Nutritional support in
chemotherapy and
radiation therapy patients is a very attractive concept. This group of patients frequently begins treatment malnourished, and the
malnutrition becomes worse because of treatment-related
nausea and
vomiting,
mucositis,
fever and other side effects. Effective
nutritional support would enhance wound healing and visceral function, improve cellular immunity and allow delivery of adequate
drug and irradiation doses, thereby increasing response rates and prolonging survival. Unfortunately, standard techniques of parenteral
nutritional support have had only limited success in advanced
cancer patients.
Weight gain is possible and immune function may be improved, but definite benefit in response rates and survival with
chemotherapy and radiation remains to be proven. Currently the author believes that the following are acceptable indications for
parenteral nutrition in
chemotherapy and radiation patients: patients who cannot eat or digest properly because of
tumor obstruction, surgical resection of gut, or other complications who have a reasonable life expectancy; cachectic patients with responsive
neoplasms who could not tolerate aggressive treatment without short-term
nutritional support; and patients suitable for trials of nutritionally modified
solution or alterations in standard techniques. Future studies might consider longer periods of support, increased concentrations of nutrients or, conversely, decreased amounts of nutrients needed by the
tumor, if such needs could be identified.