Clinical nutrition and metabolismClinical nutrition and metabolismКлиническое питание и метаболизм2658-44332782-2974Eco-Vector67902110.17816/clinutr679021EMLTSKReviewsНаучные обзорыReview ArticleNutritional Support as Part of Comprehensive Care for Palliative Patients With Cancer: A ReviewНутритивная поддержка в составе комплексной терапии паллиативных онкологических больных (обзор)https://orcid.org/0000-0003-0197-77216876-7701ObukhovaOlga A.ОбуховаОльга Аркадьевна
Russian Federation

MD, Cand. Sci. (Medicine)

кандидат мед. наук

obukhova0404@yandex.ruhttps://orcid.org/0000-0001-8463-26003692-5202KurmukovIldar A.КурмуковИлдар Анварович
Russian Federation

MD, Cand. Sci. (Medicine)

кандидат медицинских наук

kurmukovia@gmail.comhttps://orcid.org/0000-0002-9562-91134410-8937YunaevGrigory S.ЮнаевГригорий Сергеевич
Russian Federation
garik_dr@mail.ruBlokhin National Medical Research Center of OncologyНациональный медицинский исследовательский центр онкологии им. Н.Н. Блохина1405202502062024531341442904202508052025Copyright ©; 2024, Eco-VectorCopyright ©; 2024, Эко-Вектор2024Eco-VectorЭко-Векторhttps://creativecommons.org/licenses/by-nc-nd/4.0https://journals.eco-vector.com/2658-4433/article/view/679021

The role of nutritional support in incurable patients with cancer remains a topic of ongoing debate. However, clinical guidelines on palliative care recommend evaluating nutritional deficits, as fasting worsens functional status and quality of life, leads to unplanned hospitalizations, and decreases survival.

This review presents current data on the management of anorexia–cachexia syndrome as part of comprehensive palliative care. The literature search was conducted using the Scientific Electronic Library (eLIBRARY.RU) and PubMed, limited to publications from 2000 to 2024.

Based on our analysis, the necessity of individualized nutritional support has been identified as a key component of cachexia management aimed at improving quality of life. When oral intake is insufficient, initial measures include consultations with dietitians and other specialists, along with management of dyspeptic symptoms. If these measures prove ineffective, sip feeding and home enteral tube feeding are indicated. The effectiveness of pharmacological methods for managing cancer anorexia–cachexia syndrome remains a matter of debate. The need for prescribed therapeutic exercise as a measure to prevent the progression of sarcopenia is also actively discussed.

Thus, although the management of cancer anorexia–cachexia syndrome in palliative care is primarily symptomatic, individualized nutritional support combined with limited physical activity and symptom-directed therapy can improve the quality of life in palliative patients with cancer.

Роль нутритивной поддержки инкурабельных онкологических больных по-прежнему остаётся спорной темой. Однако в клинических рекомендациях по оказанию паллиативной помощи предлагается оценивать дефицит питания, поскольку голодание ухудшает функциональный статус, качество жизни, приводит к незапланированным госпитализациям и снижению выживаемости.

В настоящем обзоре представлены современные данные о коррекции синдрома анорексии-кахексии в составе комплексной паллиативной помощи. Поиск первоисточников проведён в Научной электронной библиотеке (eLibrary.ru), поисковой системе PubMed и ограничен периодом их публикаций (2000–2024 гг.).

На основании нашего анализа определена необходимость индивидуальной нутритивной поддержки как основы сдерживания кахексии, направленной на улучшение качества жизни. При недостаточном пероральном поступлении пищи в первую очередь рекомендуются консультации диетолога, смежных специалистов, коррекция диспепсических явлений. При неэффективности этих мер показано использование сипинга и домашнего зондового питания. Эффективность применения фармакологических методов коррекции синдрома анорексии-кахексии остаётся спорной. Активно обсуждается необходимость проведения дозированной лечебной гимнастики как одной из мер предотвращения прогрессирования саркопении.

Таким образом, несмотря на изначально симптоматический характер лечения синдрома анорексии-кахексии на этапе паллиативной помощи, индивидуально подобранная нутритивная поддержка в сочетании с лимитированной физической нагрузкой и симптоматическим лечением способна улучшить качество жизни паллиативных онкологических больных.

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