Perioperative nutritional support in the cancer patient

Cancer patients in whom elective surgical intervention is planned are frequently malnourished. Moreover, the tumor itself may be responsible for additionally altering metabolism in the host, although the mechanisms by which this occurs are not clear. All preoperative cancer patients should be carefully surveyed for indices of malnutrition. Patients with a history of inadequate oral protein and calorie intake, an unintentional weight loss of greater than 10 pounds, or a serum albumin level of less than 3.5 gm per dl should undergo a thorough nutritional assessment, including anthropometric measurements, 24-hour urinary urea nitrogen and creatinine measurements, and recall skin antigen testing. Surgical risk may be predicted by using indices that are sensitive and specific in assessing preoperative parameters of malnutrition. Adequate nutritional support for 7 to 10 days prior to surgery should be provided to all patients falling into the high-risk category and has been shown to significantly reduce the rate of postoperative complications and death in this group. Generally, a serum albumin of less than 3 gm per dl, a recent unintentional weight loss of greater than 10 to 15 per cent of normal body weight, and/or skin test anergy should be considered to designate high risk. In the formulation of a nutritional plan, estimates of daily energy requirements are essential and can be made by use of the Harris-Benedict equation, metabolic cart measurements, and perhaps 24-hour urinary creatinine values. Generally, 30 to 45 kcal per kg of body weight with 1.2 to 1.5 gm of protein per kg of body weight daily, regardless of the route of delivery, will provide adequate nutritional support. Patients should be fed by the enteral route if possible. Although oral intake is preferable, many malnourished cancer patients will be unable to achieve necessary protein and calorie requirements in this manner.(ABSTRACT TRUNCATED AT 250 WORDS)