Refeeding syndrome in hematological cancer patients – current approach

ABSTRACT

Introduction: According to estimates based on the GLOBOCAN database of the International Agency for Research on Cancer, in 2018 alone, 18 100 000 cancers were globally diagnosed. Importantly, the majority of cancer patients experience unintended weight loss that leads to many adverse clinical consequences, including malnutrition and cancer cachexia. At the same time, each nutritional intervention must be carried out individually, as it can lead to critical complications, resulting in a threat to the health and life of the cachectic patient. An example of this type of risk is refeeding syndrome.

Areas covered: Three factors seem to be crucial in this case: early identification of patients at risk of malnutrition, the introduction of an individualized diet regimen and constant monitoring of nutritional intervention. It seems equally important to spread awareness about the possibility of refeeding syndrome and knowledge about its patomechanisms and consequences among medical staff. This should lead to minimizing the risk of refeeding syndrome.

Expert opinion: It should be noted that current guidelines on the pathogenesis, risk factors and methods of prevention and treatment of refeeding syndrome require further modifications, that would harmonize the management regimen in both prevention and therapy of refeeding syndrome.

KEYWORDS:

• Cachexia
• cancer patients
• malnutrition
• oncology
• refeeding syndrome

Article highlights

• It is estimated that 50–80% of patients with advanced stage cancer experience cachexia, and 10–20% die of it.

• Incorrectly maintained nutritional therapy may lead to critical complications, resulting in a threat to the health and life of the cachectic patient.

• Refeeding syndrome (RS) is example of this type of risk. It is a syndrome of severe metabolic disorders that are associated with a critical systemic deficiency of electrolytes, minerals and vitamins (especially phosphorus, potassium, magnesium and vitamin B1).

• Patients with malignant neoplasms are particularly at risk of developing RS. According to the analyzes carried out in cancer patients, RS occurs in 25% of cases.

• In the case of highly developed RS, mortality reaches up to 50%.

• Prevention is the best treatment for RS. Among the most important issues related to this should be mentioned: early identification of patients at risk of malnutrition, the introduction of an individualized nutrition regimen and constant monitoring of ongoing nutritional intervention.

• Current guidelines on the pathogenesis, risk factors, methods of prevention, and treatment of RS require further modifications that will unify the patterns of management in RS.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Notes

1. BMI – Body Mass Index .

2. FFMI – fat free mass index.

3. BMI – Body Mass Index.

4. WHO – World Health Organization.

Additional information

Funding

This paper was not funded.