RESUMO
Cancer-related anorexia-cachexia syndrome (CACS) is a debilitating condition afflicting up to 80% of advanced-stage cancer patients. Characterized by progressive weight loss, muscle wasting, and metabolic abnormalities, CACS significantly compromises patients' quality of life and treatment outcomes. This comprehensive review navigates through its intricate physiopathology, elucidating its stages and diagnostic methodologies. CACS manifests in three distinct stages: pre-cachexia, established cachexia, and refractory cachexia. Early detection is pivotal for effective intervention and is facilitated by screening tools, complemented by nutritional assessments and professional evaluations. The diagnostic process unravels the complex interplay of metabolic dysregulation and tumor-induced factors contributing to CACS. Management strategies, tailored to individual patient profiles, encompass a spectrum of nutritional interventions. These include dietary counseling, oral nutritional supplements, and, when necessary, enteral nutrition and a judicious use of parenteral nutrition. Specific recommendations for caloric intake, protein requirements, and essential nutrients address the unique challenges posed by CACS. While pharmacological agents like megestrol acetate may be considered, their use requires careful evaluation of potential risks. At its core, this review underscores the imperative for a holistic and personalized approach to managing CACS, integrating nutritional interventions and pharmacological strategies based on a nuanced understanding of patient's condition.
RESUMO
OBJECTIVE: Approximately 20% of established malignant bowel obstruction (MBO) patients do not respond to pharmacological treatment. In these cases, venting percutaneous radiologic gastrostomy (VPRG) may be useful. Existing evidence is based on retrospective studies with methodological limitations. The purpose of this study is to describe safety and effectiveness for symptom control after VPRG placement in a prospective cohort of MBO patients. METHODS: Complications of VPRG placement, symptom control, destination on discharge and survival were analysed. RESULTS: Twenty-one patients were included, 13 (61.9%) of whom were women. Mean age was 62.7 years (36-85). Local pain (n=8, 38.1%) and peristomal leakage (n=4, 19%) were the most frequent minor complications. No major complications occurred. Nausea and vomiting were relieved in most patients (n=20, 95.2%) after VPRG, and small quantities of liquid diet were introduced to these patients. Median time to death after VPRG was 13 days (IQR 8.6-17.4). Thirteen patients (61.9%) were discharged, with seven of them (33.3%) returning home. CONCLUSIONS: When pharmacological treatment fails, the use of VPRG in MBO patients may be feasible, safe and effective.
RESUMO
La pandemia por SARS-CoV-2 que expuso a nuestros pacientes a una importante carga sintomática hizo de los cuidados paliativos una herramienta necesaria para la atención de estos pacientes. Los fármacos empleados para contrarrestar el virus y los tratamientos para el control de síntomas tienen múltiples interacciones debido tanto al hepatotrofismo del virus como a las vías de metabolismo de los tratamientos. Con este artículo pretendemos compartir nuestra experiencia y algunas recomendaciones farmacológicas para minimizar potenciales interacciones y efectos secundarios de los tratamientos empleados. Queda mucho por investigar, pero creemos que compartiendo información entre centros podremos brindar el mejor abordaje multidisciplinar que merecen los pacientes
The SARS-CoV-2 pandemic that exposed our patients to a significant symptom burden made palliative care a necessary tool for the care of these patients. The drugs used to counteract the virus and the treatments used for the control of symptoms have multiple interactions due to both the hepatotrophism of the virus and the metabolism pathways of treatments. With this article we aim to share our experience and some pharmacological recommendations to minimize the potential interactions and side effects of treatments. Much remains to be investigated but we believe that by sharing information between centers we shall be able to provide the best multidisciplinary approach that patients deserve