The Role of Artificial Nutrition Support in the Cancer Patient

  • Federico Bozzetti


Patients with cancer often suffer from progressive involuntary weight loss, which is called cancer wasting. Clinical features of this syndrome include anorexia, early satiety, depletion of lean and fat body mass, muscle weakness, fatigue and impaired immune function. It occurs in 30–90% of cancer patients depending on location, stage, type, grade, spread and anticancer treatment [1]. Patients with cancer of lung, pancreas, head-and-neck area and upper gastrointestinal tract often suffer from wasting [2] [5].


Parenteral Nutrition Enteral Nutrition Cancer Cachexia Artificial Nutrition Impaired Immune Function 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Nitenberg G, Raynard B (2000) Nutritional support of the cancer patients: issues and dilemmas. Crit Rev Oncol Hematol 34:137–168PubMedCrossRefGoogle Scholar
  2. 2.
    Barber MD, Ross JA, Fearon KC (1999) Cancer cachexia. Surg Oncol 8:133–141Google Scholar
  3. 3.
    DeWys WD (1980) Nutritional care of the cancer patient. JAMA 244:374–376PubMedCrossRefGoogle Scholar
  4. 4.
    Brookes GB (1985) Nutritional status—a prognostic indicator in head and neck cancer. Otolaryngol Head Neck Surg 93:69–74PubMedGoogle Scholar
  5. 5.
    Van Bokhorst-de van der Schueren MA, van Leeuwen PA, Sauerwein HP et al (1997) Assessment of malnutrition parameters in head and neck cancer and their relation to postoperative complications. Head Neck 19:419–425CrossRefGoogle Scholar
  6. 6.
    Andreyev HJ, Norman AR, Oates J, Cunningham D (1998) Why do patients with weight loss have a worse outcome when undergoing chemotherapy for gastrointestinal malignancies? Eur J Cancer 34:503–509PubMedCrossRefGoogle Scholar
  7. 7.
    Dewys WD, Begg C, Lavin PT et al (1980) Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern Cooperative Oncology Group. Am J Med 69:491–497PubMedCrossRefGoogle Scholar
  8. 8.
    Jagoe RT, Goodship TH, Gibson GJ (2001) The influence of nutritional status on complications after operations for lung cancer. Ann Thoracic Surg 71:936–943CrossRefGoogle Scholar
  9. 9.
    Ovesen L, Hannibal J, Mortesen RL (1993) The interrelationship of weight loss, dietary intake, and quality of life in ambulatory patients with cancer of the lung, breast and ovary. Nutr Cancer 10:159–167Google Scholar
  10. 10.
    Robinson G, Goldstein M, Levine GM (1987) Impact of nutritional status on DRG length of stay. JPEN J Parenter Enterai Nutr 1:49–51Google Scholar
  11. 11.
    Shaw-Stiffel TA, Zarny LA, Pleban WE et al (1993) Effect of nutrition status and other factors on length of hospital stay after major gastrointestinal surgery. Nutrition 9:140–145PubMedGoogle Scholar
  12. 12.
    O’Gorman P, McMillan DC, McArdle CS (1998) Impact of weight loss, appetite, and the inflammatory response on quality of life in gastrointestinal cancer patients. Nutr Cancer 32:76–80Google Scholar
  13. 13.
    Iganaki J, Rodrguez V, Bodey GP (1974) Proceedings: Causes of death in cancer patients. Cancer 33:568–573CrossRefGoogle Scholar
  14. 14.
    Tisdale MJ (2001) Cancer anorexia and cachexia. Nutrition 17:438–442PubMedCrossRefGoogle Scholar
  15. 15.
    Mutlu EA, Mobarhan S (2000) Nutrition in the care of the cancer patient. Nutr Clin Care 3:3–23CrossRefGoogle Scholar
  16. 16.
    Fearon KCH (2001) Nutritional support in cancer. Clin Nutr 20:187–190CrossRefGoogle Scholar
  17. 17.
    Rivadeneira DE, Evoy D, Fahey TJ 3rd et al (1998) Nutritional support of the cancer patient. CA Cancer J Clin 48:69–80PubMedGoogle Scholar
  18. 18.
    Bosaeus I, Daneryd P, Svanberg E, Lundholm K (2001) Dietary intake and resting energy expenditure in relation to weight loss in unselected cancer patients. Int J Cancer 93:380–383PubMedCrossRefGoogle Scholar
  19. 19.
    Giacosa A, Frascio F, Sukkar SG, Roncella S (1996) Food intake and body composition in cancer cachexia. Nutrition 12:S20–S23PubMedGoogle Scholar
  20. 20.
    Ripamonti C, Fulfaro F (1998) Taste alterations in cancer patients. J Pain Symptom Manage 16:349–351PubMedCrossRefGoogle Scholar
  21. 21.
    Ripamonti C, Zecca E, Brunelli C et al (1998) Randomized, controlled clinical trial to evaluate the effects of zinc sulphate on cancer patients with taste alterations caused by head and neck irradiation. Cancer 82:1938–1945PubMedCrossRefGoogle Scholar
  22. 22.
    Sitzia J, North C, Stanley J, Winterberg N ( 1997) Side effects of CHOP in the treatment of non-Hodgkin’s lymphoma. Cancer Nurs 20:430–439PubMedCrossRefGoogle Scholar
  23. 23.
    Mattsson T, Arvidson K, Heimdahl A et al (1992) Alteration in taste acuity associated with allogeneic bone marrow transplantation. J Oral Pathol Med 21:33–37PubMedCrossRefGoogle Scholar
  24. 24.
    Lockhart PB, Clark JR (1990) Oral complications following neoadjuvant chemotherapy in patients with head and neck cancer. NCI Monogr 9:99–101PubMedGoogle Scholar
  25. 25.
    Lees J (1999) Incidence of weight loss in head and neck cancer patients on commencing radiotherapy treatment at a regional oncology centre. Eur J Cancer Care (Engl) 8:133–136CrossRefGoogle Scholar
  26. 26.
    Fanning J, Hilgers RD (1993) High-dose cisplatin carboplatin chemotherapy in primary advanced epithelial ovarian cancer. Gynecol Oncol 51:182–186PubMedCrossRefGoogle Scholar
  27. 27.
    Epstein JB, Robertson M, Emerton S et al (2001) Quality of life and oral function in patients treated with radiation therapy for head and neck cancer. Head Neck 23:389–398PubMedCrossRefGoogle Scholar
  28. 28.
    DeWys WD, Walters K (1975) Abnormalities of taste sensation in cancer patients. Cancer 36:1888–1896PubMedCrossRefGoogle Scholar
  29. 29.
    Trant AS, Serin J, Douglass HO(1982) Is taste related to anorexia in cancer patients? Am J Clin Nutr 36:45–58PubMedGoogle Scholar
  30. 30.
    Gallagher P, Tweedle DE (1983) Taste threshold and acceptability of commercial diets in cancer patients. JPEN J Parenter Enterai Nutr 7:361–363Google Scholar
  31. 31.
    Tomita Y, Osaki T (1990) Gustatory impairment and salivary gland pathophysiology in relation to cancer treatment. Int J Oral Maxillofac Surg 19:299–304PubMedCrossRefGoogle Scholar
  32. 32.
    Ovesen L, Hannibal H, Sorensen M (1991) Taste thresholds in patients with small-cell lung cancer. J Cancer Res Clin Oncol 117:70–72PubMedCrossRefGoogle Scholar
  33. 33.
    Ovesen L, Sorensen M, Hannibal J, Allingstrup L (1991) Electrical taste detection thresholds and chemical smell detection thresholds in patients with cancer. Cancer 68:2260–2265PubMedCrossRefGoogle Scholar
  34. 34.
    Edsall DL (1905) Case of acute leukaemia. Am J Med Sci 130:599–600CrossRefGoogle Scholar
  35. 35.
    Musser JH, Edsall DL (1905) Study of metabolism of leukaemia under influence of X-ray. Tr Ass Am Phys 20:294–321Google Scholar
  36. 36.
    Murphy JB, Means JH, Aub JC (1917) Effect of roentgen ray and radium therapy on metabolism of patient with lymphatic leukaemia. Arch Intern Med 19:890–900Google Scholar
  37. 37.
    Waddell WR, Grillo HC (1959) Metabolic effect of fat emulsion. Am J Clin Nutr 7:43–49PubMedGoogle Scholar
  38. 38.
    Bolker N (1953) Nitrogen balance in malignant disease. Am J Roentgen 69:839–848PubMedGoogle Scholar
  39. 39.
    Pareira MD, Conrad EJ, Hicks W, Elman R (1954) Therapeutic nutrition and tube feeding. J Am Med Assoc 156:810–816PubMedGoogle Scholar
  40. 40.
    Pareira MD, Conrad EJ, Hicks W, Elman R (1955) Clinical response and changes in nitrogen balance, body weight, plasma protein and haemoglobin following tube feeding in cancer cachexia. Cancer 8:803–808PubMedCrossRefGoogle Scholar
  41. 41.
    Terepka AR, Waterhouse C (1956) Metabolic observations during the forced feeding of patients with cancer. Am J Med 20:225–238PubMedCrossRefGoogle Scholar
  42. 42.
    Watkin D, Steinfield JL (1965) Nutrient and energy metabolism in patients with and without cancer during hyperalimentation with fat administered intravenously. Am J Clin Nutr 16:182–212PubMedGoogle Scholar
  43. 43.
    Bozzetti F (1989) Effects of artificial nutrition on the nutritional status of cancer patients. JPEN J Parent Ent Nutr 13:406–420Google Scholar
  44. 44.
    Bozzetti F (1992) Nutritional support in adult cancer patients. Clin Nutr 11:167–179PubMedCrossRefGoogle Scholar
  45. 45.
    Burt ME, Gorschboth CM, Brennan MF (1982) A controlled, prospective, randomized trial comparing the metabolic effects of enterai and parenteral nutrition in the cancer patient. Cancer 49:1092–1105PubMedCrossRefGoogle Scholar
  46. 46.
    Burt ME, Stein TP, Brennan MF (1983) A controlled, randomized trial evaluating the effects of enterai and parenteral nutrition on protein metabolism in cancer-bearing man. J Surg Res 34:303–314PubMedCrossRefGoogle Scholar
  47. 47.
    Burt ME, Brennan MF (1984) Nutritional support of the patient with esophageal cancer. Semin Oncol 11:127–135PubMedGoogle Scholar
  48. 48.
    Jeevanandam M, Legaspi A, Lowry SF (1988) Effect of total parenteral nutrition on whole body protein kinetics in cachetic patients with benign or malignant disease. JPEN J Parenter Enterai Nutr 12:229–236Google Scholar
  49. 49.
    Shaw JHF, Wolfe RR (1988) Whole-body protein kinetics in patients with early and advanced gastrointestinal cancer: the response to glucose infusion and total parenteral nutrition. Surgery 103:148–155PubMedGoogle Scholar
  50. 50.
    Shaw JHF, Humberstone DA, Douglas RG, Koea J (1991) Leucine kinetics in patients with benign disease, non-weight-losing cancer, and cancer cachexia: studies at the whole-body and tissue level and the response to nutritional support. Surgery 109:37–50PubMedGoogle Scholar
  51. 51.
    Hyltander A, Warnold I, Eden E, Lundholm K (1991) Effect on whole-body protein synthesis after institution of intravenous nutrition in cancer and noncancer patients who lose weight. Eur J Cancer 27:16–21PubMedCrossRefGoogle Scholar
  52. 52.
    Bozzetti F, Gavazzi C, Ferrari P, Dworzak F (2000) Effect of total parenteral nutrition on the protein kinetics of patients with cancer cachexia. Tumori 86:408–411PubMedGoogle Scholar
  53. 53.
    Fan ST, Law WY, Wong KK, Chan WP (1989) Preoperative parenteral nutrition in patients with oesophageal cancer: a prospective, clinical trial. Clin Nutr 8:23–27PubMedCrossRefGoogle Scholar
  54. 54.
    Gray G, Meguid M (1990) Can total parenteral nutrition reverse hypalbuminemia in oncology patients? Nutr 6:225–228Google Scholar
  55. 55.
    Monson JRT, Ramsden CW, MacFie J et al (1986) Immunorestorative effect of lipid emulsions during total parenteral nutrition. Br J Surg 73:843–846PubMedCrossRefGoogle Scholar
  56. 56.
    Bozzetti F, Cozzaglio L, Villa ML et al (1995) Restorative effect of total parenteral nutrition on natural killer cell activity in malnourished cancer patients. Eur J Cancer 12:2023–2027CrossRefGoogle Scholar
  57. 57.
    Lim STK, Choa RG, Lan KH, Ong GB (1981) Total parenteral nutrition versus gastrostomy in the preoperative preparation of patients with carcinoma of the oesophagus. Br J Surg 68:69–72PubMedCrossRefGoogle Scholar
  58. 58.
    Pearlstone DB, Lee J, Alexander RHet al (1995) Effect of enterai and parenteral nutrition on amino acid levels in cancer patients. JPEN J Parenter Enterai Nutr 19:204–208Google Scholar
  59. 59.
    Nixon DW, Lawson DH, Kutner M et al (1981) Hyperalimentation of the cancer patient with protein-calorie undernutrition. Cancer Res 41:2038–2045PubMedGoogle Scholar
  60. 60.
    Dresler CM, Jeevanandam M, Brennan MF (1987) Metabolic efficacy or enterai feeding in malnourished cancer and non-cancer patients. Metabolism 36:82–88PubMedCrossRefGoogle Scholar
  61. 61.
    Jeevanandam M, Horowitz GD, Lowry SF et al (1985) Cancer cachexia: effect of total parenteral nutrition on whole body protein kinetics in man. JPEN J Parenter Enterai Nutr 9:108Google Scholar
  62. 62.
    Bozzetti F, Migliavacca S, Scotti A et al (1982) Impact of cancer, type, site, stage and treatment on the nutritional status of patients. Ann Surg 196:170–179PubMedCrossRefGoogle Scholar
  63. 63.
    Klein S, Simes J, Blackburn GL (1986) Total parenteral nutrition and cancer clinical trials. Cancer 58:1378–1386PubMedCrossRefGoogle Scholar
  64. 64.
    McGeer AJ, Detsky AS, O’Rourke K (1990) Parenteral nutrition in cancer patients undergoing chemotherapy: a meta-analysis. Nutrition 6:233–240PubMedGoogle Scholar
  65. 65.
    Haffejee AA, Angorn IB (1977) Oral alimentation following intubation for esophageal cancer. Ann Surg 186:165–170CrossRefGoogle Scholar
  66. 66.
    Holter AR, Fisher JE (1977) The effects of perioperative hyperalimentation on complications in patients with carcinoma and weight loss. J Surg Res 23:31–34PubMedCrossRefGoogle Scholar
  67. 67.
    Thompson BR, Julian TB, Stremple JF (1981) Perioperative parenteral nutrition in patients with gastrointestinal cancer. J Surg Res 30:497–500PubMedCrossRefGoogle Scholar
  68. 68.
    Daly JM, Massar E, Giacco G et al (1982) Parenteral nutrition in esophageal cancer patients. Ann Surg 196:206–208CrossRefGoogle Scholar
  69. 69.
    Meijerink WJHJ, Von Meyenfeldt MF, Rouflart MMJ, Soeters PB (1992) Efficacy of perioperative nutritional support. Lancet 340:187–188PubMedCrossRefGoogle Scholar
  70. 70.
    Von Meyenfeldt MF, Meijerink WJHJ, Rouflart MMJ et al (1992) Perioperative nutritional support: a randomized clinical trial. Clin Nutr 11:180–186CrossRefGoogle Scholar
  71. 71.
    Fan ST, Law WY, Wong KK, Chan WP (1989) Preoperative parenteral nutrition in patients with oesophageal cancer: a prospective, clinical trial. Clin Nutr 8:23–27PubMedCrossRefGoogle Scholar
  72. 72.
    Fan ST, Lo CM, Lai EC et al (1994) Perioperative nutritional support in patients undergoing hepatectomy for hepatocellular carcinoma. N Eng J Med 331:1547–1552CrossRefGoogle Scholar
  73. 73.
    Bozzetti F, Gavazzi C, Miceli R et al (2000) Perioperative total parenteral nutrition in malnourished, gastrointestinal cancer patients: a randomized, clinical trial. JPEN J Parenter Enterai Nutr 24:7–14Google Scholar
  74. 74.
    Koretz RL, Lipam TO, Klein S (2001) AGA technical review on parenteral nutrition. Gastroenterology 121:970–1001PubMedGoogle Scholar
  75. 75.
    Weisdorf SA, Lysne J, Wind D et al (1987) Positive effect of prophylactic total parenteral nutrition on long-term outcome of bone marrow transplantation. Transplantation 43:833–838PubMedGoogle Scholar
  76. 76.
    Bozzetti F (2003) Home total parenteral nutrition in incurable cancer patients: a therapy, a basic humane care or something in between? Clin Nutr 22:109–111PubMedCrossRefGoogle Scholar
  77. 77.
    Solassol C, Joyeux H, Dubois JB (1979) Total parenteral nutrition (TPN) with complete nutritive mixtures: an artificial gut in cancer patients. Nutr Cancer 1:13–18Google Scholar
  78. 78.
    Solassol C, Joyeux H (1979) Artificial gut with complete nutritive mixtures as a major adjuvant therapy in cancer patients. Acta Chir Scand 494:186–188Google Scholar
  79. 79.
    Van Gossum A, Vahedi KK, Abdel-Malik et al (2001) ESPEN-HAN Working Group. Clinical, social and rehabilitation status of long-term home parenteral nutrition patients: results of a European multicentre survey. Clin Nutr 20:205–210PubMedCrossRefGoogle Scholar
  80. 80.
    Cozzaglio L, Balzola F, Cosentino F et al (1997) Outcome of cancer patients receiving home parenteral nutrition. Italian Society of Parenteral and Enterai Nutrition (SINPE). JPEN J Parenter Enteral Nutr 21:339–342PubMedCrossRefGoogle Scholar
  81. 81.
    Scolapio JS, Fleming CR, Kelly DG et al (1999) Survival of home parenteral nutrition-treated patients: 20 years of experience at the Mayo Clinic. Mayo Clin Proc 74:217–222PubMedCrossRefGoogle Scholar
  82. 82.
    Bozzetti F, Cozzaglio L, Biganzoli E et al (2002) Quality of life and length of survival in advanced cancer patients on home parenteral nutrition. Clin Nutr 21:269–271CrossRefGoogle Scholar
  83. 83.
    Pasanisi F, Orban A, Scalfi L et al (2001) Predictors of survival in terminal-cancer patients with irreversible bowel obstruction receiving home parenteral nutrition. Nutrition 17:581–584PubMedCrossRefGoogle Scholar
  84. 84.
    Torelli GF, Campos AC, Meguid MM (1999) Use of TPN in terminally ill cancer patients. Nutrition 15:665–667PubMedCrossRefGoogle Scholar
  85. 85.
    Gervasio S, Finocchiaro C, Galletti R et al (2002) Home parenteral nutrition (HPN) in advanced cancer patients: effects on nutritional status, quality of life and predictors of survival. Clin Nutr 21(Suppl 1):78Google Scholar

Copyright information

© Springer-Verlag Italia 2006

Authors and Affiliations

  • Federico Bozzetti
    • 1
  1. 1.Department of SurgeryHospital of PratoPratoItaly

Personalised recommendations