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There are 4 purposes in the nutritional management for cancer patient. At first, we had better perform the early metabolic recovery from several invasive damages by some cancer treatments. At second, we give some special nutritional management for improvement from cancer cachexia. At third, we consider palliative nutritional management to terminal cancer patients based on pathophysiology of cachexia, their life styles and ethics. Finally, we give the social nutritional management for keeping high quality of life through well eating until the end of life. The basic nutritional management for cancer patients is administration of adequate amount of energy, protein/amino acids and micronutrients with suitable rehabilitation in order to prevent sarcopenia and malnutrition. In this paper, we explained about the metabolic influences to normal tissues, especially skeletal muscle, during chemotherapy. Also we mentioned importance to prevent sarcopenia and malnutrition during cancer treatment especially chemotherapy. Additionally, we showed the new topic about assessment for malnutrition, such as GLIM criteria, which is the global nutritional assessment formula for malnutrition including weight loss, low BMI and reduce of muscle mass. Now, we can recommend to use the global nutritional assessment and nutritional therapies even for cancer patients.

Background: Estimated glomerular filtration rate (eGFR) based on serum cystatin C (Scys) is useful for patients with decreased muscle mass, but has been also reported to be affected by cancer. The usefulness of Scys in eGFR in terminal cancer patients with decreased muscle mass is unknown. Therefore, we analyzed appropriate eGFR formulae for terminal cancer patients., Methods: Study design was a retrospective observational study. Based on creatinine height index (CHI), 184 terminal cancer patients were stratified into CHI ≥ 90% (normal muscle mass, 59 patients); CHI 60-89% (mildly to moderately decreased muscle mass, 64 patients); and CHI < 60% (severely decreased muscle mass, 61 patients) groups. Twenty-four-hour creatinine clearance was measured and converted to the glomerular filtration rate (GFR) as a renal function measure. To estimate GFR, various eGFR formulae for Japanese were used: eGFR Scys , eGFR Scr5 and eGFR Scr3 , eGFR average and eGFR Scys-Scr , and eGFR CG , based on Scys, serum creatinine (Scr), Scys and Scr combined, and Cockcroft-Gault formula (CG), respectively. Errors between measured and estimated values of renal function were verified using mean prediction errors (ME). When a 95% confidence interval (CI) of ME included 0, the accuracy of the eGFR formula was graded as good., Results: eGFR Scys ME was 0.2 (95% CI lower limit - 3.7, upper limit 4.0) mL/min/1.73 m 2 in CHI 60-89% group and 9.2 (6.1, 12.9) mL/min/1.73 m 2 in CHI < 60% group. eGFR Scys was most accurate among the eGFR formulae., Conclusions: eGFR based on Scys was demonstrated as useful in terminal cancer patients with decreased muscle mass.

There are 4 purposes in the nutritional management for cancer patient. At first, we had better perform the early metabolic recovery from several invasive damages by some cancer treatments. At second, we give some special nutritional management for improvement from cancer cachexia. At third, we consider palliative nutritional management to terminal cancer patients based on pathophysiology of cachexia, their life styles and ethics. Finally, we give the social nutritional management for keeping high quality of life through well eating until the end of life. In this paper, we explained about the metabolic influences to normal tissues during cancer treatments such as surgical operation, chemotherapy and radiotherapy. The mechanism and pathophysiology of cancer cachexia due to tumor expanding and metabolic disorders could be clear by our experimental results and other literatures. Also the nutritional management and metabolic regulation to control of symptoms and development of cachexia could be shown with prevention of sarcopenia. Administration of protein and amino acids, especially, branched chain amino acids, and some other micro nutrients should be useful for prevention of sarcopenia and cachexia. However, 3-4 weeks before death, the energy expenditure should decrease at the stage of refractory cachexia. Thus, in this point, we can recommend to reduce the total mounts of energy and solution at the nutritional management without overloading.

There have been few detailed reports on respiratory depression due to overdoses of opioids in terminal cancer patients. We investigated the situation of treatment with opioid antagonists for respiratory depression that occurred after administration of opioid at optimal doses in terminal cancer patients, to clarify pathological changes as well as causative factors. In 2443 terminal cancer patients receiving opioids, 7 patients (0.3%) received opioid antagonists: 6, morphine (hydrochloride, 5; sulfate, 1); 1, oxycodone. The median dosage of opioids was 13.3 mg/d, as converted to morphine injection. Respiratory depression occurred on this daily dose in 4 patients and after changed dose and route in 3 patients. Opioids were given through the vein in 6 patients and by the enteral route in 1 patient. Concomitant drugs included nonsteroidal anti-inflammatory drugs in 3 patients and zoledronic acid in 2 patients. In morphine-receiving patients, renal functions were significantly worsened at the time of administration of an opioid antagonist than the day before the start of opioid administration. These findings indicate that the proper use of opioids was safe and acceptable in almost all terminal cancer patients. In rare cases, however, a risk toward respiratory depression onset is indicated because morphine and morphine-6-glucuronide become relatively excessive owing to systemic debility due to disease progression, especially respiratory and renal dysfunctions. At the onset of respiratory depression, appropriate administration of an opioid antagonist mitigated the symptoms. Thereafter, opioid switching or continuous administration at reduced dosages of the same opioids prevented the occurrence of serious adverse events.

Purpose: Adverse oral symptoms gradually appear in advanced cancer patients as the disease progresses. We retrospectively investigated the associations between the incidence of oral problems and the days to death (DTD) in patients receiving palliative care., Methods: The dental assessment sheets and medical charts of 105 patients who had been admitted into the palliative care unit at our hospital were examined. Case data included evaluations of organic and functional oral conditions at the time of admission for all patients. The cohort was divided into two groups according to the DTD as the short group (<28 days from the time of dental assessment until death) and the long group (≥28 days). We compared the incidences of organic and functional oral problems between these groups., Results: Dry mouth, tongue inflammation, and bleeding spots were significantly more frequent in the short group than in the long group (78 vs. 54% for dry mouth, 67 vs. 46% for tongue inflammation, 35 vs. 14% for bleeding spots, respectively; p < 0.05). Tongue coating and candidiasis were comparable between the two groups. Dysphagia was significantly more common in the short group (43%) than in the long group (20%) (p = 0.01), as was assistance with oral health care (76 vs. 50%) (p = 0.01)., Conclusions: Our findings suggest that, during palliative care, oral complications appear more frequently when the DTD period is shorter. These symptoms may be useful indicators when deciding on the proper timing of intensive oral care intervention to decrease oral problems and pain in terminally ill patients.

A Japanese proverb says that a balanced diet leads to a healthy body. However, the relation between healthy life and nutrition has not been established precisely and quantitatively. Cancer cachexia, which is malnutrition in cancer patients, has been studied extensively. Appropriate nutrition support can prevent the progression of malnutrition in cancer patients and advance the tolerance for anticancer therapy. In refractory cachexia (terminally cancer patients), we will judge the necessity of reduction of nutrition support, what it is called "gear-change", because the support is burden for the body. It is important to restrict the quantity of nutrition and to give medical treatment to retain bodily function in these patients.

Morphine, oxycodone, and fentanyl are commonly used to control cancer pain. Because these drugs have differences in receptor affinity or pharmacokinetic parameters, changing the opioid formulation may result in an unexpected outcome, depending on the patient's condition. This study investigated whether low serum protein levels influence the effectiveness of opioid rotation by determining the impact of serum albumin levels on the analgesic effect before and after opioid rotation from morphine or oxycodone to fentanyl in cancer patients. The patients were classified into 3 groups according to their serum albumin levels before opioid rotation: group 1, <2.5 g/dL; group 2, from 2.5 g/dL to <3.0 g/dL; and group 3, ≥3.0 g/dL. There was no significant change in the percentage of patients with good pain control after rotation in group 1 or group 2; however, the percentage of patients with good pain control increased significantly in group 3. When the percentage of patients whose numerical rating scale scores increased, were unchanged, or decreased after rotation were compared, a significant difference in the percentage of those showing improvement was noted among the 3 groups and between groups 1 and 3. These findings suggest that monitoring serum albumin levels during fentanyl therapy is useful for pain management, and that the effectiveness of opioid rotation to fentanyl in patients with serum albumin levels of <2.5 g/dL should be carefully evaluated after rotation.

Context: Although an evidence-based clinical guideline for parenteral hydration therapy was established in Japan, the efficacy of the guideline has not been assessed., Objectives: Our purpose was to explore the effect of parenteral hydration therapy based on this clinical guideline on quality of life (QoL), discomfort, symptoms, and fluid retention signs in patients with advanced cancer., Methods: This multicenter, prospective, observational study included 161 patients with advanced abdominal cancer who received guideline-based hydration therapy. We evaluated the longitudinal changes of the global QoL (Item 30 of European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire-C30); the Discomfort Scale; the intensity of seven physical symptoms; and the severity of fluid retention signs. We also evaluated patient satisfaction and the feeling of benefit from hydration one week after the study commenced, and bronchial secretions, hyperactive delirium, communication capacity, and agitation 48 hours before a patient's death., Results: The global QoL, the Discomfort Scale, and the intensities of all physical symptoms, except for vomiting and drowsiness, were stable throughout the study period. More than 80% of patients maintained all fluid retention signs. Patient global satisfaction was 76.4 (0-100) and feeling of benefit was 5.43 (range 0-7)., Conclusion: Guideline-based parenteral hydration therapy contributed to maintaining global QoL and provided satisfaction and a feeling of benefit without increasing discomfort and worsening symptoms and fluid retention signs in patients with advanced cancer., (Copyright © 2012 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.)

For clinical treatment of cancer patients, surgical operation, chemotherapy, radiotherapy, immunotherapy and palliative care are available. Among these therapies, the main radical treatments such as surgical operation, chemotherapy and radiotherapy provide patients with anti-cancer-effects, but also cause unwanted invasive influences to normal tissues. Nutritional support is essential for cancer patients because it helps reduce these invasive influences and promotes recovery of damaged non-cancer tissues. Nutritional support for cancer patients receiving any anti-cancer therapies helps decrease the degree of invasion to non-cancer tissues and healthy body functions, helps with the promotion of reproduction and recovery of injured tissues and functions, normalizes metabolic disturbances by anti-cancer therapies, improves malnutrition based by side effects of invasive treatments, promotes immune-function using immune-nutrients, and offers nutritional care for patients at the terminal stage by assisting in metabolic conditioning for patients with cancer cachexia.