The number of new cancers diagnosed worldwide is increasing.
The American Cancer Society estimated that there were 12 million
new cancers diagnosed worldwide in the year 2007, with the
number expected to more than double in the next 50 years (1). The
amount of malnutrition in patients with cancer at first referral
varies by the site and the stage of disease (2). Recent data have
suggested that as many as 56.0% of patients with gastrointestinal
cancers have clinically significant weight loss at first referral (3).
Weight loss at presentation (ie, first referral) is associated with
poorer survival, reduced likelihood of objective response to treatment,
and poorer quality of life (QOL) (2,4,5). The data on weight
loss in cancer patients show convincing associations with poorer
clinical outcomes, but there is no evidence at present to suggest
that there is a causal link between these variables. Despite this,
European, American, and Australian guidelines on the nutritional
management of malnourished patients with cancer have
recommended that nutrition receives prompt attention and that
intervention is commenced in malnourished patients or those in
whom difficulties with eating are anticipated (6–8). The evidence
for these recommendations and ones relating to nutritional intervention
during treatment phases is largely lacking and is mainly on
the basis of expert opinion.
In the United Kingdom, the National Institute for Health and
Clinical Excellence has recommended that health care professionals
should consider oral nutrition support to improve nutritional
intake for people who can swallow safely and who are
malnourished or at risk of malnutrition (9). This recommendation
is on the basis of an analysis that included few trials conducted in
cancer patients and relied largely on trials conducted in the elderly
or perioperative patients. There are no universally accepted cut-offs
for defining malnutrition, but there is broad acceptance that a low
body mass index or substantial amounts of weight loss in the preceding
months are indicative of malnutrition (6,9) and associated
with poorer outcome in cancer patients
The number of new cancers diagnosed worldwide is increasing.The American Cancer Society estimated that there were 12 millionnew cancers diagnosed worldwide in the year 2007, with thenumber expected to more than double in the next 50 years (1). Theamount of malnutrition in patients with cancer at first referralvaries by the site and the stage of disease (2). Recent data havesuggested that as many as 56.0% of patients with gastrointestinalcancers have clinically significant weight loss at first referral (3).Weight loss at presentation (ie, first referral) is associated withpoorer survival, reduced likelihood of objective response to treatment,and poorer quality of life (QOL) (2,4,5). The data on weightloss in cancer patients show convincing associations with poorerclinical outcomes, but there is no evidence at present to suggestthat there is a causal link between these variables. Despite this,European, American, and Australian guidelines on the nutritionalmanagement of malnourished patients with cancer haverecommended that nutrition receives prompt attention and thatintervention is commenced in malnourished patients or those inwhom difficulties with eating are anticipated (6–8). The evidencefor these recommendations and ones relating to nutritional interventionduring treatment phases is largely lacking and is mainly onthe basis of expert opinion.In the United Kingdom, the National Institute for Health andความเป็นเลิศทางคลินิกได้แนะนำว่า สุขภาพผู้เชี่ยวชาญด้านการดูแลควรสนับสนุนโภชนาการปากเพื่อปรับปรุงคุณค่าทางโภชนาการสำหรับคนที่สามารถกลืนได้อย่างปลอดภัย และผู้บริโภคmalnourished ขึ้น ที่เสี่ยงต่อการขาดสารอาหาร (9) คำแนะนำนี้โดยใช้การวิเคราะห์ที่ไม่ทดลองจัดขึ้นอาศัยส่วนใหญ่ในการทดลองดำเนินการในผู้สูงอายุและผู้ป่วยโรคมะเร็งหรือผู้ป่วย perioperative มีตัดไม่ยอมรับแบบไม่ชอบสำหรับการกำหนดขาดสารอาหาร แต่มีการยอมรับสิ่งที่เป็นดัชนีมวลกายหรือพบยอดเงินของการสูญเสียน้ำหนักในก่อนหน้านี้เดือนจะส่อขาดสารอาหาร (6,9) และเชื่อมโยงมีผลย่อมในผู้ป่วยโรคมะเร็ง
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