18] Andreyev H J,Norman A R,Oates J,et al. Why do patients with weight loss have a worse outcome when undergoing chemotherapy for gastrointestinal malignancies[J]. Eur J Cancer, 1998,34(4):503-509.
[19] Peterson S J,Mozer M. Differentiating sarcopenia and cachexia among patients with cancer[J]. Nutr Clin Pract,2017,32(1):30-39.
[20] Salandini M C,Pecorelli N,De Nardi P,et al. Muscle loss in cancer patients:pathophysiology and impact on theoutcome[J]. J Nutr Oncol,2016,1(1):15-20.
[21] Schaap L A,van Schoor N M,Lips P,et al. Associations of sarcopenia definitions, and their components, with the incidence of recurrent falling and fractures:the longitudinal aging study Amsterdam[J].J Gerontol A Biol Sci Med Sci, 2018,73(9):1199-1204.
[22] Leong D P,Teo K K,Rangarajan S,et al. Prognostic value of grip strength:findings from the prospective urban rural epidemiology(PURE)study[J]. Lancet,2015,386(9990):266-273.
[23] Ibrahim K,May C R, Patel H P,et al. Implementation of grip strength measurement in medicine for older people wards as part of routine admission assessment:identifying facilitators and barriers using a theory-led intervention[J]. BMC Geriatr,2018,18(1):79.
[24] Shiroyama T,Nagatomo I,Koyama S,et al. Impact of sarcopeniain patients with advanced non-small cell lung cancer treated with PD-1 inhibitors:a preliminary retrospective study[J]. Sci Rep,2019,9(1):2447.
[25] Nakamura R, Inage Y,Tobita R,et al. Sarcopenia in Resected NSCLC:effect on postoperative outcomes[J]. J Thorac Oncol,2018,13(7):895-903.
[26] Goates S,Du K, Braunschweig C A,et al. Economic burden of disease-associated malnutrition at the state level[J]. PLoS One,2016,11(9):e0161833.
[27] Snider J T,Linthicum M T, Wu Y,et al. Economic burden of community-based disease-associated malnutrition in the United States[J]. JPEN J Parenter Enteral Nutr,2014,38(2 Suppl):S77-S85.
[28] Inotai A,Nuijten M,Roth E,et al. Modelling the burden of disease-associated malnutrition[J]. e-SPEN Journal,2012,7(5):e196-e204.
[29]石汉平.肿瘤营养疗法[J].中国肿瘤临床,2014,41(18):1141-1145.
[30]石汉平,赵青川,王昆华,等.营养不良的三级诊断[J].肿瘤代谢与营养电子杂志,2015,2(2):31-36.
[31] Hutton J L,Martin L,Field C J,et al. Dietary patterns in patients with advanced cancer:implications for anorexia-cachexia therapy[J]. Am J Clin Nutr,2006,84(5):1163-1170.
[32] Llop-Talaveron J M,Farran-Teixidor L,Badia-Tahull M B,et al.Artificial nutritional support in cancer patients after esophagectomy:11 years of experience[J]. Nutr Cancer,2014,66(6):1038-1046.
[33] Peng J,Cai J,Niu Z X,et al. Early enteral nutrition compared with parenteral nutrition for esophageal cancer patients after esophagectomy:a meta-analysis[J]. Dis Esophagus, 2016,29(4):333-341.
[34] Takesue T,Takeuchi H,Ogura M,et al. A prospective randomized trial of enteral nutrition after thoracoscopic esophagectomy for esophageal cancer[J]. Ann Surg Oncol,2016,23(Suppl 5):S1060-S1061.
[35] Wu W,Zhong M,Zhu D M,et al. Effect of early full-Calorie nutrition support following esophagectomy:arandomized controlled trial[J].JPEN J Parenter Enteral Nutr,2017,41(7):1146-1154.
[36] Adiamah A,Skorepa P,Weimann A,et al. The impact of preoperative immune modulating nutrition on outcomes in patients undergoing surgery for gastrointestinal cancer:asystematic review and meta-analysis[J]. Ann Surg,2019. DOI:10. 1097/SLA. 0000000000003256.
[37] Moya P, Miranda E, Soriano-Irigaray L,et al. Perioperative immunonutrition in normo-nourished patients undergoing laparo-scopic colorectal resection[J]. Surg Endosc, 2016,30(11)4946-4953.
[38] Sakurai Y. Nutritional management of cancer patients undergoing chemotherapy and chemoradiation therapy[J]. J Nutr Oncol,2016,1(1):10-14.
[39] Lundholm K,Daneryd P,Bosaeus I,et al. Palliative nutritional intervention in addition to cyclooxygenase and erythropoietin treatment for patients with malignant disease:effects on survival, metabolism, and function[J]. Cancer,2004,100(9):1967-1977.
[40] Khosravi A, Esfahani-Monfared Z, Seifi S, et al. Prospective randomized phase II parallel study of vinorelbine maintenance therapy versus best supportive care in advanced non-small cell lung cancer[J]. Tanaffos,2017,6(3):207-216.
[41] Yeh K Y,Hsia S,Chang P H,et al. Comprehensive nutrition intervention with omega-3 fatty acid, micronutrient and probioticenriched regimens improves malnutrition in patients with head and neck cancers[J]. J Nutri Oncol, 2016,1(1):44-45.
[42]石汉平,江华,李薇,等.中国肿瘤营养治疗指南[M].北京:人民卫生出版社,2015.
[43] Philipson T J,Snider J T,Lakdawalla D N,et al. Impact of oral nutritional supplementation on hospital outcomes[J]. Am J Manag Care,2013,19(2):121-128.
[44] Snider J T,Jena A B,Linthicum M T,et al. Effect of hospital use of oral nutritional supplementation on length of stay, hospital cost, and 30-day readmissions among medicare patients with COPD[J]. Chest,2015,147(6):1477-1484.
[45] Stratton R J,H6buterne X,Elia M. A systematic review and metaanalysis of the impact of oral nutritional supplements on hospital readmissions[J]. Ageing Res Rev,2013,12(4):884-897.
[46] Elia M, Normand C, Laviano A, et al. A systematic review of the cost and cost effectiveness of using standard oral nutritional supplements in community and care home settings[J]. Clin Nutr,2016,35(1):125-137.
[47] Sulo S, Feldstein J, Partridge J, et al. Budget impact of a comprehensive nutrition-focused quality improvement program for malnourished hospitalized patients[J]. Am Health Drug Benefits,2017,10(5);262-270.
[48]石汉平,陈伟,杨柳青,等.建设“无饿医院”[J].肿瘤代谢与营养电子杂志,2018,5(3):225-230.
[49]石汉平.整体营养疗法[J].肿瘤代谢与营养电子杂志,2017,4(2):130-135.
[50]石汉平.营养疗法应该成为肿瘤患者的基本治疗[J].中华结直肠疾病电子杂志,2013,2(3):99-101.
[51]石汉平.肿瘤营养[M].北京:科学技术文献出版社,2018.