[Impact of antineoplastic drugs on the nutritional status of older patients with cancer. Can the medical oncologist minimize the impact of these drugs on the nutrirional status of these patients?]

Abstract:

Introduction:Aging is associated, per se, with the loss of functional reserve of different organs and systems, a greater risk of vulnerability and frailty, sarcopenia and malnutrition, a reality that is extended to cancer patients. There are several factors that are associated with malnutrition in the elderly individual, such as the difficulty in regulating food intake, loss of appetite and anorexia associated with age, alteration of the senses of taste and smell, dysgeusia or economic problems. In the case of the cancer patient, other factors are added to these factors, such as: type of tumor; tumor stage; evolutionary moment of the disease; and baseline situation. Many therapeutic strategies used against the tumor, such as surgery, treatment with radiotherapy (concomitant or not with chemotherapy) and treatment with antitumor drugs influence also the risk of malnutrition. Thus, for example, concomitant chemo-radiation therapy in head and neck tumors, in lung cancer or in pelvic tumors represents a high nutritional risk antitumor therapy. Some of the repercussions of malnutrition in the oncological elderly are severe. Thus, for example, malnutrition in these individuals is associated with: worse survival; increased risk of early discontinuation of chemotherapy treatment; increased risk of chemotherapy toxicity; increased toxicity from other antitumor drugs; and increased risk of mortality during chemotherapy treatment. Taking this information into account, it is essential: to optimize the nutritional status in older patients with cancer prior to starting a systemic antitumor treatment; to carry out a nutritional follow-up throughout the treatment; and to offer early and intense management of malnutrition once it appears, with the purpose of minimizing the impact of antitumor drugs in older patients with cancer. Early management of malnutrition could improve drugs tolerance and increase the health-related quality of life in these patients. Introducción:El envejecimiento se asocia a la pérdida de reserva funcional de distintos órganos y sistemas, a un mayor riesgo de vulnerabilidad y de fragilidad, a la sarcopenia y a la malnutrición, realidad que se hace extensible a los pacientes oncológicos. Varios factores se asocian a la malnutrición en el individuo de edad avanzada: dificultad para regular la ingesta de alimentos, pérdida de apetito y anorexia asociadas a la edad, alteración de los sentidos del gusto y olfato, disgeusia o problemas económicos. En el caso del paciente oncológico, a estos factores se añaden otros como: tipo de tumor; estadio tumoral; momento evolutivo de la enfermedad; y situación basal. También las distintas estrategias terapéuticas utilizadas frente al tumor, como cirugía, tratamiento con radioterapia (concomitante o no a quimioterapia) y tratamiento con fármacos antitumorales influyen en el riesgo de malnutrición. Así, por ejemplo, la quimio-radioterapia concomitante en tumores de cabeza y cuello, en cáncer de pulmón o en tumores de localización pélvica, representa una terapia antitumoral de alto riesgo nutricional. Algunas de las repercusiones de la malnutrición en el anciano oncológico son severas. La malnutrición en estos individuos se asocia a: peor supervivencia; mayor riesgo de interrupción precoz del tratamiento con quimioterapia; aumento en el riesgo de toxicidad de la quimioterapia; mayor toxicidad por otros fármacos antitumorales; y riesgo incrementado de mortalidad durante el tratamiento con quimioterapia. Teniendo en cuenta esta información, resulta fundamental optimizar el estado nutricional en el anciano oncológico previo al inicio de un tratamiento antitumoral sistémico, hacer un seguimiento a lo largo del tratamiento y ofrecer un manejo precoz e intenso de la malnutrición una vez aparezca, con la finalidad de minimizar el impacto de los fármacos antitumorales en el anciano, de mejorar la tolerancia de tales fármacos y aumentar la calidad de vida relacionada con la salud en estos pacientes.

journal_name

Nutr Hosp

journal_title

Nutricion hospitalaria

authors

Molina-Garrido MJ

doi

10.20960/nh.02986

subject

Has Abstract

pub_date

2020-07-01 00:00:00

pages

22-30

issue

Spec No1

eissn

0212-1611

issn

1699-5198

journal_volume

34

pub_type

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