Standards, options and recommendations for nutritional support in adult patients with advanced or terminal cancer

Context. The "Standards, Options and Recommendations" (SOR) project, starte d in 1993, is a collaboration between the National Federation of Comprehens ive Cancer Centres (FNCLCC), the 20 French Cancer Centers and specialists f rom French Public Universities, General Hospitals and Private Clinics. The main objective is the development of clinical practice guidelines to improv e the quality of health care and outcome for cancer patients. The methodolo gy is based on literature review and critical appraisal by a multidisciplin ary group of experts, with feedback from specialists in cancer care deliver y. Objectives. To develop clinical practice guidelines according to the def initions of the Standards, Options and Recommendations project far nutritio nal support in adult patients with advanced or terminal cancer. Methods. Da ta were identified by searching Medline; web sites and using the personal r eference lists of members of the expert groups. Once the guidelines were de fined, the document was submitted for review to 95 independent reviewers. R esults. The main recommendations for nutritional support in adult patients with advanced or terminal cancer are: I) Palliative care has been defined i n a consensual way and is governed by the law (standard). Nutritional suppo rt is a palliative care which aim is to maintain and restore the "well-bein g" of the patient (standard). 2) Digestive symptoms and nutritional trouble s are frequently noted in patients with advanced or terminal cancer (standa rd, level of evidence B2). Karnofsky index (KI'S) and performance status (P S) are functional scores with a prognostic value and have to be used (stand ard, level of evidence B2). 3) Anorexia has a bad predictive value in patie nts with advanced or terminal cancer (standard, level of evidence B2). 4) I n France, patients with advanced or terminal cancer are referred to medical institutions, palliative care units or remained at home (standard). Patien ts need a multidisciplinary follow-up (standard). An active participation o f patients and/or their family circle is very important and physicians have to pay attention for their opinions (standard). 5) Dietetic counseling can help patients to improve their alimentation and its drawbacks (standard). Palliative nutritional care often includes medicinal treatments (standard). 7) Artificial nutrition can slow down nutritional degradation, avoid dehyd ration and improve quality of life in patients with advanced stage cancer ( especially head and neck cancer for enteral nutrition arid digestive occlus ions for parenteral nutrition) and unable to eat adapted meals (standard, l evel of evidence C). 8) IX hen life expectancy is below 3 months with a KPS less than or equal to 50% (or PS > 2), artificial nutrition is not recomme nded (recommendation, expert agreement). 9) The assessment of nutritional c are in patients with advanced or terminal cancer has to include functional scores measurement, quality of life and satisfaction degree of the patient and/or their family (standard, expert agreement).