Parenteral Nutrition as Part of Cancer Patient Treatment
Malnutrition represents a potentially serious complication for cancer patients. If it is not possible to meet the nutritional demands of the body through the enteral route, parenteral nutrition must be initiated. A doctor will recommend it in situations where the patient is at risk from the consequences of malnutrition. Up to 45% of these patients struggle with at least a 10% loss of their body weight.
Malnutrition as a significant complication of overall condition
Malnutrition or undernutrition is a condition caused by insufficient intake of nutrients. For cancer patients, it represents a serious complication that can have fatal consequences. It is essential to start timely and adequate nutritional therapy. Active cancer proliferation causes metabolic and humoral changes, leading to protein-energy malnutrition. Nutritionally at-risk diagnoses mainly include head and neck cancers, esophageal, stomach, pancreatic, and lung cancers. According to clinical data from the American Society for Parenteral and Enteral Nutrition (ASPEN), regardless of tumor type, malnutrition affects 40% of patients.
Enteral nutrition in oncology
The physiological way for the body to receive nutrition is through the gastrointestinal tract, either through oral intake or via a feeding tube (gastrostomy, jejunostomy, nasogastric tube, percutaneous endoscopic gastrostomy /PEG/, and percutaneous endoscopic jejunostomy /PEJ/). Sipping also brings several advantages as it provides additional nutritional support. However, enteral nutrition (EN) is often inadequate for various reasons.
EN and parenteral nutrition (PN) go hand in hand. It is always necessary to individually assess the patient's overall condition and prognosis. The goal of therapy is to gently supply the appropriate nutrients to the body. In case of EN failure, PN is chosen despite its associated risks.
Parenteral nutrition in oncology
Nutrition is administered from nutritional bags directly into the bloodstream through designated access points. The doctor follows the concept of critical nutritional points during oncological treatment. According to clinical studies, PN can slow down protein catabolism. Every oncology department should closely collaborate with a nutrition specialist.
Especially during chemotherapy, PN provides significant benefits as patients often struggle with nausea, vomiting, and loss of appetite, leading to food intake refusal.
If a doctor indicates PN as part of palliative care, it is often primarily for the psychological harmony of the terminally ill patient. The patient, along with their close companions, experiences anxiety and depression. The goal of PN in this situation is not to increase weight or muscle mass. PN cannot reverse anorexia resulting from the terminal stage of cancer, but it can positively affect the patient's psychological state.
PN can be administered continuously over 24 hours or cyclically, with nighttime administration being preferred. This provides the patient with the benefit of free daily activities. The nutritional bag should drip for at least 12 hours.
Central venous access points for PN administration are highly susceptible to infectious complications, mainly due to the migration of microorganisms from the hands of healthcare personnel during handling. It is therefore essential to observe strict aseptic conditions. Catheter-related sepsis is a serious nursing problem that can have fatal consequences.
Types of PN access points:
- Peripheral ports
- Central venous catheters (CVC):
- Nontunneled
- Tunneled (Broviac)
- Peripherally inserted central catheter (PICC)
- Venous port
Bags covering all physiological needs
The nutritionist determines the caloric needs for the administered nutrition, including added vitamins and trace elements. These are added to the bags just before connecting them to the access point to ensure chemical stability.
- Energy: determined e.g., using the Harris-Benedict equation
- Fats: recommended daily dosage of 1−1.5 g/kg
- Carbohydrates: recommended daily dosage of 3−6 g/kg
- Amino acids: recommended daily dosage of 1−2 g/kg
- Micronutrients
Incorrectly determined nutritional dosage can endanger the patient with the development of the so-called overfeeding syndrome, which results from the overloading of the body with nutrients. As a prevention of this complication, it is recommended at the beginning of nutritional therapy to reduce the dose by 25−50%, with a gradual increase.
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Sources:
1. Maňásek V. Nutritional treatment in cancer patients. Oncological Review 2017; 6: 34−43.
2. Tilton J. Benefits and risks of parenteral nutrition in cancer patients. Oncology Nurse Advisor, 2011 Aug 1. Available at: www.oncologynurseadvisor.com/home/hot-topics/palliative-care/benefits-and-risks-of-parenteral-nutrition-in-patients-with-cancer/3
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