欧洲肠外肠内营养学会癌症患者营养指南（一）

前情提要

大纲

O. 方法

O1. 基本信息

  • 术语与缩写

  1. 指南的目标（目的和健康问题）

  2. 目标人群

  3. 参与的专业组织

  4. 患者的观点

  5. 目标使用者

  6. 利益冲突和资金投入

O2. 方法

  1. 设计

  2. 检索

  3. 推荐意见

  4. 共识

  5. 发表前审查

  6. 更新指南

O3. 发表后影响

  1. 促进与阻碍

  2. 应用工具

  3. 成本

  4. 监察和审核/质量指标

A. 背景

  1. 代谢

  2. 临床影响

  3. 营养目的

B. 癌症患者总论

  1. 筛查

  2. 能量及底物需求

  3. 营养干预

  4. 运动训练

  5. 药理营养素和具有药理作用的物质

C. 特定患者类型相关干预

  1. 手术

  2. 放疗

  3. 治愈性化疗

  4. 大剂量化疗和造血干细胞移植

  5. 癌症存活者

  6. 晚期癌症

R. 参考文献

E. 证据列表

第O章：方法

O1、基本信息

0、术语和缩写

术语

“癌症患者”是指癌症确诊后，等待或正在进行癌症针对性治疗、对症治疗和/或接受姑息治疗的患者。

癌症治愈患者被称为“癌症生存者”。

“药理营养素”是指以药理剂量供给、调节免疫和代谢功能、发挥临床结局影响的营养素。

缩写

  • AML：急性粒细胞性（髓细胞性）白血病

  • ASCO：美国临床肿瘤学会

  • BCAA：支链氨基酸

  • BIA：生物阻抗分析

  • BMI：体重指数（体质指数、体质量指数、身体质量指数）

  • BMT：骨髓移植

  • BMR：基础代谢率

  • CHT：化疗

  • CRP：C-反应蛋白

  • d：天

  • DEXA：双能X线骨密度

  • DHA：22:6二十二碳六烯酸

  • ECOG：东部肿瘤协作组

  • EAPC：欧洲姑息治疗协会

  • EFSA：欧洲食品安全局

  • EN：肠内营养

  • EPA：20:5二十碳五烯酸

  • ERAS：术后加速康复

  • ESMO：欧洲肿瘤内科学会

  • FDA：美国食品药品管理局

  • GI：肠胃

  • GL：指南

  • GPS：格拉斯哥预后评分

  • GvHD：移植物抗宿主病

  • HCT：造血干细胞移植

  • HMB：β羟丁酸甲酯

  • HTA：16:4十六碳三烯酸酸

  • IGF-I：胰岛素样生长因子I

  • ISOO：国际口腔肿瘤学会

  • LOS：住院长度（天）

  • MA：醋酸甲地孕酮

  • MASCC：多国癌症支持治疗协会

  • mGPS：修订格拉斯哥预后评分

  • MNA：微型营养评定

  • MNI：国际医学营养

  • MST：营养不良筛查工具

  • MUST：营养不良通用筛查工具

  • NSAID：非甾体抗炎药

  • NSCLC：非小细胞肺癌

  • ONS：口服营养补充剂

  • N-3脂肪酸：N-3或ω-3系列多不饱和脂肪酸

  • PAL：体力活动水平

  • PEG：经皮内镜下胃造口术

  • PG-SGA：患者主观整体评定

  • PICO：人群利益、干预、比较、结局

  • PN：肠外营养

  • QoL：生活质量

  • RCT：随机对照试验

  • REE：静息能量消耗

  • RT：放疗

  • SARM：选择性雄激素反应调节剂

  • SGA：主观整体评定

  • TEE：总能量消耗

  • THC：四氢大麻酚

  • TNF：肿瘤坏死因子

  • TPN：全肠外营养

  • WHO：世界卫生组织

Clin Nutr. 2016 Aug 6. [Epub ahead of print]

ESPEN guidelines on nutrition in cancer patients.

Jann Arends, Patrick Bachmann, Vickie Baracos, Nicole Barthelemy, Hartmut Bertz, Federico Bozzetti, Ken Fearon, Elisabeth Hütterer, Elizabeth Isenring, Stein Kaasa, Zeljko Krznaric, Barry Laird, Maria Larsson, Alessandro Laviano, Stefan Mühlebach, Maurizio Muscaritoli, Line Oldervoll, Paula Ravasco, Tora Solheim, Florian Strasser, Marian van Bokhorst- De van der Schueren, Jean-Charles Preiser.

University of Freiburg, Germany; Centre Régional de Lutte Contre le Cancer Léon Bérard, Lyon, France; University of Alberta, Edmonton, Canada; Centre hospitalier universitaire, Liége, Belgium; University of Milan, Milan, Italy; Western General Hospital, Edinburgh, United Kingdom; Medical University of Vienna, Austria; Bond University, Gold Coast, Australia; Norwegian University of Science and Technology, Trondheim, Norway; University Hospital Center and School of Medicine, Zagreb, Croatia; Beatson West of Scotland Cancer Centre, Edinburgh, United Kingdom; Karlstad University, Karlstad, Sweden; University of Rome La Sapienza, Roma, Italy; University of Basel, Basel, Switzerland; The Norwegian Heart and Lung Association (LHL), Oslo, Norway; Faculty of Medicine, University of Lisbon, Lisbon, Portugal; European Palliative Care Research Centre (PRC), Norwegian University of Science and Technology and Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Cantonal Hospital St. Gallen, Switzerland; VU University Medical Center (VUmc), Amsterdam, Netherlands; HAN University of Applied Sciences, Nijmegen, Netherlands; Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.

Outline

O. METHODS

O1. Basic information

  • Terms and abbreviations

  1. Goals (Objectives and health questions) of the guideline

  2. Target Population

  3. Professional groups involved

  4. Patient views

  5. Target users

  6. Conflict of interest and funding

O2. Methods

  1. Design

  2. Searches

  3. Recommendations

  4. Consensus

  5. Review before publication

  6. Updating guideline

O3. Post-publication impact

  1. Facilitators and barriers

  2. Tools for application

  3. Costs

  4. Monitoring and auditing / Quality indicators

A. BACKGROUND

  1. Metabolism

  2. Clinical effects

  3. Aims of nutrition

B. GENERAL CONCEPTS FOR ALL CANCER PATIENTS

  1. Screening

  2. Energy and substrate requirements

  3. Nutritional interventions

  4. Exercise training

  5. Pharmaconutrients and pharmacological agents

C. INTERVENTIONS RELEVANT TO SPECIFIC PATIENT CATEGORIES

  1. Surgery

  2. Radiotherapy

  3. Curative chemotherapy

  4. High-dose chemotherapy and hematopoietic stem cell transplantation

  5. Cancer survivors

  6. Advanced cancer

R. References

E. Evidence Tables

CHAPTER O: METHODS

O1. BASIC INFORMATION

0. TERMS and ABBREVIATIONS

A "cancer patient" is a patient with a cancer diagnosis who is either waiting for or on cancer directed treatment, on symptomatic treatment, and/or receiving palliative care.

Patients cured from their cancer are termed "cancer survivors".

"Pharmaconutrients" are nutrients supplied in pharmacological doses to modulate immune and metabolic functions and exert effects on clinical outcome.

Abbreviations used

  • AML: acute myeloic leukemia

  • ASCO: American Society of Clinical Oncology

  • BCAA: branched-chain amino acids

  • BIA: bio impedance analysis

  • BMI: body mass index

  • BMT: bone marrow transplantation

  • BMR: basal metabolic rate

  • CHT: chemotherapy

  • CRP: C-reactive protein

  • d: day

  • DEXA: dual-energy x-ray absorptiometry

  • DHA: 22:6 docosahexaenoic acid

  • ECOG: Eastern Cooperative Oncology Group

  • EAPC: European Association for Palliative Care

  • EFSA: European Food Safety Authority

  • EN: enteral nutrition

  • EPA: 20:5 eicosapentaenoic acid

  • ERAS: enhanced recovery after surgery

  • ESMO: European Society for Medical Oncology

  • FDA: U.S. Food and Drug Agency

  • GI: gastrointestinal

  • GL: guideline

  • GPS: Glasgow Prognostic Score

  • GvHD: graft versus host disease

  • HCT: hematopoietic stem cell transplantation

  • HMB: ß-hydroxy methyl butyrate

  • HTA: 16:4 hexadecatetraenoic acid

  • IGF-I: insulin-like growth factor I

  • ISOO: International Society of Oral Oncology

  • LOS: length of hospital stay (days)

  • MA: megestrol acetate

  • MASCC: Multinational Association of Supportive Care in Cancer

  • mGPS: modified Glasgow Prognostic Score

  • MNA: Mini Nutritional Assessment

  • MNI: Medical Nutrition International

  • MST: Malnutrition Screening Tool

  • MUST: Malnutrition Universal Screening Tool

  • NSAID: non-steroidal anti-inflammatory drugs

  • NSCLC: non-small cell lung cancer

  • ONS: oral nutritional supplements

  • N-3 fatty acids: polyunsaturated fatty acids of the N-3 or omega-3 series

  • PAL: physical activity level

  • PEG: percutaneous endoscopic gastrostomy

  • PG-SGA: patient-generated Subjective Global Assessment

  • PICO: populations of interest, interventions, comparisons, outcomes

  • PN: parenteral nutrition

  • QoL: quality of life

  • RCT: randomized controlled trial

  • REE: resting energy expenditure

  • RT: radiotherapy

  • SARM: selective androgen response modifyer

  • SGA: Subjective Global Assessment

  • TEE: total energy expenditure

  • THC: tetrahydrocannabinol

  • TNF: tumor necrosis factor

  • TPN: total parenteral nutrition

  • WHO: World Health Organization

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