如何解决癌症病人的食欲不佳问题

babyvot · 发表于 2013-5-24 19:50:26

学习学习、

轻婷点水 · 发表于 2013-6-2 21:54:01

学习学习！谢谢老马！

dd163 · 发表于 2013-6-2 22:19:55

学习了，感谢马哥辛苦了！

木梓言 · 发表于 2013-6-3 15:27:40

好贴，对我们这种入门级菜鸟挺实用，谢谢分享。
父亲最近体重下降厉害，准备着手速愈素了，期待效果~~

老马 · 发表于 2013-6-7 02:23:25

GTx的随机双盲安慰剂对照的用于评估Enobosarm治疗癌症患者肌肉萎缩和身体机能效果的2期临床试验结果。Enobosarm (GTx-024)是一种选择性抗原受体调节剂，是一种新型非甾体组织特异性蛋白同化制剂，具有潜在的增强肌肉质量改善身体机能的作用而且对通常与睾酮或非选择性合成代谢类固醇有关的前列腺皮肤或毛发没有有害的副作用，通讯作者是来自马里兰州巴尔的摩市约翰霍普金斯大学医学院内分泌学和代谢学系的Adrian S. Dobs博士。

　　在疾病发展过程中癌症诱导的肌肉萎缩很早就开始了，导致机能下降和其他不利的后果，例如疲劳和体重减轻，这与无肌肉损失的患者相比能促成残疾，生活质量降低和总生存期短。没有药物被证实用于预防和治疗癌症患者的肌肉萎缩。2期试验这些入选的非小细胞肺癌（NSCLC），结直肠癌（CRC），非霍奇金淋巴瘤（NHL），慢性淋巴细胞白血病（CLL）或乳腺癌患者，以enobosarm 1毫克或3毫克每日口服剂量治疗的患者表现出显着增加消瘦的体重（主要终点）和生理功能（次要终点之一）。相同时期得到安慰剂的患者在总消瘦体重或身体机能不显示明显的增加。

　　通讯作者，Adrian Dobs博士，2期试验的一名研究员，祥述说，“肌肉萎缩是一种常见的和毁灭性的癌症相关症状，到今天没有有效的治疗方法。这是第一个良好的对照临床试验，显示enobosarm是一种选择性的合成代谢剂，不仅能增加肌肉的质量，同时改善身体功能在临床相关的爬楼梯的活动，适用于广泛的癌症类型。在看到这个2期临床试验的结果之后，我正在期待POWER 1和POWER 2这两个3期临床研究的结果，来确认enobosarm有能力预防和治疗晚期非小细胞肺癌患者肌肉萎缩。”

老马 · 发表于 2013-7-13 23:31:57

Use of Appetite Stimulants in Long-term Care
Professional Refresher
http://www.nutrition411.com/prof ... s-in-long-term-care
When a resident in a long-term care facility exhibits unintended weight loss, dietitians assess the patient and recommend additional food, changes in eating environment, nutrition supplements, speech or occupation therapy, and other interventions. In some cases appetite-stimulant medications are recommended. But are they safe for the long-term care population, and are they effective?

The role of appetite stimulants in treatment of anorexia in the elderly is not clear. Despite limited research, several medications are used to promote weight gain in the elderly. However, none are specifically indicated for the treatment of weight loss in the elderly (Huffman, Rehman, Niedert, Zanni). The US Food and Drug Administration (FDA) has not labeled any drugs for use in elderly patients with weight loss (Huffman, Zanni). Nonetheless, these drugs often are prescribed for this purpose.

Appetite stimulant medications that often are prescribed include Megace® (megestrol), Marinol® (dronabinol), Periactin® (cyproheptadine), Oxandrin® (oxandrolone), Remeron® (mirtazapine), and Eldertonic®. Each drug has specific dose recommendations and contraindications that are beyond the scope of this article. Megace and Marinol are both documented to improve the anorexia associated with weight loss in acquired immunodeficiency syndrome (AIDS) and cancer patients. Oxandrin is an anabolic steroid that also is successfully used in AIDS and cancer patients. Remeron is an antidepressant that corrects chemical imbalances found in depression and may increase appetite in the process. Periactin is an antihistamine that appears to increase appetite, although the mechanism of action is not identified. Eldertonic is a sherry-based beverage containing a mix of vitamins and minerals that often serves to stimulate the appetite. Other medications are known to increase appetite in some patients, but are not prescribed for that purpose. In those cases, increased appetite or weight gain often is listed as a side effect of the medication.

Dietitians should consider the facts before ordering appetite stimulants in the elderly population. The first consideration is a person’s medical condition, advance directives, and plans for palliative care. Is the patient otherwise healthy and cognitive? Does the patient and/or family want aggressive treatment of weight loss or poor food intake? If so, the patient is perhaps a candidate for an appetite stimulant. Is the weight loss part of an inevitable decline because of a medical condition? If so, an appetite stimulant medication is perhaps not appropriate.

It is necessary to factor in the patient’s currently prescribed medications when making a decision about whether to recommend an appetite stimulant. Perhaps the patient is already taking a medication that causes anorexia and involuntary weight loss. A number of commonly prescribed drugs, including Lasix®, Coumadin®, and digoxin (Niedert), can result in anorexia.

If weight loss is a side effect of one medication, should the patient receive another medication to offset that side effect? If a patient is taking several medications already, adding another to the mix to increase appetite sometimes is contraindicated because of drug/drug interactions. If the patient has difficulty swallowing medications or frequently refuses medications, adding another to the medication regimen may not prove helpful.

Dietetics practitioners should know that many products used as appetite stimulants are used beyond the approved product labeling (Niedert). In some cases, the research supporting the medication for appetite stimulation is anecdotal. A pharmacist is an excellent resource for information on prescribing medications as an appetite stimulant.

Patients who have diabetes and are taking appetite stimulants should have their blood sugar monitored carefully. An increase in food intake might result in blood sugar fluctuations that will requirement adjustment of diabetes medications.
Although medications may help promote appetite and weight gain in the elderly, health care professionals should not consider them as the first line of treatment (Huffman) and consider them only after all other approaches have failed. It appears that appetite stimulants are not effective in some elderly patients, although the scientific evidence is not conclusive (Rehman). However, if the medications result in an increased appetite and prevent involuntary weight loss without unwanted side effects, appetite stimulants are perhaps a good idea for some patients. Health care facilities should evaluate each resident to determine which medication to use based on medical history, current medications, and prognosis for improvement of health and quality of life.

Implications for dietetics practitioners
Because of the issues surrounding the use of appetite stimulants in long-term care, including polypharmacy and labeling issues, dietitians should seek input from other health care professionals, including pharmacists, when recommending use of appetite stimulants.

References and recommended readings

American Medical Directors Association. Altered Nutritional Status in the Long-term Care Setting Clinical Practice Guidelines. Columbia, MD: American Medical Directors Association; 2010.

Huffman G. Evaluating and treating unintentional weight loss in the elderly. Am Fam Physician [serial online].2002;65:640-650.
Available at: http://www.aafp.org/afp/2002/0215/p640.html.
Accessed May 24, 2011.

Niedert KC, Dorner B. Nutrition Care of the Older Adult. 2nd ed. Chicago, IL: American Dietetic Association; 2004.

Rehman HU. Involuntary weight loss in the elderly. Clin Geriatr [serial online]. 2005;13:37-45.
Available at: http://www.imsersomayores.csic.e ... 9/art-05-08-01.pdf.
Accessed May 24, 2011.

Thomas DR. Guidelines for the use of orexigenic drugs in long-term care. Nutr Clin Pract. 2006;21:82-87.

Zanni GR. Involuntary weight loss—an ignored vital sign in seniors. Pharmacy Times [serial online].
Available at: http://www.pharmacytimes.com/pub ... cusWeightLoss-0110.
Accessed May 24, 2011

老马 · 发表于 2013-7-14 00:08:40

本帖最后由老马于 2013-7-14 00:15 编辑

BCAA supplementation Branch Chain Amino Acids 支链氨基酸
复方氨基酸注射液20AA10% 500毫升*1瓶山东鲁抗辰欣药业有限公司瓶 97.3
Branched-chain amino acids (BCAAs) are naturally-occurring molecules that form the building blocks of protein. BCAA supplements may improve appetite in cancer patients and slow the progression of amyotrophic lateral sclerosis (ALS). BCAAs are also used to potentially boost athletic performance.

支链氨基酸（BCAAs），侧链具有分支结构的氨基酸。在蛋白质中常见的有苏氨酸、缬氨酸和异亮氨酸等。天然存在分子，形成蛋白质的构建结块。 BCAA补充剂可能会提高癌症患者的食欲，并抑制慢肌萎缩性脊髓侧索硬化症（ALS）的发展。支链氨基酸也促进合成代谢（肌肉增长），可用来提高运动机能。

http://www.iherb.com/Amino-Acids