טיפול תרופתי בסוף החיים
פעילויות > הכנס השנתי ה-13 > טיפול ברזון קיצוני וברעב במחלה מתקדמת
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טיפול ברזון קיצוני (CACHEXIA) וברעב (STARVATION) במחלה מתקדמת דר' נתן צ'רני, מנהל היחידה לטיפול תומך וכאב אונקולוגי, המרכז הרפואי שערי צדק, ירושלים Both cancer related Anorexia-cachexia syndrome and starvation are common problems in th management of advanced cancer. They have a common terminal path insofar as they both lead to profound malnutrition and with all of its physiological social and prognostic implications. |
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The physiology and pathophysiology of these 2 syndromes is however very different.
Primary anorexia-cachexia syndrome is a catabolic state characterized by proteolysis, inflammation and diminished capacity to utilize nutrients.
Treatment approaches involve behavioral and pharmacologic approaches to ease destress and to minimize the or reverse the effects of the catabolic state. |
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Phramocologic approaches to improve appetite my be of some value. Enteral
feeding supplements are of limited value and parenteral feeding is of no value.
In
contrast, cancer patients with functioning bowel and normal metabolic processes who
are unable to swallow or who suffer from bowl obstructions have reduced proteolysis,
diminished inflammation and reduced basal metabolic rates.
Nutritional replenishment may, in select cases help restore strength, function and possibly prolong survival. Intervention need to be specific to the anatomy of the obstructive problem and may include stents, tube feeding or, in selected patients TPN. These complex patient care issues challenge some widely held palliative care dogmas regarding the avoidance if interventional or expensive therapies. |
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