MEDICAL NUTRITION THERAPY IN END-STAGE PANCREATIC CANCER: A CASE REPORT

Öz

Pancreatic cancer is often diagnosed late, and when diagnosed, it is usually in a metastatic state to other regions. With a generally poor prognosis and low survival rate, pancreatic cancer is associated with several risk factors such as genetics, age, smoking, diets rich in red and processed meats, and obesity. Symptoms of pancreatic cancer include jaundice, pale-colored stools, dark urine, pain in the upper or middle abdomen and back, fatigue, unexplained weight loss, and loss of appetite. Malnutrition is a frequently observed issue in patients with pancreatic cancer. During this process, monitoring the patient’s nutritional status and providing appropriate interventions are crucial for improving quality of life. This case report discusses the body composition, dietary intake, eating patterns, changes in nutritional status, and the medical nutrition therapy applied to a terminal pancreatic cancer patient admitted to a palliative care unit.

Anahtar Kelimeler

• Pancreatic cancer
• medical nutrition therapy
• enteral parenteral nutrition

SON EVRE PANKREAS KANSERİNDE TIBBİ BESLENME TEDAVİSİ: OLGU SUNUMU

Öz

Pankreas kanseri sıklıkla geç teşhis edilir ve teşhis edildiğinde genellikle diğer bölgelere metastaz yapmış durumdadır. Genel prognozu kötü ve hayatta kalma oranı düşük olan pankreas kanseri; genetik, yaş, sigara kullanımı, kırmızı ve işlenmiş etlerden zengin diyetler ve obezite gibi çeşitli risk faktörlerine sahiptir. Semptomları arasında sarılık, açık renkli dışkı, koyu renkli idrar, üst veya orta karın ve sırtta ağrı, yorgunluk, bilinen bir sebep olmadan ağırlık kaybı ve iştah kaybı bulunur. Malnütrisyon, pankreatik kanser hastalarında sık görülen bir sorundur. Bu süreçte hastanın yaşam kalitesini artırmak adına beslenme durumunun takip edilmesi ve gerekli müdahalelerin yapılması oldukça önemlidir. Bu olgu sunumunda, palyatif bakım servisine yatışı yapılmış son evre pankreas kanserli bir hastanın vücut kompozisyonu, diyet alımı, yeme düzeni, beslenme durumundaki değişiklikler ve uygulanan tıbbi beslenme tedavisi ele alınmaktadır.

Anahtar Kelimeler

• Pankreas kanseri
• tıbbi beslenme tedavisi
• enteral parenteral nütrisyon

Kaynakça

1. 1. World Health Organization. Cancer. Available at: https://www.who.int/news-room/fact-sheets/detail/cancer.
2. 2. Pancreatic Cancer Action Network. What is pancreatic cancer? 2018. Available at: https://pancan.org/facing-pancreatic-cancer/about-pancreatic-cancer/what-is-pancreatic-cancer/.
3. 3. National Cancer Institute. Pancreatic cancer treatment. 2023. Available at: https://www.cancer.gov/types/pancreatic/patient/pancreatic-treatment-pdq.
4. 4. Vincent A, Herman J, Schulick R, Hruban RH, Goggins M. Pancreatic cancer. The Lancet. 2011;378(9791):607-20.
5. 5. Ilic M, Ilic I. Epidemiology of pancreatic cancer. World Journal of Gastroenterology. 2016;22(44):9694-705.
6. 6. Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2021. CA: A Cancer Journal for Clinicians. 2021;71(1):7-33.
7. 7. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians. 2021;71(3):209-49.
8. 8. McGuigan A, Kelly P, Turkington RC, Jones C, Coleman HG, McCain RS. Pancreatic cancer: a review of clinical diagnosis, epidemiology, treatment and outcomes. World Journal of Gastroenterology. 2018;24(43):4846-61.

9. 9. Seufferlein T, Porzner M, Becker T, Budach V, Ceyhan G, Esposito I, et al. S3-Leitlinie zum exokrinen Pankreaskarzinom. Zeitschrift für Gastroenterologie. 2013;51(12):1395-440.
10. 10. Witvliet-van Nierop JE, Lochtenberg-Potjes CM, Wierdsma NJ, Scheffer HJ, Kazemier G, Ottens-Oussoren K, et al. Assessment of nutritional status, digestion and absorption, and quality of life in patients with locally advanced pancreatic cancer. Gastroenterology Research and Practice. 2017;2017:6193765.
11. 11. Latenstein AEJ, Dijksterhuis WPM, Mackay TM, Beijer S, van Eijck CHJ, de Hingh IHJT, et al. Cachexia, dietetic consultation, and survival in patients with pancreatic and periampullary cancer: a multicenter cohort study. Cancer Medicine. 2020;9(24):9385-95.
12. 12. Martin L, Senesse P, Gioulbasanis I, Antoun S, Bozzetti F, Deans C, et al. Diagnostic criteria for the classification of cancer-associated weight loss. Journal of Clinical Oncology. 2015;33(1):90-9.
13. 13. Emanuel A, Krampitz J, Rosenberger F, Kind S, Rötzer I. Nutritional interventions in pancreatic cancer: a systematic review. Cancers (Basel). 2022;14(9):2212.
14. 14. Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F, et al. ESPEN guidelines on nutrition in cancer patients. Clinical Nutrition. 2017;36(1):11-48.
15. 15. World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. WHO Technical Report Series, No. 894. Geneva: World Health Organization; 2000.
16. 16. Muscaritoli M, Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, et al. ESPEN practical guideline: Clinical nutrition in cancer. Clinical Nutrition. 2021;40(5):2898-913.
17. 17. Shao A, Hathcock JN. Risk assessment for the amino acids taurine, L-glutamine and L-arginine. Regulatory Toxicology and Pharmacology. 2008;50(3):376-99.
18. 18. Cederholm T, Jensen GL, Correia M, Gonzalez MC, Fukushima R, Higashiguchi T, et al. GLIM criteria for the diagnosis of malnutrition – a consensus report from the global clinical nutrition community. Clinical Nutrition. 2019;38(1):1-9.
19. 19. Gärtner S, Krüger J, Aghdassi AA, Steveling A, Simon P, Lerch MM, Mayerle J. Nutrition in pancreatic cancer: a review. Gastrointestinal Tumors. 2016;2(4):195-202.
20. 20. Fearon K, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL, et al. Definition and classification of cancer cachexia: an international consensus. The Lancet Oncology. 2011;12(5):489-95.
21. 21. Arends J, Baracos V, Bertz H, Bozzetti F, Calder PC, Deutz NEP, et al. ESPEN expert group recommendations for action against cancer-related malnutrition. Clinical Nutrition. 2017;36(5):1187-96.
22. 22. Emanuel A, Krampitz J, Rosenberger F, Kind S, Rötzer I. Nutritional interventions in pancreatic cancer: a systematic review. Cancers (Basel). 2022;14(9):2212.
23. 23. Patel S. Emerging trends in nutraceutical applications of whey protein and its derivatives. Journal of Food Science and Technology. 2015;52:6847-58.
24. 24. Attaallah W, Yılmaz AM, Erdoğan N, Yalçın AS, Aktan AÖ. Whey protein versus whey protein hydrolyzate for the protection of azoxymethane and dextran sodium sulfate induced colonic tumors in rats. Pathology and Oncology Research. 2012;18:817-22.
25. 25. Zhang QX, Ling YF, Sun Z, Zhang L, Yu HX, Kamau SM, et al. Protective effect of whey protein hydrolysates against hydrogen peroxide-induced oxidative stress on PC12 cells. Biotechnology Letters. 2012;34:2001-6.
26. 26. Pennings B, Boirie Y, Senden JM, Gijsen AP, Kuipers H, van Loon LJ. Whey protein stimulates postprandial muscle protein accretion more effectively than do casein and casein hydrolysate in older men. American Journal of Clinical Nutrition. 2011;93(5):997-1005.