Malnutrition and weight loss are common in patients with cancer for 3 reasons. First, experimentally, cancer has preferentially gotten our calorie then the left over is distributed to our healthy cells. Secondly, cancer treatments such as chemo and radiation decrease our appetite. Finally, depression is common after diagnosis of cancer and may affect our mood and appetite.
It is logical to conclude that our nutritional technology could help cancer patient patients. Some of my patients have asked about having nutrition given to them using intravenous way (TPN-total parenteral nutrition). TPN is a solution mixture of sugar, fat and protein and infused usually in the hospital or sometimes at home. The American Gastroenterological Association (AGA) reviewed 26 randomized trials of parenteral nutritional support in cancer patients, including 19 in those receiving chemotherapy, three in patients being treated with radiation therapy (RT), and four in those undergoing stem cell transplantation. AGA concluded that TPN in cancer patients have no effect in mortality, 40% increase in overall complication rates (16% increase in infection), and 7% reduction in tumor response to treatment.
TPN may play role for a short period in very malnourished patients undergoing surgery. If you are not malnourished, TPN seems to increase complications. In the Veterans Affairs Cooperative Study, 395 malnourished patients who underwent abdominal/chest surgeries (65 percent of whom had cancer) were randomly assigned to TPN for seven days before surgery and three days after surgery or no TPN. Overall, patients receiving TPN had a higher rate of infectious complications (14 versus 6 percent) and a nonsignificant reduction in 30 day mortality (7.3 versus 4.9 percent). However, in the severely malnourished subgroup (n = 24), those treated with TPN had significantly fewer noninfectious complications than controls (43 versus 5 percent)
So, what should we do if we have cancer and losing weight. I recommend to eat 5-6 small meals a day, instead of 3 large meals. Do eat more thick creamy soups, dairy (milk, milk shakes, cheese, yogurt, ice cream) and peanut butters. Nutritional supplement such as Ensure and Boost also are useful but more expensive than milk (Milk has about the same amount of protein). Your doctors could also prescribe appetite stimulants (Progestin and Marinol). However, they have some potential side effects such as depression, blood clot and hallucination. If you ended up in the hospital, some studies suggest that giving you food thru feeding tube is healthier than using TPN. However, there are some circumstances that TPN would still be suitable. Do discuss with you doctor.
Reference:
- Koretz RL, et al. AGA technical review on parenteral nutrition. Gastroenterology. 2001;121(4):970
- Perioperative total parenteral nutrition in surgical patients. The Veterans Affairs Total Parenteral Nutrition Cooperative Study Group. N Engl J Med. 1991;325(8):525.
- Bozzetti F, et al. Postoperative enteral versus parenteral nutrition in malnourished patients with gastrointestinal cancer: a randomised multicentre trial. Lancet. 2001;358(9292):1487.
It is logical to conclude that our nutritional technology could help cancer patient patients. Some of my patients have asked about having nutrition given to them using intravenous way (TPN-total parenteral nutrition). TPN is a solution mixture of sugar, fat and protein and infused usually in the hospital or sometimes at home. The American Gastroenterological Association (AGA) reviewed 26 randomized trials of parenteral nutritional support in cancer patients, including 19 in those receiving chemotherapy, three in patients being treated with radiation therapy (RT), and four in those undergoing stem cell transplantation. AGA concluded that TPN in cancer patients have no effect in mortality, 40% increase in overall complication rates (16% increase in infection), and 7% reduction in tumor response to treatment.
TPN may play role for a short period in very malnourished patients undergoing surgery. If you are not malnourished, TPN seems to increase complications. In the Veterans Affairs Cooperative Study, 395 malnourished patients who underwent abdominal/chest surgeries (65 percent of whom had cancer) were randomly assigned to TPN for seven days before surgery and three days after surgery or no TPN. Overall, patients receiving TPN had a higher rate of infectious complications (14 versus 6 percent) and a nonsignificant reduction in 30 day mortality (7.3 versus 4.9 percent). However, in the severely malnourished subgroup (n = 24), those treated with TPN had significantly fewer noninfectious complications than controls (43 versus 5 percent)
So, what should we do if we have cancer and losing weight. I recommend to eat 5-6 small meals a day, instead of 3 large meals. Do eat more thick creamy soups, dairy (milk, milk shakes, cheese, yogurt, ice cream) and peanut butters. Nutritional supplement such as Ensure and Boost also are useful but more expensive than milk (Milk has about the same amount of protein). Your doctors could also prescribe appetite stimulants (Progestin and Marinol). However, they have some potential side effects such as depression, blood clot and hallucination. If you ended up in the hospital, some studies suggest that giving you food thru feeding tube is healthier than using TPN. However, there are some circumstances that TPN would still be suitable. Do discuss with you doctor.
Reference:
- Koretz RL, et al. AGA technical review on parenteral nutrition. Gastroenterology. 2001;121(4):970
- Perioperative total parenteral nutrition in surgical patients. The Veterans Affairs Total Parenteral Nutrition Cooperative Study Group. N Engl J Med. 1991;325(8):525.
- Bozzetti F, et al. Postoperative enteral versus parenteral nutrition in malnourished patients with gastrointestinal cancer: a randomised multicentre trial. Lancet. 2001;358(9292):1487.
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