Hypercaloric Feeding It was hoped that enteral or parenteral nutritional support would circumvent cancer anorexia and alleviate malnutrition. However, the inability of hypercaloric feeding to increase lean mass, especially skeletal muscle mass, has been repeatedly shown.5 The place of aggressive nutritional management in malignant disease also remains ill-defined and most systematic prospective studies that have evaluated total parenteral nutrition combined with chemotherapy or radiotherapy have been disappointing.81,82 No significant survival benefit and no significant decrease in chemotherapy-induced toxicity have been demonstrated. Indeed, an increase in infections and mechanical complications has been reported.6,83 However, parenteral nutrition may facilitate administration of complete chemoradiation therapy doses for esophageal cancer84 and may have beneficial effects in certain patients with decreased food intake because of mechanical obstruction of the gastrointestinal tract.81,82 Home parenteral nutrition can also be rewarding for such patients. If the gut can be used for nutritional support, enteral nutrition has the advantage of maintaining the gut-mucosal barrier and immunologic function, as well as the advantage of having low adverse side effects and low cost.53,81,82 The effects of caloric intake on tumor development and growth are still being debated.85 A clear benefit from nutritional support may thus be limited to a specific, small subset of patients with severe malnutrition who may require surgery or may have an obstructing, but potentially therapy-responsive tumor.71,81,86 A novel approach is to supplement substances such as omega-3 fatty acids that reduce IL-1 and TNF-a production and may improve the efficacy of nutritional support.71,81 Applicable References: 5. Kotler DP. Cachexia. Ann Intern Med 2000;133:622-634. 6. Barber MD, Ross JA, Fearon KC. Cancer cachexia. Surg Oncol 1999;8:133-141. 53. Nelson KA, Walsh D, Sheehan FA. The cancer anorexia-cachexia syndrome. J Clin Oncol 1994;12:213-225. 71. Nitenberg G, Raynard B. Nutritional support of the cancer patient: Issues and dilemmas. Crit Rev Oncol Hematol 2000;34:137-168. 81. Body JJ. Metabolic sequelae of cancers (excluding bone marrow transplantation). Curr Opin Clin Nutr Metab Care 1999;2:339-344. 82. Body JJ. The syndrome of anorexia-cachexia. Curr Opin Oncol 1999;11:255-260. 83. Klein S, Kinney J, Jeejeebhoy K, et al. Nutrition support in clinical practice: Review of published data and recommendations for future research directions. Am J Clin Nutr 1997;66: 683-706. 84. Sikora SS, Ribeiro U, Kane JM, III., et al. Role of nutrition support during induction chemoradiation therapy in esophageal cancer. JPEN J Parenter Enteral Nutr 1998;22:18-21. 86. Nelson KA. The cancer anorexia-cachexia syndrome. Semin Oncol 2000;27:64-68. Remember we are NOT Doctors and have NO medical training. This site is like an Encylopedia - there are many pages, many links on many topics. Support our work with any size DONATION - see left side of any page - for how to donate. You can help raise awareness of CAM.