FROM LABORATORY TO BEDSIDE - NEW STRATEGIES IN THE TREATMENT OF MALNUTRITION IN CANCER-PATIENTS

The objective of this review is to present and discuss the current and the possible future perspectives of artificial nutrition in preventin g and treating cancer cachexia. English-language studies published in the last 25 years were retrieved using MEDLINE, bibliographies and con sultation with experts. MEDLINE search terms included ''cancer,'' ''ma lnutrition;'' and ''nutritional suppoa.'' In vivo and in vitro control led studies were selected, and data from each study were independently abstracted by the authors. Data obtained indicate that cancer cachexi a is a common manifestation of advanced malignant disease, characteriz ed by marasmus due to impaired nutrient metabolism, weight loss, and a nemia, In patients, the presence of cachexia increases morbidity and m ortality, delays or impedes the delivery of the adequate treatment, re duces the efficacy of anti-neoplastic therapy, and impairs patient's q uality of life. Indirect evidence indicates that cancer cachexia is me diated by circulating cytokines, produced by the host in response to t he presence of the malignancy. In the past two decades, nutritional su pport was used to counteract the detrimental effect of cancer cachexia on the host, but with limited success. More recently, the better unde rstanding of the mechanisms of cancer cachexia and the identification of pharmacologic effects provided by specific nutrients, has formed th e rationale for a ''new'' mode of nutrition therapy/nutritional suppor t, adding pharmacotherapy to adjunctive initial care.