18 maart 2005: Bron: Cancer. 2004 May 1;100(9):1967-77. br>
Specifieke extra voeding in combinatie met EPO en COX-2 remmers verlengen significant het leven, betere energiebalans, vet toename en minder bloedingen van terminale sterk vermagerde kankerpatiënten met verschillende vormen van solide tumoren, aldus een gerandomiseerde studie bij 309 deelnemende kankerpatiënten. Echter alleen algemene extra voeding TPN had geen significant positief effect, alleen wat meer energie bleek uit de gemeten waarden. Conclusie van de onderzoekers is dan ook dat er een limiet zit op toedienen van algemeen extra voeding op het effect op de overlevingstijd en effect op bijwerkingen. Onze lekenconclusie: Ook deze studie pleit dus indirect voor gericht toegediende specifieke extra voeding en voedingstoffen op advies en onder deskundige begeleiding van een voedingsdeskundige, bv. een orthomoleculaire arts of Moermanarts.

Palliative nutritional intervention in addition to cyclooxygenase and erythropoietin treatment for patients with malignant disease: Effects on survival, metabolism, and function.

Lundholm K, Daneryd P, Bosaeus I, Korner U, Lindholm E.
Department of Surgery, Sahlgrenska University Hospital, Goteborg University, Gothenburg, Sweden. kent.lundholm@surgery.gu.se

BACKGROUND: The role of nutrition in the palliative treatment of patients with malignancy-related cachexia is unclear. The goal of the current study was to determine whether specialized, nutrition-focused patient care could improve integrated whole-body metabolism and functional outcome in unselected weight-losing patients with malignant disease who were receiving systemic antiinflammatory (cyclooxygenase -inhibitory) treatment along with erythropoietin (EPO) support.

METHODS: Three hundred nine patients with malignant disease who experienced progressive cachexia due to solid tumors (primarily gastrointestinal lesions) were randomized to receive a COX inhibitor (indomethacin, 50 mg twice daily) and EPO (15-40,000 units per week) along with specialized, nutrition-focused patient care (oral nutritional support and home total parenteral nutrition ) provided on a patient-by-patient basis to attenuate inflammation, prevent anemia, and improve nutritional status. Control patients received the same indomethacin and EPO doses that study patients received without the added nutritional support. All patients were treated and followed until death. Biochemical assays (blood, liver, kidney, and thyroid), nutritional state assessment (food intake and body composition), and exercise testing with simultaneous measurement of whole-body respiratory gas exchange before and during exercise were performed before the start of treatment and then at regular intervals during the treatment period (every 2-30 months after treatment initiation). Statistical analyses were performed on 'intention-to-treat' and 'as-treated' bases.

RESULTS: Home TPN was provided to approximately 50% of the study patients without severe complications. Over the entire observation period, rhEPO prevented the development of anemia in both study patients and control patients. Intention-to-treat analysis revealed an improvement in energy balance for nutritionally supported patients (P < 0.03); no other significant differences in outcome between study patients and control patients were observed. As-treated analysis demonstrated that patients receiving nutrition experienced prolonged survival (P < 0.01), which was accompanied by improved energy balance (P < 0.001), increasing body fat (P < 0.05), and a greater maximum exercise capacity (P < 0.04). A trend toward increased metabolic efficiency at maximum exercise (P < 0.06) for study patients relative to control patients also was observed.

CONCLUSIONS: The results of the current study strongly support that nutrition is a limiting factor influencing survival and that nutritional support protects integrated metabolism and metabolic function in patients with progressive cachexia secondary to malignant disease. Copyright 2004 American Cancer Society.

PMID: 15112279 [PubMed - indexed for MEDLINE]

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