高齢者のがんの栄養管理

高齢者のがんの栄養管理に関するレビュー論文を紹介します。

Federico Bozzettia: Nutritional aspects of the cancer/aging interface. Journal of Geriatric Oncology doi:10.1016/j.jgo.2011.03.003

高齢者のがん患者における筋肉量減少の原因として、サルコペニア（加齢による狭義）、悪液質、飢餓があり、これらが重複することが少なくありません（実際には廃用性筋萎縮も無視できません）。サルコペニアや悪液質は飢餓とは異なりますが、それでも適切な栄養管理が重要です。

結論には以下のような文章があります。

Clinicians are aware that an optimal nutritional support is unable to reverse a status of both sarcopenia and cachexia, that it can only prevent a further acute nutritional deterioration and that this condition should be faced with a combined approach: nutritional, pharmacologic and perhaps rehabilitative.

栄養管理単独ではなく薬剤、リハと併用したアプローチが重要とあります。perhapsが個人的には残念ですが（笑）。NSTであってもリハであっても、高齢者のがん患者には、栄養、薬剤、リハ（運動）の包括的アプローチが重要であることを認識した栄養ケアプランやリハプランの立案と実践が重要だといえます。

Abstract
The progressive aging of populations coupled with the increasing prevalence of cancer in elderly people, due to their long exposure to potential oncogenic factors, represents a formidable challenge for the health system. Moreover, whereas in many adult cancer patients, malignancy represents the primary basic target to be treated, in the elderly patients a concurrent status of sarcopenia multiplies the risk of aggressive therapies and forces the clinician to maintain a holistic view of his patient.

A common problem for the elderly cancer patient is the progressive malnutrition which is due to coexistence and/or potentiation of the metabolic alterations related to sarcopenia with underlying cancer cachexia. Both processes lead to loss of body weight, lean body mass, and muscle function, as well as a progressive deterioration of function of many organ/systems, a poor quality of life and finally to a poor adaptation to any stress event.

Although neither sarcopenia nor cancer cachexia may be reduced to a condition of simple starvation, an adequate nutritional intake is the conditio sine qua non which can make possible any attempt of aggressive oncologic therapies which are validated in adult subjects.

This paper, after a short review of topics including the interaction between sarcopenia and cancer cachexia, the nutritional status as a component of geriatric assessment tools, the prevalence of malnutrition and the negative prognostic role of malnutrition, focuses on the theoretical and practical aspects of the nutritional support of the elderly cancer patient.