Malnutrition in patients with gastric cancer is strongly associated with poor prognosis. Malnutrition associated with gastric cancer not only affects patient safety and recovery during the perioperative period (the period between the decision to operate and the end of surgery and basic recovery), weakens the efficacy of radiotherapy and increases the risk of adverse drug reactions, but can also reduce skeletal muscle quality and function, increase the chance of postoperative complications and nosocomial infections, as well as prolong patients’ hospital stay, increase the incidence of complications and morbidity and mortality, worsen It also prolongs patients’ hospital stay, increases the incidence of complications and death, deteriorates patients’ quality of life, and increases medical costs. Malnutrition also limits the choice of treatment options for patients with gastric cancer, forcing them to choose treatment options that are not optimal or not very appropriate.
It is important to improve the nutritional status of patients with gastric cancer. In this article, we will take a look at which patients with gastric cancer need nutritional support.
Four types of patients who “don’t eat” need nutritional support
Patients who are already malnourished, those who are expected to become malnourished, and those who need nutritional support for gastric cancer treatment all need nutritional support. In short, these can be summarized as four “no-nos.
- Patients who are “afraid to eat” for example, patients who experience bloating, abdominal pain, nausea, vomiting, and other discomforts after eating, and patients who have just been discharged from surgery but have not yet returned to a normal diet.
- “Patients who don’t want to eat” For example, patients who have just learned they have cancer and have not yet adjusted their physical and mental state, experiencing anxiety, worry or even depression, and patients whose appetite is affected by advanced gastric cancer.
- “Can’t eat” patients for example, patients with complete obstruction or bleeding from stomach cancer, patients who have just been discharged from the hospital after surgery and whose gastrointestinal function has not yet recovered.
- Patients who are “not allowed to eat” For example, patients with gastric cancer causing incomplete obstruction, patients who have had severe gastrointestinal reactions during radiotherapy.
Do obese patients still need nutritional support?
With changes in diet and lifestyle, the number of overweight and obese people is gradually increasing. For an overweight, over-nourished patient who has just undergone gastric cancer surgery, has not yet defecated (farted), has not recovered gastrointestinal function, and has no significant reduction in objective nutritional indicators or malnutrition or potential malnutrition, is nutritional support therapy also needed in this situation?
The answer is yes! These patients also require nutritional support therapy.
The answer is yes!
Is nutritional support needed and how is it assessed?
To assess whether a patient needs nutritional support, physicians usually consider whether the patient has the following factors: inadequate intake, weight loss, antitumor therapy (including surgery, radiation therapy, chemotherapy), etc.
Preoperative nutritional support is indicated for patients with severe malnutrition (weight loss of no less than 20%) and moderate malnutrition (weight loss of 10% to 19%). Postoperative nutritional support is indicated for all patients who benefit from preoperative nutritional support, all patients who are malnourished, patients who are unable to eat orally after surgery, or patients who eat less than 60% of their energy requirements orally for 1 week after surgery [based on 30kcal/(kg∙d) for ambulatory patients and 35kcal/(kg∙d) for ambulatory patients].
Nutritional support is not routinely recommended for all patients undergoing radiation and/or chemotherapy. In patients receiving radiation and/or chemotherapy, physicians usually consider early placement of a jejunal nutrition tube or fistula to establish a feeding tube when diet, nutrition education, and oral nutrients do not meet nutritional needs.
So, how do you determine if malnutrition is present?
In 2015, the European Society for Clinical Nutrition and Metabolism (ESPEN) introduced new diagnostic criteria for malnutrition, and malnutrition can be diagnosed if any 1 of the following 3 criteria are met:
- Body Mass Index is no more than 18.5 kg/m Body Mass Index (BMI) is a number derived by dividing body weight (kg) by the square of height (m).
- Weight and age-specific BMI loss weight loss of no less than 10% at any one time compared to usual weight, or no less than 5% over 3 months; and a BMI of no more than 20 kg/m for young people and no more than 22 kg/m for people no less than 70 years old.
- Weight loss and reduction in fat free body mass index weight loss of not less than 10% at any one time or not less than 5% in 3 months compared to usual weight; and fat free body mass index of not more than 15 for women and 17 for men. The body mass index (FFMI) is the square of (1 – fat rate) x weight (kg) / height (m).
Summary
Patients who are already malnourished, who are expected to become malnourished soon, and who are receiving treatment for gastric cancer that requires nutritional support need to receive nutritional support. Simply put, patients with gastric cancer who are “afraid to eat,” “don’t want to eat,” “can’t eat,” “won’t let eat,” etc. need nutritional support therapy. In short, once patients with gastric cancer are afraid to eat,” “don’t want to eat,” “can’t eat,” “not allowed to eat,” etc., they need to receive nutrition support treatment. For each patient, please listen to the professional advice of doctors. (Written by Peng Deng, Department of Gastrointestinal Oncology, The First Hospital of China Medical University)