Kanserin Önlenmesinde ve Tedavisinde Güncel Beslenme Yaklaşımları

Öz

Kanser hücrelerin kontrolsüzce bölünmesiyle meydana gelen bir hastalık grubudur. Son zamanlarda prevalansı dünyada ve ülkemizde atmakta olan kanser önde gelen ölüm nedenlerindendir. Meme, akciğer, kolon ve rektum ve prostat kanserleri en sık görülen kanser türlerindendir. Kanser oluşum nedenlerine bakıldığında hem genetik hem de çevresel etmenlerden etkilendiği görülmektedir. Gerek tanı öncesi gerekse tedaviye başlandıktan sonra kanser hastalarında beslenmenin önemi büyüktür. Kanser tedavisinde, cerrahi, kemoterapi, radyoterapi, kemoradyoterapi ve immünoterapi gibi birçok yöntem kullanılmaktadır. Tedavi sürecinde hasta tedavinin şekline ve seyrine bağlı olarak birçok beslenme problemi ile karşılaşmaktadır. Örneğin malnütrisyon kanser hastalarında oldukça sık görülen problemlerden bir tanesidir. Özellikle yağsız doku kaybına neden olarak vücut direncini düşürmektedir. Ayrıca anti-kanser tedavisi sürecinde yan etkiler doğurarak iyileşme sürecini olumsuz etkilediği bildirilmektedir. Kanserde optimal beslenme tedavisi sık araştırılan konulardandır ancak halen belirsizliğini korumaktadır. Günümüzde, hem kanseri önleme hem de kanser tedavisinde çeşitli beslenme yaklaşımları gündeme gelmektedir. Bu yaklaşımlardan bazıları, oral nütrisyonel suplement kullanımı, ketojenik diyet uygulaması, probiyotik kullanımı ve fonksiyonel besin uygulamalarıdır. Bu önleme ve tedavi yaklaşımlarına yönelik kanıtlar tartışmalı olmasına rağmen umut vaat etmektedir. Kanser hastalığı hassas bir süreç olduğundan beslenme yaklaşımlarının hastada yan etki oluşturmayacak bir biçimde uygulanmasına dikkat edilmelidir. Bu derlemenin amacı, kanserin önlenmesinde ve tedavisinde güncel beslenme yaklaşımlarını literatür bilgileri ışığında incelemektir.

Anahtar Kelimeler

• Kanser
• beslenme
• diyet tedavisi

Current Nutritional Approaches in the Prevention and Treatment of Cancer

Öz

Cancer is a group of diseases that occur when cells divide uncontrollably. Cancer is one of the leading causes of death worldwide, with its prevalence rising both globally and in our country. Breast, lung, colon and rectum and prostate cancers are among the most common types of cancer. Cancer development is influenced by both genetic and environmental factors. Nutrition is of great importance in cancer patients, both before diagnosis and after treatment. Many methods such as surgery, chemotherapy, radiotherapy, chemoradiotherapy and immunotherapy are used in cancer treatment. During the treatment process, the patient encounters many nutritional problems depending on the form and course of the treatment. Malnutrition, for instance, is among the most common complications observed in cancer patients. It reduces body resistance, especially by causing loss of lean tissue. In addition, it is reported that it negatively affects the healing process by causing side effects during the anti-cancer treatment process. Optimal nutritional therapy in cancer is one of the most frequently researched topics, but it still remains unclear. Today, various nutritional approaches are on the agenda for both cancer prevention and cancer treatment. Some of these approaches are oral nutritional supplement use, ketogenic diet application, probiotic use and functional food applications. The evidence for these prevention and treatment approaches is promising, although controversial. Since cancer is a sensitive process, care should be taken to apply nutritional approaches in a way that does not cause side effects in the patient. The aim of this review is to examine current nutritional approaches in the prevention and treatment of cancer in light of the current literature.

Anahtar Kelimeler

• Cancer
• nutrition
• diet therapy

Kaynakça

1. 1. Raymond JL, Morrow K. Krause and Mahan’s Food and the Nutrition Care Process. 16th ed. Philadelphia, PA: Saunders; 2022.
2. 2. World Health Organizations. Cancer. World Health Organizations. https://www.who.int/news-room/fact-sheets/detail/cancer. Yayınlanma tarihi. Şubat 2020. Erişim tarihi 10 Ocak 2023.
3. 3. Haskins CP, Champ CE, Miller R, Vyfhuis MAL. Nutrition in cancer: Evidence and equality. Adv Radiat Oncol. 2020;5(5):817-823. doi: 10.1016/j.adro.2020.05.008.
4. 4. Muscaritoli M, Arends J, Bachmann P, et al. ESPEN practical guideline: Clinical nutrition in cancer. Clin Nutr. 2021;40(5):2898-2913. doi: 10.1016/j.clnu.2021.02.005.
5. 5. Ravasco P. Nutrition in cancer patients. J Clin Med. 2019;8(8):1211. doi: 10.3390/jcm8081211.
6. 6. Yin W, Wang J, Jiang L, James Kang Y. Cancer and stem cells. Exp Biol Med (Maywood). 2021;246(16):1791-1801. doi: 10.1177/15353702211005390.
7. 7. Brown JC, Caan BJ, Meyerhardt JA, et al. The deterioration of muscle mass and radiodensity is prognostic of poor survival in stage I-III colorectal cancer: A population-based cohort study (C-SCANS). J Cachexia Sarcopenia Muscle. 2018;9(4):664-672. doi: 10.1002/jcsm.12305.
8. 8. Demark-Wahnefried W, Peterson BL, Winer EP, et al. Changes in weight, body composition, and factors influencing energy balance among premenopausal breast cancer patients receiving adjuvant chemotherapy. J Clin Oncol. 2001;19(9):2381-2389. doi: 10.1200/JCO.2001.19.9.2381.

9. 9. Wigmore SJ, Plester CE, Ross JA, Fearon KC. Contribution of anorexia and hypermetabolism to weight loss in anicteric patients with pancreatic cancer. Br J Surg. 1997;84(2):196-197.
10. 10. Mantzorou M, Koutelidakis A, Theocharis S, Giaginis C. Clinical value of nutritional status in cancer: What is its ımpact and how it affects disease progression and prognosis? Nutr Cancer. 2017;69(8):1151-1176. doi: 10.1080/01635581.2017.1367947.
11. 11. Ravasco P, Monteiro-Grillo I, Vidal PM, Camilo ME. Nutritional deterioration in cancer: The role of disease and diet. Clin Oncol (R Coll Radiol). 2003;15(8):443-450. doi: 10.1016/s0936-6555(03)00155-9.
12. 12. Prado CM, Cushen SJ, Orsso CE, Ryan AM. Sarcopenia and cachexia in the era of obesity: Clinical and nutritional impact. Proc Nutr Soc. 2016;75(2):188-198. doi: 10.1017/S0029665115004279.
13. 13. Bazzan AJ, Newberg AB, Cho WC, Monti DA. Diet and nutrition in cancer survivorship and palliative care. Evid Based Complement Alternat Med. 2013;2013:917647. doi: 10.1155/2013/917647.
14. 14. Orell-Kotikangas H, Österlund P, Mäkitie O, et al. Cachexia at diagnosis is associated with poor survival in head and neck cancer patients. Acta Otolaryngol. 2017;137(7):778-785. doi: 10.1080/00016489.2016.1277263.
15. 15. Fearon K, Strasser F, Anker SD, et al. Definition and classification of cancer cachexia: An international consensus. Lancet Oncol. 2011;12(5):489-495. doi: 10.1016/S1470-2045(10)70218-7.
16. 16. Kim SH, Lee SM, Jeung HC, et al. The effect of nutrition intervention with oral nutritional supplements on pancreatic and bile duct cancer patients undergoing chemotherapy. Nutrients. 2019;11(5):1145. doi: 10.3390/nu11051145.
17. 17. Sittitrai P, Ruenmarkkaew D, Booyaprapa S, Kasempitakpong B. Effect of a perioperative immune-enhancing diet in clean-contaminated head and neck cancer surgery: A randomized controlled trial. Int J Surg. 2021;93:106051. doi: 10.1016/j.ijsu.2021.106051.
18. 18. Taubes G. Cancer research. Unraveling the obesity-cancer connection Science. 2012;335(6064):28-32. doi: 10.1126/science.335.6064.28.
19. 19. Dowling RJ, Goodwin PJ, Stambolic V. Understanding the benefit of metformin use in cancer treatment. BMC Med. 2011;9:33. doi: 10.1186/1741-7015-9-33.
20. 20. Simone BA, Champ CE, Rosenberg AL, et al. Selectively starving cancer cells through dietary manipulation: Methods and clinical implications. Future Oncol. 2013;9(7):959-976. doi: 10.2217/fon.13.31.
21. 21. Siddle K. Molecular basis of signaling specificity of insulin and IGF receptors: Neglected corners and recent advances. Front Endocrinol (Lausanne). 2012;3:34. doi: 10.3389/fendo.2012.00034.
22. 22. D'Esposito V, Passaretti F, Hammarstedt A, et al. Adipocyte-released insulin-like growth factor-1 is regulated by glucose and fatty acids and controls breast cancer cell growth in vitro. Diabetologia. 2012;55(10):2811-2822. doi: 10.1007/s00125-012-2629-7.
23. 23. Fine EJ, Miller A, Quadros EV, Sequeira JM, Feinman RD. Acetoacetate reduces growth and ATP concentration in cancer cell lines which over-express uncoupling protein 2. Cancer Cell Int. 2009;9:14. doi: 10.1186/1475-2867-9-14.
24. 24. Zuccoli G, Marcello N, Pisanello A, et al. Metabolic management of glioblastoma multiforme using standard therapy together with a restricted ketogenic diet: Case Report. Nutr Metab (Lond). 2010;7:33. doi: 10.1186/1743-7075-7-33.
25. 25. Römer M, Dörfler J, Huebner J. The use of ketogenic diets in cancer patients: A systematic review. Clin Exp Med. 2021;21(4):501-536. doi: 10.1007/s10238-021-00710-2.
26. 26. Paoli A, Rubini A, Volek JS, Grimaldi KA. Beyond weight loss: A review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. Eur J Clin Nutr. 2013;67(8):789-796. doi: 10.1038/ejcn.2013.116.
27. 27. Klement RJ, Kämmerer U. Is there a role for carbohydrate restriction in the treatment and prevention of cancer? Nutr Metab (Lond). 2011;8:75. doi: 10.1186/1743-7075-8-75.
28. 28. Boden G, Sargrad K, Homko C, Mozzoli M, Stein TP. Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetes. Ann Intern Med. 2005;142(6):403-411. doi: 10.7326/0003-4819-142-6-200503150-00006.
29. 29. Fraser DA, Thoen J, Bondhus S, et al. Reduction in serum leptin and IGF-1 but preserved T-lymphocyte numbers and activation after a ketogenic diet in rheumatoid arthritis patients. Clin Exp Rheumatol. 2000;18(2):209-214.
30. 30. Bauersfeld SP, Kessler CS, Wischnewsky M, et al. The effects of short-term fasting on quality of life and tolerance to chemotherapy in patients with breast and ovarian cancer: A randomized cross-over pilot study. BMC Cancer. 2018;18(1):476. doi: 10.1186/s12885-018-4353-2.
31. 31. Goss AM, Chandler-Laney PC, Ovalle F, et al. Effects of a eucaloric reduced-carbohydrate diet on body composition and fat distribution in women with PCOS. Metabolism. 2014;63(10):1257-1264. doi: 10.1016/j.metabol.2014.07.007.
32. 32. Cohen CW, Fontaine KR, Arend RC, et al. A ketogenic diet reduces central obesity and serum ınsulin in women with ovarian or endometrial cancer. J Nutr. 2018;148(8):1253-1260. doi: 10.1093/jn/nxy119.
33. 33. Cohen CW, Fontaine KR, Arend RC, Soleymani T, Gower BA. Favorable effects of a ketogenic diet on physical function, perceived energy, and food cravings in women with ovarian or endometrial cancer: A randomized, controlled trial. Nutrients. 2018;10(9):1187. doi: 10.3390/nu10091187.
34. 34. Khodabakhshi A, Akbari ME, Mirzaei HR, Seyfried TN, Kalamian M, Davoodi SH. Effects of Ketogenic metabolic therapy on patients with breast cancer: A randomized controlled clinical trial. Clin Nutr. 2021;40(3):751-758.
35. 35. Khodabakhshi A, Seyfried TN, Kalamian M, Beheshti M, Davoodi SH. Does a ketogenic diet have beneficial effects on quality of life, physical activity or biomarkers in patients with breast cancer: a randomized controlled clinical trial. Nutr J. 2020;19(1):87. doi: 10.1186/s12937-020-00596-y.
36. 36. World Health Organization-Food and Agricultural Organization, Probiotics in Food: Health and Nutritional Properties and Guidelines for Evaluation, FAO Food and Nutritional Paper. FAO/WHO, Rome, 2006 No.8592-5-105513-0.
37. 37. World Health Organization-Food and Agricultural Organization, Guidelines for the Evaluation of Probiotics in Food, FAO/WHO joint report., London, 2002.
38. 38. Kumar M, Kumar A, Nagpal R, et al. Cancer-preventing attributes of probiotics: An update. Int J Food Sci Nutr. 2010;61(5):473-496. doi: 10.3109/09637480903455971.
39. 39. O'Toole PW, Marchesi JR, Hill C. Next-generation probiotics: The spectrum from probiotics to live biotherapeutics. Nat Microbiol. 2017;2:17057. doi: 10.1038/nmicrobiol.2017.57.
40. 40. Raman M, Ambalam P, Kondepudi KK, et al. Potential of probiotics, prebiotics and synbiotics for management of colorectal cancer. Gut Microbes. 2013;4(3):181-192. doi: 10.4161/gmic.23919.
41. 41. Lu K, Dong S, Wu X, Jin R, Chen H. Probiotics in cancer. Front Oncol. 2021;11:638148. doi: 10.3389/fonc.2021.638148.
42. 42. Zheng C, Chen T, Lu J, et al. Adjuvant treatment and molecular mechanism of probiotic compounds in patients with gastric cancer after gastrectomy. Food Funct. 2021;12(14):6294-6308. doi: 10.1039/d1fo01375k.
43. 43. Juan Z, Chen J, Ding B, et al. Probiotic supplement attenuates chemotherapy-related cognitive impairment in patients with breast cancer: A randomised, double-blind, and placebo-controlled trial. Eur J Cancer. 2022;161:10-22. doi: 10.1016/j.ejca.2021.11.006.
44. 44. Zaharuddin L, Mokhtar NM, Muhammad Nawawi KN, Raja Ali RA. A randomized double-blind placebo-controlled trial of probiotics in post-surgical colorectal cancer. BMC Gastroenterol. 2019;19(1):131. doi: 10.1186/s12876-019-1047-4.
45. 45. Jiang C, Wang H, Xia C, et al. A randomized, double-blind, placebo-controlled trial of probiotics to reduce the severity of oral mucositis induced by chemoradiotherapy for patients with nasopharyngeal carcinoma. Cancer. 2019;125(7):1081-1090. doi: 10.1002/cncr.31907.
46. 46. Serna-Thomé G, Castro-Eguiluz D, Fuchs-Tarlovsky V, et al. Use of functional foods and oral supplements as adjuvants in cancer treatment. Rev Invest Clin. 2018;70(3):136-146. doi: 10.24875/RIC.18002527.
47. 47. Food Quality and Standards Service. Report On Functional Foods. Ernährungsdenkwerkstatt.http://ernaehrungsdenkwerkstatt.de/fileadmin/user_upload/EDWText/TextElemente/PHN-Texte/WHO_FAO_Report/Functional_Foods_Report_FAO_Nov2007.pdf. Yayınlanma tarihi. Kasım 2007. Erişim tarihi. 12 Ocak 2023.
48. 48. Sporn MB, Suh N. Chemoprevention: an essential approach to controlling cancer. Nat Rev Cancer. 2002;2(7):537-543. doi:10.1038/nrc844.
49. 49. de Martel C, Ferlay J, Franceschi S, et al. Global burden of cancers attributable to infections in 2008: A review and synthetic analysis. Lancet Oncol. 2012;13(6):607-615.
50. 50. Ames BN, Shigenaga MK, Hagen TM. Oxidants, antioxidants, and the degenerative diseases of aging. Proc Natl Acad Sci USA. 1993;90(17):7915-7922.
51. 51. Abrams JS, Mooney MM, Zwiebel JA, et al. Implementation of timeline reforms speeds initiation of National Cancer Institute-sponsored trials. J Natl Cancer Inst. 2013;105(13):954-959. doi: 10.1093/jnci/djt137.
52. 52. Ames BN, Shigenaga MK. Oxidants are a major contributor to aging. Ann N Y Acad Sci. 1992;663:85-96. doi: 10.1111/j.1749-6632.1992.tb38652.x.
53. 53. Okada F. Inflammation and free radicals in tumor development and progression. Redox Rep. 2002;7(6):357-368. doi: 10.1179/135100002125001135.
54. 54. Aghajanpour M, Nazer MR, Obeidavi Z, Akbari M, Ezati P, Kor NM. Functional foods and their role in cancer prevention and health promotion: a comprehensive review. Am J Cancer Res. 2017;7(4):740-769.
55. 55. Kim JW, Han SW, Cho JY, et al. Korean red ginseng for cancer-related fatigue in colorectal cancer patients with chemotherapy: A randomised phase III trial. Eur J Cancer. 2020;130:51-62. doi:10.1016/j.ejca.2020.02.018.
56. 56. Luo J, Ke D, He Q. Dietary tomato consumption and the risk of prostate cancer: A meta-analysis. Front Nutr. 2021;8:625185. doi:10.3389/fnut.2021.625185.
57. 57. Li WQ, Zhang JY, Ma JL, et al. Effects of Helicobacter pylori treatment and vitamin and garlic supplementation on gastric cancer incidence and mortality: Follow-up of a randomized intervention trial. BMJ. 2019;366:l5016. doi:10.1136/bmj.l5016.
58. 58. Rafati M, Ghasemi A, Saeedi M, et al. Nigella sativa L. for prevention of acute radiation dermatitis in breast cancer: A randomized, double-blind, placebo-controlled, clinical trial. Complement Ther Med. 2019;47:102205. doi:10.1016/j.ctim.2019.102205.
59. 59. Chen KL, Jung P, Kulkoyluoglu-Cotul E, et al. Impact of diet and nutrition on cancer Hallmarks. J Cancer Prev Curr Res. 2017;7(4):240. doi: 10.15406/jcpcr.2017.07.00240.