Clinical Hospital Rijeka,Croatia
Renata Dobrila-Dintinjana is engaged in fi eld of gastrointestinal cancers and Supportive Cancer Care for 20 years and she has authored more than 50 peerreviewed articles and over 100 reports. She is author of ten book chapters, reviewer for couple of international journals (J of Supportive Cancer Care,) and international projects in fi eld of Cancer Research. She is also invited speaker in Postgraduated Courses regarding abdominal malignancies (Hong Kong, Moscow) and in many International Congresses and Symposia. She is member of several National Scientifi c Committees regarding Gastrointestinal Cancer and Supportive Cancer Care. She is serving as co-editor of Journal of Hepato-Gastroenterology and is Coordinator for Oncology section of IASGO.
Cancers of the colon and rectum together are second most common tumor type worldwide. The prognosis for the survival after disease progression is usually poor (1). Cancer anorexia-cachexia syndrome is highly prevalent among patients with colorectal cancer, and has a large impact on morbidity and mortality, and on patient quality of life. Early intervention with nutritional supplementation has been shown to halt malnutrition, and may improve outcome in some patients (2). The etiology of cancer-associated malnutrition appears to be related to the pathological loss of inhibitory control of catabolic pathways, whose increased activities are not counterbalanced by the increased central and peripheral anabolic drive (3). The goals of nutritional support in patients with colorectal cancer are to improve nutritional status to allow initiation and completion of active anticancer therapies (chemotherapy and or radiotherapy) and improve quality of life (3, 4). Cancer growth and dissemination but also cancer treatments, including surgery, chemotherapy, and radiation therapy, interfere with taste, ingestion, swallowing, and digest food which leads to hypophagia. Also, chemotherapy agents may cause nausea and diarrhea (3, 4). Although many new agents are on the market to combat these symptoms, prevalence of colorectal cancer is still high (1). We studied the influence of nutritional support (counseling, nutritional supplements, megestrol acetate) on physical status and symptoms in patients with colorectal cancer during chemotherapy. The study was designed to investigate whether dietary counseling or oral nutrition commercial supplements during chemotherapy and/or BSC affected nutritional status and influence survival status prevalence in patients with colorectal cancer. Results: Three hundred and eighty-eight colorectal cancer patients were included in the study. Nottingham Screening Tool Questionnaire, Appetite Loss Scale and Karnofsky Performance Status were taken to evaluate the nutritive status of patients. Group I consisted of 215 patients who were monitored prospectively and were given nutritional support and in this group weight gain of 1,5 kg (0,6.2,8 kg) and appetite improvement was observed in patients with colorectal cancer. In both groups Karnofsky Performance Status didn’t change significantly reflecting the impact of the disease itself. Nutritional counseling, supplemental feeding and pharmacological support do temporarily stop weight loss and improve appetite, QoL and social life, but this improvement has no implications on patients KPS and course of their disease. Conclusion: These results encourage further studies with more specific nutritional supplementation in patients with colorectal cancer and probably in gastrointestinal oncology.