:fej\ejf9iXj`c\`if[\:Xhl\o`X&8efi\o`X )'(( (

SUPLEMENTO 1

Revista Brasileira de Cuidados Paliativos 2011; 3 (3) - Suplemento 1

Re v i s t a B r a s i l e i r a d e C u i d a d o s Pa l i a t i v o s 2 011; 3 (3) - S u p l e m e n t o 1
 :fej\ejf9iXj`c\`if[\:Xhl\o`X&8efi\o`X )'(( *

SUPLEMENTO 1

CONSENSO BRASILEIRO DE CAQUEXIA/ ANOREXIA

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Re v i s t a B r a s i l e i r a d e C u i d a d o s Pa l i a t i v o s 2 011; 3 (3) - S u p l e m e n t o 1
+ )'(( :fej\ejf9iXj`c\`if[\:Xhl\o`X&8efi\o`X
SUPLEMENTO1
INTRODUÇÃO
CAQUEXIA - DEFINIÇÃO E ESTÁGIOS
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SUPLEMENTO 1
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METABOLISMO DE PROTEÍNAS:
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REFERÊNCIAS
1. Andrew IM, Waterfield K, Hildreth AJ, Kirkpatrick G, Hawkins C. Quantifying the impact of standardized assessment and symptom management
Df!7UeiYl]U 7UeiYl]U 7UeiYl]UFYZfUhzf]U tools on symptoms associated with cancer-induced anorexia cachexia sundrome. Palliative Medicine. 2009 Dec; 23(8):680-8.
2. Sarhill N, Mahmoud FA, Christie R, Tahir A. Assessment of nutritional status and fluid deficits in advanced cancer. Americam Journal of Hospice
:ibW]cbU`]XUXYZ…g]WU( + , - %& & Palliative Care. 2003 Nov-Dec; 20(6):465-473.
3. Stewart GD, Skipworth RJE, Fearon KCH. Cancer cachexia and fatigue. Clinical Medicine. 2006 Marc-Apr; 6(2):140-3.
FYU`]nU€~cXUgUh]j]XUXYgX]zf]Ug.
4. Fearon et al. Definition and classification of cancer cachexia: an international consensus. The Lancet Oncology. 2011.
vWUdUnXYfYU`]nUfhcXUgUgUh]j]XUXYg 5. Kemik O, Sumer A, Kemik AS, Hasirci I, Purisa, S, Dulger AC, et al. The relationship among acute-phase response proteins, citokynes and hormones
\UV]hiU]ggYaU^iXU in cachetic patients with colon cancer. World Journal of Surgical Oncology. 2010; 8:85.
    v WUdUn XY fYU`]nUf U aU]cf]U XUg 6. Blum D, Omlin A, Fearon K, Baracos V, Radbruch L, Kaasa S, et al. Evolving classification systems for cancer cachexia: ready for clinical practice?
Uh]j]XUXYg aUgUdfYgYbhUU`[ia[fUiXY Support Care Cancer. 2010; 18: 273-279.
XYdYbXƒbW]U 7. Bozzetti F, Mariani L. Defining and classifying cancer cachexia: a proposal by the SCRINIO Working Group. Journal of Parenteral and Enteral
    v ]bWUdUn XY fYU`]nUf U aU]cf]U XUg Nutrition. 2009; 33(4):361-367.
Uh]j]XUXYggYaU^iXU 8. Churm D, Andrew IM, Holden K, Hildreth AJ, Hawkins C. A questionnaire study of the approach to the anorexia-cachexia syndrome in patients
with cancer by a staff in a district general hospital. Support Care Cancer. 2009; 17: 503-507.
8YdYbXƒbW]UhchU`
9. Lasheen W, Walsh D. The cancer anorexia-cachexia syndrome: myth or reality? Support Care Cancer. 2010; 18:265-272.
10. Strasser F, Bruera ED. Update on anorexia and cachexia. Hematol Oncol Clin North Am. 2002 Jun;16(3):589-617.
=A7& ' ( * + 0&$ 11. Blum D, Omlin A, Fearon K, Baracos V, Radbruch L, Kaasa S, Strasser F Evolving classification systems for cancer cachexia: ready for clinical
practice? Support Care Cancer. 2010 Mar;18(3):273-9.
12. Kwang AY , Kandia M. Objective and Subjective Nutritional Assessment of Patients with Cancer in Palliative Care. AM J HOSP PALLIAT CARE.
DYgcWcfdcfU`& ' ( * + , - DYfXU0)' ( * %% !DYfXU2)) * %% %& 5bhYf]cf  89G9AD9B<C 2010 March; 27(2):117-26
ci :ÝG=7C7CADFCA9H=8C( 13. Barton BE. IL-6-like cytokines and cancer cachexia: consequences of chronic inflammation. Immunol Res. 2001;23(1):41-58.
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REFERÊNCIAS 4. McMillan DC, Leen E, et al. Effect of extended ibuprofen administration on the acute phase protein response in colorectal cancer patients. Eur
J Surg Oncol. 1995;21:531-534.
5. Preston T, Fearon KC, McMillan DC, et al. Effect of ibuprofen on the acute-phase response and protein metabolism in patients with cancer and
1. Kuhn CM. Anabolic Steroids. Recent Progress in Hormone Research. 2002; 57:411-434
weight loss. Br J Surg. 1995;82:229-234.
2. Kickman AT. Pharmacology of anabolic steroids. British Journal of Pharmacology. 2008: 154:502-521
6. Wigmore SJ, Falconer JS, Plester CE, et al. Ibuprofen reduces energy expenditure and acute- phase protein production compared with placebo in
3. Argilés JM. Optimal manegement of cancer anorexia-cachexia syndrome, Cancer Management and Research.2010; 2:27-38
pancreatic cancer patients. Br J Cancer. 1995;72:185-188.
4. Loprinzi CL, Jatoi A Pharmacologic manegement of cancer anorexia/cachexia www.uptodate.com Last literature review version 18.
7. McMillan DC, Wigmore SJ, Fearon KC, et al. A prospective randomized study of megestrol acetate and ibuprofen in gastrointestinal cancer
1. Cyproheptadine http://www.drugbank.ca/drugs/DB00434
patients with weight loss. Br J Cancer. 1999;79:495-500.
2. Goodman and Gilman’s .Manual of pharmacology and therapeutics.11th ed., 2008
8. Lundholm K, Gelin J, Hyltander A, et al. Anti-inflammatory treatment may prolong survival in undernourished patients with metastatic solid tumors.
3. Akio Inui, MD, PhD. Cancer anorexia-cachexia syndrome: current issues in research and management. J Clin. 2002; 52:72-91
Cancer Res. 1994;54:5602-5606.
4. Cyproheptadine http://www.drugs.com/pro/cyproheptadine.html
9. Inui A. Cytokine and sickness behavior: Implications from knockout animal models. Trends Immunol;22:469-473.
1. Inui A . Cancer Anorexia-Cachexia Syndrome: Current Issues in Research and Management CA Cancer . J Clin 2002;52:72-91
10. Mantovani G, Maccio A, Massa E, et al. Managing cancer-related anorexia / cachexia. Drugs 2001;61:499-514.
2. Solomon DH NSAIDs. Therapeutic use and variability of response in adults, 2011 www.uptodate.com
Masferrer JL, Leahy KM, Koki AT, et al. Antiangiogenic and antitumor activities of cyclooxygenase-2 inhibitors. Cancer Res
3. http://www.drugbank.ca/drugs
2000;60:130

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Pa l i a t i v o s 2 011; 3 (3) - S u p l e m e n t o 1
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REFERÊNCIAS BIBLIOGRÁFICAS CAQUEXIA: DEFINIÇÕES E ESTÁGIOS
1.Laviano A, Inui A, Marks DL, Meguid MM, Pichard C, Rossi Fanelli F,Seelaender M. Neural control of the anorexia-cachexia syndrome. Am J Physiol
Endocrinol Metab. 2008 Nov;295(5 :E1000 8.
2.Fox KM, Brooks JM, Gandra SR, Markus R, Chiou CF. Estimation of Cachexia among Cancer Patients Based on Four Definitions. J Oncol. 2009.Jul 1.
3. Springer J, von Haehling S, Anker SD. The need for a standardized definition for cachexia in chronic illness. Nat Clin Pract Endocrinol Metab.
2006 Aug;2(8):416-7.
4. Evans WJ, Morley JE, Argilés J, Bales C, Baracos V, Guttridge D, Jatoi A,Kalantar-Zadeh K, Lochs H, Mantovani G, Marks D, Mitch WE, Muscaritoli
M, Najand A, Ponikowski P, Rossi Fanelli F, Schambelan M, Schols A, Schuster M, Thomas D,Wolfe R, Anker SD. Cachexia: a new definition. Clin
Nutr. 2008 Dec;27(6):793-9.
5. Blum D, Omlin A, Baracos VE, Solheim TS, Tan BH, Stone P, Kaasa S, Fearon K,Strasser F; European Palliative Care Research Collaborative. Cancer
cachexia: A systematic literature review of items and domains associated with involuntary weight loss in cancer. Crit Rev Oncol Hematol. 2011 Jan
7. [Epub ahead of print]
6. Baldwin C. Nutritional support for malnourished patients with cancer. Curr Opin Support Palliat Care. 2011 Mar;5(1):29-36.
7. Bozzetti F; SCRINIO Working Group. Screening the nutritional status in oncology: a preliminary report on 1,000 outpatients. Support Care Cancer.
2009 Mar;17(3):279-84.
8. Fearon KC, Voss AC, Hustead DS; Cancer Cachexia Study Group. Definition of cancer cachexia: effect of weight loss, reduced food intake, and
systemic inflammation on functional status and prognosis. Am J Clin Nutr. 2006 Jun;83(6):1345-50.
9. Muscaritoli M, Anker SD, Argilés J, Aversa Z, Bauer JM, Biolo G, Boirie Y,Bosaeus I, Cederholm T, Costelli P, Fearon KC, Laviano A, Maggio M, Rossi
Fanelli F, Schneider SM, Schols A, Sieber CC. Consensus definition of sarcopenia, cachexia and pre-cachexia: joint document elaborated by Special
Interest Groups(SIG) “cachexia-anorexia in chronic wasting diseases” and “nutrition in geriatrics”. Clin Nutr. 2010 Apr;29(2):154-9
10. Fearon K, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL, Jatoi A,Loprinzi C, Macdonald N, Mantovani G, Davis M, Muscaritoli M, Ottery
F, Radbruch L, Ravasco P, Walsh D, Wilcock A, Kaasa S, Baracos VE. Definition and classification of cancer cachexia: an international consensus.
Lancet Oncol. 2011 Feb 4. [Epub ahead of print]
11. Penna F, Minero VG, Costamagna D, Bonelli G, Baccino FM, Costelli P.Anti-cytokine strategies for the treatment of cancer-related anorexia and
cachexia. Expert Opin Biol Ther. 2010 Aug;10(8):1241-50.
12. Stephens NA, Gallagher IJ, Rooyackers O, Skipworth RJ, Tan BH, Marstrand T,Ross JA, Guttridge DC, Lundell L, Fearon KC, Timmons JA. Using
transcriptomics to identify and validate novel biomarkers of human skeletal muscle cancer cachexia. Genome Med. 2010 Jan 15;2(1):1.
13. Tan BH, Fearon KC. Cytokine gene polymorphisms and susceptibility to cachexia.Curr Opin Support Palliat Care. 2010 Dec;4(4):243-8.
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REFERÊNCIAS BIBLIOGRÁFICAS: FISIOPATOLOGIA
1.Argilés JM, Alvarez B, López-Soriano FJ. The metabolic basis of cancer cachexia. Med Res Rev. 1997 Sep;17(5):477-98.
2. Fearon KC, Moses AG. Cancer cachexia. Int J Cardiol. 2002 Sep;85(1):73-81.
3. Saini A, Al-Shanti N, Stewart CE. Waste management - cytokines, growthfactors and cachexia. Cytokine Growth Factor Rev. 2006 Dec;17(6):475-
86.2006 Nov 22.Erratum in: Cytokine Growth Factor Rev. 2007 Jun-Aug;18(3-4):345. Nasser, Al-Shanti [corrected to Al-Shanti, Nasser
4. Argilés JM, López-Soriano FJ, Busquets S. Novel approaches to the treatment of cachexia. Drug Discov Today. 2008 Jan;13(1-2):73-8.
5. Barber MD, Ross JA, Fearon KC. Changes in nutritional, functional, and inflammatory markers in advanced pancreatic cancer. Nutr Cancer.
1999;35(2):106-10.
6. Brown JK. A systematic review of the evidence on symptom management of cancer-related anorexia and cachexia. Oncol Nurs Forum. 2002
Apr;29(3):517-32.
7. Skipworth RJ, Stewart GD, Dejong CH, Preston T, Fearon KC. Pathophysiology of cancer cachexia: much more than host-tumour interaction? Clin
Nutr. 2007 Dec;26(6):667-76.
8. von Haehling S, Genth-Zotz S, Anker SD, Volk HD. Cachexia: a therapeutic approach beyond cytokine antagonism. Int J Cardiol. 2002 Sep;85(1):173-83.
9. Argilés JM, Olivan M, Busquets S, López-Soriano FJ. Optimal management of cancer anorexia-cachexia syndrome. Cancer Manag Res. 2010 Jan
22;2:27-38.
10. DeWys WD. Pathophysiology of cancer cachexia: current understanding and areas for future research. Cancer Res. 1982;42(2 Suppl):721s-726s.
11. Tan BH, Fearon KC. Cytokine gene polymorphisms and susceptibility to cachexia.Curr Opin Support Palliat Care. 2010 Dec;4(4):243-8.
12.Inui A. Cancer anorexia-cachexia syndrome: current issues in research and management. CA Cancer J Clin. 2002 Mar-Apr;52(2):72-91.
13. Costa G. Cachexia, the metabolic component of neoplastic diseases. Cancer Res. 1977 Jul;37(7 Pt 2):2327-35.
14. Argilés JM, Moore-Carrasco R, Fuster G, Busquets S, López-Soriano FJ. Cancer cachexia: the molecular mechanisms. Int J Biochem Cell Biol. 2003
Apr;35(4):405-9.
15.Lawson DH, Richmond A, Nixon DW, Rudman D. Metabolic approaches to cancer cachexia. Annu Rev Nutr. 1982;2:277-301.
16.Laviano A, Inui A, Marks DL, Meguid MM, Pichard C, Rossi Fanelli F,
Seelaender M. Neural control of the anorexia-cachexia syndrome. Am J Physiol Endocrinol Metab. 2008 Nov;295(5):E1000-8.
17. Grossberg AJ, Scarlett JM, Marks DL. Hypothalamic mechanisms in cachexia. Physiol Behav. 2010 Jul 14;100(5):478-89.
18.Penna F, Minero VG, Costamagna D, Bonelli G, Baccino FM, Costelli P.Anti-cytokine strategies for the treatment of cancer-related anorexia and
cachexia. Expert Opin Biol Ther. 2010 Aug;10(8):1241-50.
19. Fearon K, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL, Jatoi A,Loprinzi C, Macdonald N, Mantovani G, Davis M, Muscaritoli M, Ottery
F, Radbruch L, Ravasco P, Walsh D, Wilcock A, Kaasa S, Baracos VE. Definition and classification of cancer cachexia: an international consensus.
Lancet Oncol. 2011 Feb 4. [Epub ahead of print]
20. Argilés JM, Busquets S, López-Soriano FJ. Metabolic interrelationships between liver and skeletal muscle in pathological states. Life Sci. 2001
August 10;69(12):1345-61.
21.Bruera E, Sweeney C. Cachexia and asthenia in cancer patients. Lancet Oncol. 2000 Nov;1:138-47.
22. Marcelli AR, Demopoulos RI, Goswami S, Mittal KR. Comparison of p53 and MIB1 expression in benign and borderline areas of ovarian serous
tumors. Int J Gynecol Pathol. 1996 Jan;15(1):39-44.
23. Klein S, Koretz RL. Nutrition support in patients with cancer: what do the data really show? Nutr Clin Pract. 1994 Jun;9(3):91-100.
24.Pichard C, Kyle UG. Body composition measurements during wasting diseases. Curr Opin Clin Nutr Metab Care. 1998 Jul;1(4):357-61.
25.Bosaeus I, Daneryd P, Svanberg E, and Lundholm K. Dietary intake and resting energy expenditure in relation to weight loss in unselected cancer
patients. Int J Cancer 93: 380–383, 2001).
26. Tisdale MJ. Wasting in cancer. J Nutr. 1999 Jan;129(1S Suppl):243S-246S.
27.Tisdale MJ. Cancer cachexia. Curr Opin Gastroenterol. 2010, Mar;26(2):146-51.
28. McCarthy DO. Rethinking nutritional support for persons with cancer cachexia. Biol Res Nurs. 2003 Jul;5(1):3-17.
29. Lundholm K, Daneryd P, Bosaeus I, Körner U, Lindholm E. Palliative nutritional intervention in addition to cyclooxygenase and erythropoietin treatment
for patients with malignant disease: Effects on survival, metabolism, and function.Cancer. 2004 May 1;100(9):1967-7
30.Baldwin C. Nutritional support for malnourished patients with cancer. Curr Opin Support Palliat Care. 2011 Mar;5(1):29-36.
31. Nelson KA, Walsh D, Sheehan FA. The cancer anorexia-cachexia syndrome. J Clin Oncol. 1994 Jan;12(1):213-25.
32. De Blaauw I, Deutz NE, Von Meyenfeldt MF. Metabolic changes in cancer cachexia--first of two parts. Clin Nutr. 1997 Aug;16(4):169-76.
33. Seelaender ,M.C.L. & Curi, R. Metabolic aspects in cancer cachexia. J.Braz.Ass.Adv.Sci. , 1994, 46: 92-96
34. Rivera CA, Wheeler MD, Enomoto N, Thurman RG. A choline-rich diet improves survival in a rat model of endotoxin shock. Am J Physiol. 1998
Oct;275(4 Pt1):G862-7.
35. Tayek JA. A review of cancer cachexia and abnormal glucose metabolism in humans with cancer. J Am Coll Nutr. 1992 Aug;11(4):445-56.
36.Tessitore L, Costelli P, Baccino FM. Humoral mediation for cachexia intumour-bearing rats. Br J Cancer. 1993 Jan;67(1):15-23.
37.Tijerina AJ. The biochemical basis of metabolism in cancer cachexia. Dimens Crit Care Nurs. 2004 Nov-Dec;23(6):237-43.
38.Fearon KC, Falconer JS, Slater C, McMillan DC, Ross JA, Preston T. Albumin synthesis rates are not decreased in hypoalbuminemic cachectic cancer
patients with an ongoing acute-phase protein response. Ann Surg. 1998 Feb;227(2):249-54.
39.Dworzak F, Ferrari P, Gavazzi C, Maiorana C, Bozzetti F. Effects of cachexia due to cancer on whole body and skeletal muscle protein turnover.
Cancer. 1998Jan 1;82(1):42-8.
40.Llovera M, García-Martínez C, López-Soriano FJ, Argilés JM. The effect of chronic tumour necrosis factor-alpha treatment on urinary nitrogen excretion
in the rat. Biochem Mol Biol Int. 1994 Jul;33(4):681-9.
41. García-Martínez C, López-Soriano FJ, Argilés JM. Amino acid uptake in skeletal muscle of rats bearing the Yoshida AH-130 ascites hepatoma. Mol
Cell Biochem.1995 Jul 5;148(1):17-23.
42.Medina MA, Sanchez-Jimenez F, Marquez J, Rodriguez Quesada A, Nunez de Castro I. Relevance of glutamine metabolism to tumor cell growth.
Mol Cell Biochem. 1992 Jul 6;113(1):1-15.
43.Argilés JM, López Soriano FJ. [The molecular bases of the cachexia associated with cancer]. Med Clin (Barc). 1990 Jan 13;94(1):18-20.
Review. Spanish.
44.Nishihira T, Takagi T, Mori S. Leucine and manifestation of antitumor activity by valine-depleted amino acid imbalance. Nutrition. 1993 Mar-
Apr;9(2):146-52.
45.Costelli P, Garcia-Martinez C, Llovera M, Carbo N, Lopez-Soriano FJ, Agell N, Tessitore L, Baccino FM, Argiles JM. Muscle protein waste in tumor-
bearing rats is effectively antagonized by a beta 2-adrenergic agonist (clenbuterol). Role of the ATP-ubiquitin-dependent proteolytic pathway. J Clin
Invest. 1995 May;95(5):2367-72.
46. van Royen M, Carbó N, Busquets S, Alvarez B, Quinn LS, López-Soriano FJ, Argilés JM. DNA fragmentation occurs in skeletal muscle during tumor
growth: A link with cancer cachexia? Biochem Biophys Res Commun. 2000 Apr 13;270(2):533-7.
Re v i s t a B r a s i l e i r a d e C u i d a d o s Pa l i a t i v o s 2 011; 3 (3) - S u p l e m e n t o
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47. Baumann H, Gauldie J. The acute phase response. Immunol Today. 1994 Feb;15(2):74-80.
48. Durham WJ, Dillon EL, Sheffield-Moore M. Inflammatory burden and amino acid metabolism in cancer cachexia. Curr Opin Clin Nutr Metab Care.
2009Jan;12(1):72-7.
49. Pond CM. Long-term changes in adipose tissue in human disease. Proc Nutr Soc.2001 Aug;60(3):365-74.
50. Shaw JH, Wolfe RR. Fatty acid and glycerol kinetics in septic patients and in patients with gastrointestinal cancer. The response to glucose infusion
and parenteral feeding. Ann Surg. 1987 Apr;205(4):368-76.
51.Bing C, Trayhurn P. New insights into adipose tissue atrophy in cancer cachexia. Proc Nutr Soc. 2009 Nov;68(4):385-92.
52. Machado AP, Costa Rosa LF, Seelaender MC. Adipose tissue in Walker 256 tumour-induced cachexia: possible association between decreased
leptin concentration and mononuclear cell infiltration. Cell Tissue Res. 2004Dec;318(3):503-14.
53. Yang YS, Song HD, Shi WJ, Hu RM, Han ZG, Chen JL. Chromosome localization analysis of genes strongly expressed in human visceral adipose
tissue. Endocrine. 2002 Jun;18(1):57-66.
54. Deng Y, Scherer PE. Adipokines as novel biomarkers and regulators of the metabolic syndrome. Ann N Y Acad Sci. 2010 Nov;1212:E1-E19.
55. Smiechowska J, Utech A, Taffet G, Hayes T, Marcelli M, Garcia JM. Adipokines in patients with cancer anorexia and cachexia. J Investig Med.
2010, Mar;58(3):554-9.
56.Mracek T, Stephens NA, Gao D, Bao Y, Ross JA, Rydén M, Arner P, Trayhurn P, Fearon KC, Bing C. Enhanced ZAG production by subcutaneous
adipose tissue is linked to weight loss in gastrointestinal cancer patients. Br J Cancer. 2011 Feb 1;104(3):441-7.
57. Evans RD, Williamson DH. Tissue-specific effects of rapid tumour growth on lipid metabolism in the rat during lactation and on litter removal.
Biochem J. 1988 May 15;252(1):65-72.
58. Mulligan HD, Tisdale MJ. Metabolic substrate utilization by tumour and host tissues in cancer cachexia. Biochem J. 1991 Jul 15;277 ( Pt 2):321-6.
59. Kazantzis M, Seelaender MC. Cancer cachexia modifies the zonal distribution of lipid metabolism-related proteins in rat liver. Cell Tissue Res.
2005 Sep;321(3):419-27.
60. Lira FS, Tavares FL, Yamashita AS, Koyama CH, Alves MJ, Caperuto EC, Batista ML Jr, Seelaender M. Effect of endurance training upon lipid
metabolism in the liver of cachectic tumour-bearing rats. Cell Biochem Funct. 2008 Aug;26(6):701-8.
REFERÊNCIAS BIBLIOGRÁFICAS-AVALIAÇÃO E CUIDADOS DE ENFERMAGEM EM PACIENTES
RECEBENDO DIETA ENTERAL
1- ASPEN Enteral Nutrition Practice Recommendations. J Parenter Enteral Nutr 2009; 33(2): 122-167.
2- Ciosak SI, Oliveira MFR, Silva MSS, Moreira RSC, Hasegawa MLH. Terapia Nutricional no Câncer: Cuidados de Enfermagem In: Waitzberg DL.
Dieta, Nutrição e Câncer. São Paulo: Atheneu; 2004. P. 554-562.
3- ESPEN Guidelines on Enteral Nutrition: Non-surgical Oncology. Clinical Nutrition 2006; 25: 245-259
4- ESPEN Guidelines on Parenteral Nutrition: Central Venous Catheters (acess,care,diagnosis and therapy of complications). Clinical Nutrition 2008;
28: 365-377.
5- BRASIL. Ministério da Saúde. Portaria Nº 272 de 8 de abril de 1998. Regulamento Técnico para a Terapia de Nutrição Parenteral. In: Brasil.
Ministério da Saúde. Agência Nacional de Vigilância Sanitária. Brasília; 1998.
6- BRASIL. Ministério da Saúde. Resolução 2000da Diretoria Colegiada – RDC Nº 63 de 6 de julho de 2000. Regulamento Técnico para a Terapia
de Nutrição Enteral. In: Brasil. Ministério da Saúde. Agência Nacional de Vigilância Sanitária. Brasília; 2000.
REFERÊNCIAS BIBLIOGRÁFICAS-AVALIAÇÃO NUTRICIONAL NO PACIENTE COM CÂNCER
1. Nitenberg G, Raynard B. Nutritional support of the cancer patient: issues and dilemmas. Critical Reviews in Oncology Hematology 2000; 34:137–68.
2. Raslan MPB, Gonzalez MC, Dias MCG, Paes-Barbosa FC, Cecconello I, Waitzberg DL. Aplicabilidade dos métodos de triagem nutricional no
paciente hospitalizado. Rev. Nutr. 2008; 21(5): 553-61.
3. Slaviero KA, Read JA, Clarke SJ, Rivory LP. Baseline Nutritional Assessment in Advanced Cancer Patients Receiving Palliative Chemotherapy. Nutrition
and Cancer, 46 (2): 148–57.
4. Raslan MPB, Gonzalez MC, Torrinhas RSMM, Ravacci GR, Pereira JCR, Waitzberg DL. Complementarity of Subjective Global Assessment (SGA) and
Nutritional Risk Screening 2002 (NRS 2002) for predicting poor clinical outcomes in hospitalized patients. Clin Nutr 2011; 30 (1): 49-53.
5. Raslan, MPB. Desempenho de testes de rastreamento nutricional como preditores de desfechos clínicos negativos em pacientes hospitalizados. [Tese
apresentada à Faculdade de Medicina da Universidade de São Paulo para obtenção do título de doutor]. São Paulo, 2010.
6. Raslan MPB, Gonzalez MC, Dias MCG, Nascimento M, Castro M, Marques P, Segatto S, Torrinhas RSMM, Cecconello I, Waitzberg DL. Comparison
of nutritional risk screening tools for predicting clinical outcomes in hospitalized patients. Nutrition, 2010; 26 (7-8): 721-26.
7. Kondrup J, Allison SP, Elia M, Vellas B, Plauth M. ESPEN (European Society for Parenteral and Enteral Nutrition) guidelines for nutrition screening
2002. Clin Nutr 2003; 22(4):415-21.
8. Destky AS, McLaughlin JR, Baker JP et al. What is subjective global assessment of nutritional status? JPEN 1987; 11: 8-13.
9. Barbosa-Silva MCG, Barros AJD. Avaliação Nutricional Subjetiva. Parte 1 - revisão de sua validade após duas décadas de uso. Arq Gastroenterol.
2002; 39 (3): 181-7.
10. Gonzalez MC, Borges LR, Silveira DH, Assunção MCF, Orlandi SP. Validação da versão em português da avaliação subjetiva global produzida
pelo paciente. Rev Bras Nutr Clin 2010; 25 (2):102-8.
11. Ottery FD. Definition of standardized nutritional assessment and intervevtional pathways in oncology. Nutrition 1996; 12: S15-19.
12. Muscaritoli M, Anker SD, Argilés J, Aversa Z, Bauer JM, Biolo G et al. Consensus definition of sarcopenia, cachexia and pre-cachexia: joint document
elaborated by Special Interest Group (SIG) “cachexia-anorexia in chronic wasting diseases” and “nutrition in geriatrics”. Clin Nutr 2010; 29:154-59.
13. Kwang AY, Kandiah M. Objective and Subjective Nutritional Assessment of patients with cancer in palliative care. Am J of Hospice Palliative Med
2010; 27 (2): 117-26.
14. Kirsh KL, Dugan C, Theobald DE, Passik SD. A chart review, pilot study of two single-item screens to detect cancer patients at risk for cachexia.
Palliative and Supportive Care 2003; 1: 331–35.
15. Barreto-Andrade JC, Medina-Franco H. Serum albumin is an independent prognostic factor for survival in soft tissue sarcomas. Rev Invest Clin
2009; 61(3): 198-204.
16. Kemik O, Sumer A, Kemik AS, Hasirci I, Purisa S, Dulger AC, Demiriz B, Tuzun S. The relationship among acute-phase response proteins, cytokines
and hormones in cachectic patients with colon cancer. World J Surg Oncol. 2010; 28 (8): 85.
17. Nelson KA, Walsh D. The Cancer Anorexia–Cachexia Syndrome: A Survey of the Prognostic Inflammatory and Nutritional Index (PINI) in Advanced
Disease. Journal of Pain and Symptom Management 2002; 24(4): 424-28.
18. O’Brien CO, Young AJ, Sawka MN, Bioelectrical impedance to estimate changes in hydration status. International J Sports Med. 2002; 23: 61-6.
19. Andrew IM, Waterfield K, Hildreth AJ, Kirkpatrick G, Hawkins C. Quantifying the impact of standardized assessment and symptom management
tools on symptoms associated with cancer-induced anorexia cachexia syndrome. Palliat Med; 2009 23: 680-88.
1 Re v i s t a B r a s i l e i r a d e C u i d a d o s Pa l i a t i v o s 2 011; 3 (3) - S u p l e m e n t o 1
*/ )'(( :fej\ejf9iXj`c\`if[\:Xhl\o`X&8efi\o`X
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REFERÊNCIAS BIBLIOGRÁFICAS - MEDICAMENTOS E NUTRACÊUTICOS PRECONIZADOS NO
TRATAMENTO DA CAQUEXIA INDUZIDA PELO CÂNCER
1. Kuhn CM. Anabolic Steroids. Recent Progress in Hormone Research. 2002; 57:411-434
2. Kickman AT. Pharmacology of anabolic steroids. British Journal of Pharmacology. 2008: 154:502-521
3. Argilés JM. Optimal manegement of cancer anorexia-cachexia syndrome, Cancer Management and Research.2010; 2:27-38
4. Loprinzi CL, Jatoi A Pharmacologic manegement of cancer anorexia/cachexia www.uptodate.com Last literature review version 18.
1. Cyproheptadine http://www.drugbank.ca/drugs/DB00434
2. Goodman and Gilman’s .Manual of pharmacology and therapeutics.11th ed., 2008
3. Akio Inui, MD, PhD. Cancer anorexia-cachexia syndrome: current issues in research and management. J Clin. 2002; 52:72-91
4. Cyproheptadine http://www.drugs.com/pro/cyproheptadine.html
1. Inui A . Cancer Anorexia-Cachexia Syndrome: Current Issues in Research and Management CA Cancer . J Clin 2002;52:72-91
2. Solomon DH NSAIDs. Therapeutic use and variability of response in adults, 2011 www.uptodate.com
3. http://www.drugbank.ca/drugs
4. McMillan DC, Leen E, et al. Effect of extended ibuprofen administration on the acute phase protein response in colorectal cancer patients. Eur J
Surg Oncol. 1995;21:531-534.
5. Preston T, Fearon KC, McMillan DC, et al. Effect of ibuprofen on the acute-phase response and protein metabolism in patients with cancer and weight
loss. Br J Surg. 1995;82:229-234.
6. Wigmore SJ, Falconer JS, Plester CE, et al. Ibuprofen reduces energy expenditure and acute- phase protein production compared with placebo in
pancreatic cancer patients. Br J Cancer. 1995;72:185-188.
7. McMillan DC, Wigmore SJ, Fearon KC, et al. A prospective randomized study of megestrol acetate and ibuprofen in gastrointestinal cancer patients
with weight loss. Br J Cancer. 1999;79:495-500.
8. Lundholm K, Gelin J, Hyltander A, et al. Anti-inflammatory treatment may prolong survival in undernourished patients with metastatic solid tumors.
Cancer Res. 1994;54:5602-5606.
9. Inui A. Cytokine and sickness behavior: Implications from knockout animal models. Trends Immunol;22:469-473.
10. Mantovani G, Maccio A, Massa E, et al. Managing cancer-related anorexia / cachexia. Drugs 2001;61:499-514.
11. Masferrer JL, Leahy KM, Koki AT, et al. Antiangiogenic and antitumor activities of cyclooxygenase-2 inhibitors. Cancer Res 2000;60:130
REFERÊNCIAS BIBLIOGRÁFICAS – MEDIDAS DIETÉTICAS
Arends J et al. ESPEN Guidelines on Enteral Nutrition: Non-surgical oncology. Clinical Nutrition, 2006;25:245–259.
August DA et al. Clinical Guidelines: Nutrition Support Therapy During Adult Anticancer Treatment and in Hematopoietic Cell Transplantation. Journal
of Parenteral and Enteral Nutrition,2009;33(5):472-500.
Barber et al. Fish oil–enriched nutritional supplement attenuates progression of the acute-phase response in weight-losing patients with advanced pan-
creatic cancer. The Journal of Nutrition,1999a;129:1120-1125.
Barber et al. The effect of an oral nutritional supplement enriched with fish oil on weight-loss in patients with pancreatic câncer. British Journal of
Cancer,1999b;81(1):80–86.
Barber MD. Cancer cachexia and its treatment with fish-oil-enriched nutritional supplementation. Nutrition,2001;17:751-55.
Bozzetti F. The patient with incurable aphagic cancer: to feed or not to feed? Nutrition,2001;17(7-8):676-77.
Bozzetti F; on behalf of the SCRINIO Working Group. Screening the nutritional status in oncology: a preliminary report on 1,000 outpatients. Support
Care Cancer, 2009;17:279-284.
Bozzetti F et al. ESPEN Guidelines on Parenteral Nutrition: Non-surgical oncology. Clinical Nutrition,2009:1–10.
Bozzetti F & Mariani L. Defining and classifying cancer cachexia: a proposal by the SCRINIO Working Group. J Parenter Enteral Nutr,2009; 33:361-367.
Bozzetti F. Effects of artificial nutrition on the nutritional status of câncer patients. JPEN,1989;13:406.
Brasil. Consenso Nacional de Nutrição Oncológica. Instituto Nacional do Câncer. Rio de Janeiro: INCA, 2009. 126p.
Burns P et al. Phase II study of high-dose fish oil capsules for patients with cancer-related cachexia. A Cancer and Leukemia Group B study. Cancer,2004;
101:370–378.
Candela CG et al. Organograma Prático para a Prescrição Dietética em Câncer. In: Waitzberg, DL. Dieta, Nutrição e Câncer. São Paulo: Editora
Atheneu, 2006.
Colomer R et al. n-3 Fatty acids, cancer and cachexia: a systematic review of the literature. British Journal of Nutrition,2007; 97:823–831.
Eberhardie C. Nutrition support in palliative care. Nursing standard, 2002;17(2):47-52.
Fearon KC et al. Effect of a protein and energy dense n-3 fatty acid enriched oral supplement on loss of weight and lean tissue in cancer cachexia: a
randomized double blind trial. Gut,2003;52(10):1479–1486
Fearon KC et al. Definition and classification of cancer cachexia: an international consensus. The Lancet Oncology,2011;12(5): 489–495.
Ferrell BR & Coyle N. Textbook of Palliative Nurse. New York: Oxford, 2001.
Feuz A & Rapin CH. An observational study of the role of pain control and food adaptation of eldery patients with terminal cancer. J Am Diet As-
soc,1994;94:767-770.
Gogos CA et al. Dietary omega-3 polyunsaturated fatty acids plus vitamin E restore immunodeficiency and prolong survival for severely ill patients with
generalized malignancy: a randomized control trial. Cancer,1998;82(2):395-402.
Hutton JL et al. Dietary patterns in patients with advanced câncer: implications for anorexia-cachexia therapy. Am J Clin Nutr,2006;84:1163-1170.
Isering EA, Capra S, Bauer JD. Nutrition intervention is benedicial in oncology patients receiveing radiotherapy to gastrointestinal or head and neck
area. Br J Cancer,2004;91-447-452.
Instituto Nacional do Câncer/INCA. Consenso Nacional de Nutrição Oncológica. 2009
Jatoi A et al. An eicopentaenoic acid supplement versus megestrol acetate versus both for patients with cancer-associated wasting: a North Cen Cancer
Treatment Group and National Cancer Institute Canada collaborative effort. J Clin Oncol,2004;22:2469–2476.
Kenler AS et al. Early enteral feeding in postsurgical cancer patients. Fish oil structured lipid-based polymeric formula versus a standard polymeric
formula. Annals of Surgery,1996; 223(3):316–333.
Lundholm K et al. Palliative nutritional intervention in addition to cyclooxygenase and erythropoietin treatment for patients with malignant disease: effects
on survival, metabolism and function. Cancer,2004;100:1967-1977.
Meydani S. Effects of (n-3) polyunsaturated fatty acids on cytokine production and their biological function. Nutrition,1996;12,S8–S14.
Morley JE. Calories and caquexia. Clinic Nutrition and metabolic Care,2009;12:607-610.
Murray K. Essentials in Hospice Palliative Care. Saanichton. Ed Life and Death Matters. 2nd edition, 2009.
Okusaka et al. Prognosis of advanced pancreatic cancer patients with reference to calorie intake. Nutrition and Cancer,1998;32(1):55-58.
Pettey C et al. What´s to eat? Cancer patients help decide. RN,1998;61:23-26.
Re v i s t a B r a s i l e i r a d e C u i d a d o s Pa l i a t i v o s 2 011; 3 (3) - S u p l e m e n t o
:fej\ejf9iXj`c\`if[\:Xhl\o`X&8efi\o`X )'(( *0
SUPLEMENTO 1
Pelzer, U et al. Parenteral Nutrition support for patients with pancreatic cancer. Results of a phase II study. BMC Cancer,2010;10(86):5.
Pereira, JP. The Pallium Palliative Pocketbook: a peer-reviewed, reference resource. 1st ed. Edmonton, Canada: The Pallium Project,2008.
Persson CR et al. A randomized study of nutritional support in patients with colorectal and gastric cancer. Nutr Cancer,2002;42:48-58.
Ravasco P et al. Impact of nutrition on outcome: a prospective randomized controlled trial in patients undergoing radiotherapy. Head Neck,2002;57:659-668.
Ravasco P et al. Dietary counseling improves patients outcomes: a prospective, randomized, controlled trial in colorectal cancer patients undergoing
radiotherapy. J Clin Oncol,2005;23:1431-1448.
Rosenfeld, RS. Cuidados Nutricionais no Paciente Terminal. In: Waitzberg, DL. Dieta, Nutrição e Câncer. São Paulo: Editora Atheneu,2006.
Schwerin HS et al. Food, eating habits, and health: a further examination of the relationship between food eating patterns and nutritional health. Am
J Clin Nutr,1982;35:1319-25.
Stewart GD et al. Cancer cachexia and fatigue. Clinical Medicine. 2006;6(2):140-143.
Strasser, F & Bruera, ED. Update on anorexia and caquexia. Hematol Oncol Clin N Am,2002;16:589-617.
Wallengren O et al. Diet energy density and energy intake in palliative care cancer patients. Clin Nutr,2005;24:266-273.
Wigmore SJ et al. Effect of oral eicosapentaenoic acid on weight loss in patients with pancreatic cancer. Nutrition & Cancer,2002;36(2):177–184.
Zuijdgeest-Van Leeuwen SD et al. Eicosapentaenoic acid ethyl ester supplementation in cachectic cancer patients and healthy subjects: effects on lipolysis
and lipid oxidation. Clinical Nutrition,2000;19(6):417–423.
REFERÊNCIAS BIBLIOGRÁFICAS - CUIDADOS DE ENFERMAGEM COM
A PELE DO PACIENTE CAQUÉTICO
1. European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel. Prevention and treatment of pressure ulcers: quick reference
guide. Washington DC: National Pressure Ulcer Advisory Panel; 2009.
2. Ayello EA, Sibbald RG. Preventing pressure ulcers and skin tears. In: Capezuti E, Zwicker D, Mezey M, Fulmer T, editor(s). Evidence-based geriatric
nursing protocols for best practice. 3rd ed. New York (NY): Springer Publishing Company; 2008 Jan. p. 403-29.
3. ECRI, ISMP. Skin tears: the clinical challenge. Patient Safety Advisory 2006; 3(3):2,5-10.
4. Ratliff CR, Fletcher KR. Skin tears: a review of the evidence to support prevention and treatment. Ostomy Wound Manage. 2007; 53(3):32-4,36,38-40.
5. Roberts MJ. Preventing and managing skin tears: a review. Journal of Wound Ostomy and Continence Nursing 2007; 34(3):256-9.
6. Xiaoti Xu BS, Kwan Lau MD, Breena R, Taira MD, Adam JS. The current management of skin tears. American Journal of Emergency Medicine 2009;
27:729–33.
7. Baranoski S Skin tears: the enemy of frail skin. Adv Skin Wound Care 2000;13(3 Pt 1):123-6.
8. Baranoski, S. Skin tears: guard against this enemy of frail skin. Nursing Management 2001; 32(8):25-31.
9. Kirkpatrick M. Skin tears: the enemy of the aged. Australian Resource Centre for Healthcare Innovations 2005. Disponível em: http://www.archi.net.
au/elibrary/health_administration/baxter_2005_nsw_health_awards/education_and_training/skin_tears em 12 de setembro de 2009.
10. Koepsel K. Blisters, abrasions, skin tears. PodiatryNetwork.com 2002. Disponível em: http://www.podiatrynetwork.com/r_blisters.cfm em 12 de
setembro de 2009.
11. Cleveland clinic. How to care for a skin tear. [online] 2003. Disponível em: http://www.clevelandclinic.org/health/health-info/docs/3800/3885.
asp?index=4277&src=news em 12 de setembro de 2009.
12. ECRI, ISMP. Sample police on skin tear management. Patient Safety Advisory 2006.
13. Reddy M. Skin and wound care: important considerations in the older adult. Advances in Skin and Wound Care 2008; 21(9):424-36.
14. Bolhuis J. Evidence-based skin tear protocol. Long Term Living 2008. Disponível em www.ltlmagazine.com em 28 de abril de 2009.
15. Meuleneire F. Using a soft silicone-coated net dressing to manage skin tears. J Wound Care. 2002; 11(10):365–9.
16. Meuleneire F. The management of skin tears. Nursing Times 2003; 99(5):69-71.
17. LeBlanc K, Christensen D, Orsted HL, Keast DH. Prevention and treatment of skin tears. Wound Care Canada 2008; 6(1):14-32.
18. Joanna Briggs Institute Best Practice. Topical skin care in aged care facilities. Best Practice 2007; 11(3):1-4.
19. Fleck CA. Preventing and treating skin tears. Advances in Skin and Wound Care 2007; 20(6):315-20.
20. LeBlanc K, Baranoski S. Prevention and management of skin tears. Adv Skin Wound Care 2009; 22:325-32; quiz 333-4.
21. Baranoski S. Skin tears: staying on guard against the enemy of frail skin. Nursing 2003; 30(9):41-6; quiz 47.
22. Baranoski S. How to prevent and manage skin tears. Adv Skin Wound Care 2003; 16(5):268-70.
REFERÊNCIAS BIBLIOGRÁFICAS-HIPODERMÓCLISE E CONTROLE DE SINTOMAS
1. Sasson M, Shvartzman MD. Hypodermoclysis: An Alternative Infusion Technique. American Family Physician, Vol 64, no 9, p 1575-1578, 2001.
2. Vía subcutânea. Uilidad em el control de sintomas Del paciente terminal. MEDIFAM 2002; 12: 104-110.
3. López PL ET al. Vías alternativas a La via oral em cuidados paliativos: la via subcutânea. Revista Valenciana de Medicina de Família 2000:8:30.
4. Helen Hays. Hypodermoclysis for Symptom Control in Terminal Care. Can Fam Physician Vol. 31: June 1985.
5. Molloy W. Hypodermoclysis in the Care of Older Adults An old solutionfor newu problems? Canadian Family Physician vo 38, p 2038-2043, 1992.
6. Christopher M. et al. Continuous Subcutaneous Infusion Practices of United States Hospices. Journal of Pain and Symptom Management 10 Vol. 22
No. 6,p. 1027-1034, 2001.
7. Dalal S, Bruera E. Dehydration in Cancer Patients: To Treat or Not To Treat . The Journal of Supportive Oncology vol 2, no. 6, p 467-487, 2004.
8. Bruera E, et al. Effects of Parenteral Hydration in Terminally Ill Cancer Patients: A Preliminary Study. Vol 23, no. 10, p 2366-2371, 2005.
9. Rochon PA, et al. A Systematic Review of the Evidence for Hypodermoclysis To Treat Dehydration in Older People. Journal of Gerontology: Medical
Sciences, Vol. 52A, No. 3, MI69-MI76, 1997.
10. NHS Guidelines for de use of subcutaneous medications in palliative care. ASD-PCPD, editor. Glasgow: NHS Greater Glasgow: 2008.
11. Remington R, Hultman T. Hypodermoclysis to Treat Dehydration: A Review of the Evidence. JAGS Vol 55, no 1, December 2007.
12. Ferreira K, Santos AC. Hipodermóclise e Administração de medicamentos por via subcutânea, uma técnica do passado com futuro.Pratica hos-
pitalar, 2009; 65: 109-114
13. Colica DD, et al. Hipodermoclisis Un Método Alternativo de hidratación. Revista Del Hospital Provado de Comunidad. Vol 5, no. 2, agosto/diciembre, 2002.
REFERÊNCIAS BIBLIOGRÁFICAS - ASPECTOS PSICOLÓGICOS
1. KENZLER Wilhelm. Significado do Aleitamento Materno. In: Hugo Issler. (Org.). O Aleitamento Materno no Contexto Atual: Políticas, Práticas e Bases
Científicas. São Paulo: SARVIER, 2008, v.1, p.255-259.
2. COUTINHO, Sonia Bechara; TERUYA Keiko. Sobrevivência Infantil e Aleitamento Materno. In: José Dias Rego. (Org.). Aleitamento Materno. 2a ed.
Rio de Janeiro: Editora Atheneu, 2006, v. 1, p. 1-26.
1 Re v i s t a B r a s i l e i r a d e C u i d a d o s Pa l i a t i v o s 2 011; 3 (3) - S u p l e m e n t o 1
+' )'(( :fej\ejf9iXj`c\`if[\:Xhl\o`X&8efi\o`X
SUPLEMENTO1
3. BLUM D, HESS J, OMLIN A, JURT G, STRASSER F. Comprehensive cancer cachexia staging and its impact in the outpatient oncology setting: A phase
II study. J Clin Oncol 27, 2009 (suppl; abstr e20530)
4. BRUERA E. Pharmacological interventions in cachexia and anorexia. In: Oxford Textbook of Palliative Medicine , 3rd Edition 2004, p552-560
5. SANCHO F. J. V Tratamiento de la anorexia y caquexia en el paciente terminal Oncología, 2005; 28 (3):135-138
6. STRASSER F; BRUERA ED. Update on anorexia and cachexia. Hematol Oncol Clin N AM 16 (2002) 589-617.
7. STRASSER F. Pathophysiology of the anorexia/cachexia syndrome. In Oxford Textbook of Palliative Medicine, 3rd, Edition 2004, p520-533
8. MORAES, Tania Mara, Como cuidar de um doente em fase avançada de doença. O Mundo da Saúde. São Paulo: 2009;33(2):231-238
9. BENARROZ, MO; FAILLACE, GBD e BARBOSA, LA. Bioética e nutrição em cuidados paliativos oncológicos em adultos. Cad. Saúde Pública, Rio
de Janeiro, 25(9):1875-1882, set, 2009
10. Hopkinson JB. The emotional aspects of cancer anorexia. Curr Opin Support Palliat Care. 2010 Dec;4(4):254-8.
11. Inui A. Cancer Anorexia-Cachexia Syndrome: Current Issues in Research and Management. CA Cancer J Clin 2002;52:72-91
12. DE PRADO C, VITERI A , FUENTE N . Aspectos psicológicos del paciente con cáncer Gac Med Bilbao 2003; 100(1) : 28-31 Bilbao Gac Med
2003; 100 (1): 28-31
13. HOLLAND J, ROWLAND J and PLUMB M. Psychological Aspects of Anorexia in Cancer Patients. . Cancer Res 1977; 37:2425-2428. Published
online July 1, 1977.
14. PASQUINI, M.; BIONDI, M. Depression in cancer patients: a critical review. Clinical Practice and Epidemiology in Mental Health, v. 3, n. 2, 2007.
Disponível em: http://www.cpementalhealth.com/content/3/1/2.
15. TENG CT et al. Aspectos psiquiatricos do paciente com câncer. In CARVALHO, VA et al. Temas em Psico-Oncologia. São Paulo. Ed. Summus, 2008
16. Manual diagnóstico e estatístico de transtornos mentais: DSM-IV-TR. Trad. Cláudia Dornelles. 4. ed. rev. Porto Alegre: Artmed, 2003.
17. Classificação de transtornos mentais e de comportamento da CID-10: descrições clínicas e diretrizes diagnósticas. Coord. Organização Mundial
da Saúde. Trad. Dorgival Caetano. Porto Alegre: Artes Médicas, 1993.
18. WICK JY, GR Zanni. Consult Pharm. 2009 Dec;24(12):874-83.
19. PALLLIATIVE CARE GUIDELINES: Anorexia / Cachexia in Palliative Care. © NHS Lothian. Re-issue date: August 2010. Review date: August 2013
www.palliativecareguidelines.scot.nhs.uk/documents/Anorexia.pdf
20. MacDONALD N. Cancer cachexia and targeting chronic inflammation: a unified approach to cancer treatment and palliative/supportive care. J
Support Oncol. 2007 Apr;5(4):157-62.
21. BRUADE HD, MacDONALD N, CHASEN M. Healing and survivorship: what makes a difference? Curr Oncol. 2008 Aug;15(4):185-7.
22. GRANDA-CAMERON C, DeMILLE D, LYNCH MP, HUNTZINGER C, ALCOM T, LEVICOFF J, ROOP C, MINTZER D. An interdisciplinary approach
to manage cancer cachexia.
23. HISNLEY R; HUGHES R. The reflections you get’: an exploration of body image and cachexia. International Journal of Palliative Nursing, 2007 Vol
13 No. 2. p 84-89.
REFERÈNCIAS BIBLIOGRÁFICAS-EXERCÍCIO FÍSICO
1. Argiles JM, Busquets S, Toledo M, Lopez-Soriano FJ. The role of cytokines in cancer cachexia. Current Opinion in Supportive & Palliative Care.
2009;3:263-268
2. Argilés JM, Alvarez B, López-Soriano FJ. The metabolic basis of cancer cachexia. Medicinal Research Reviews. 1997;17:477-498
3. Argilés JM, López-Soriano FJ, Busquets S. Novel approaches to the treatment of cachexia. Drug Discovery Today. 2008;13:73-78
4. Bao Y, Bing C, Hunter L, Jenkins JR, Wabitsch M, Trayhurn P. Zinc-[alpha]2-glycoprotein, a lipid mobilizing factor, is expressed and secreted by
human (sgbs) adipocytes. FEBS Letters. 2005;579:41-47
5. Laviano A, Inui A, Marks DL, Meguid MM, Pichard C, Rossi Fanelli F, Seelaender M. Neural control of the anorexia-cachexia syndrome. Am J Physiol
Endocrinol Metab. 2008;295:E1000-1008
6. Machado AP, Costa Rosa LFPB, Seelaender MCL. Adipose tissue in walker 256 tumour-induced cachexia: Possible association between decreased
leptin concentration and mononuclear cell infiltration. Cell and Tissue Research. 2004;318:503-514
7. Petersen AMW, Pedersen BK. The anti-inflammatory effect of exercise. J Appl Physiol. 2005;98:1154-1162
8. Flynn MG, McFarlin BK, Markofski MM. State of the art reviews: The anti-inflammatory actions of exercise training. Am. J. Lifestyle Med. 2007;1:220-235
9. Fischer C. Interleukin-6 in acute exercise and training: What is the biological relevance? Exerc Immunol Rev. 2006;12:6-33
10. Steensberg A, Fischer CP, Keller C, Moller K, Pedersen BK. Il-6 enhances plasma il-1ra, il-10, and cortisol in humans. Am. J. Physiol. Endocrinol.
Metab. 2003;285:E433-437
11. Fallon KE, Fallon SK, Boston T. The acute phase response and exercise: Court and field sports. Br. J. Sports Med. 2001;35:170-173
12. Mattusch F, Dufaux B, Heine O, Mertens J, Rost R. Reduction of the plasma concentration of c-reactive protein following nine months of endurance
training. Int. J. Sports Med. 2000;21:21-24
13. Keller C, Keller P, Giralt M, Hidalgo J, Pedersen BK. Exercise normalises overexpression of tnf-alpha in knockout mice. Biochem. Biophys. Res.
Commun. 2004;321:179-182
14. Fischer C, Berntsen A, Perstrup L, Eskildsen P, Pedersen B. Plasma levels of interleukin-6 and c-reactive protein are associated with physical inactivity
independent of obesity. Scand J Med Sci Sports. 2003;0:1-8
15. Beyaert R, Fiers W. Tumor necrosis factor and lymphotoxin. In: Mire-Sluis A, Thorpe R, eds. Cytokines. Blanche Lane: Academic Press; 1999:335-345.
16. Steinacker J, Lormes W, Reissnecker S, Liu Y. New aspects of the hormone and cytokine response to training. Eur. J. Appl. Physiol. 2004;91:382-391
17. Lehmann M, Knizia K, Gastmann U, Petersen K, Khalaf A, Bauer S, Kerp L, J K. Influence of 6-week, 6 days per week, training on pituitary function
in recreational athletes. Br J Sports Med. 1993;27:186-192
18. Batista Junior ML, Lopes RD, Seelaender MC, Lopes AC. Anti-inflammatory effect of physical training in heart failure: Role of tnf-alpha and il-10.
Arq Bras Cardiol. 2009;93:643-651, 692-700
19. Bacurau RF, Belmonte MA, Seelaender MC, Costa Rosa LF. Effect of a moderate intensity exercise training protocol on the metabolism of macrophages
and lymphocytes of tumour-bearing rats. Cell Biochem Funct. 2000;18:249-258
20. Lira FS, Rosa JC, Zanchi NE, Yamashita AS, Lopes RD, Lopes AC, Batista Jr ML, Seelaender M. Regulation of inflammation in the adipose tissue in
cancer cachexia: Effect of exercise. Cell Biochemistry and Function. 2009;27:71-75
21. Zinna EM, Yarasheski KE. Exercise treatment to counteract protein wasting of chronic diseases. Curr Opin Clin Nutr Metab Care 2003;6:87-93
22. Lemmey AB, Marcora SM, Chester K, Wilson S, Casanova F, Maddison PJ. Effects of high-intensity resistance training in patients with rheumatoid
arthritis: a randomized controlled trial. Arthritis Rheum 2009;61:1726-34
23. Plasqui G. The role of physical activity in rheumatoid arthritis. Physiol Behav 2008; 94:270-5
24. al-Majid S, McCarthy DO. Resistance exercise training attenuates wasting of the extensor digitorum longus muscle in mice bearing the colon-26
adenocarcinoma. Biol Res Nurs 2001;2:155-66
25. Doyle C, Kushi LH, Byers T, et al. Nutrition, Physical Activity and Cancer Survivorship Advisory Committee; American Cancer Society. Nutrition
and physical activity during and after cancer treatment: an American Cancer Society guide for informed choices. CA Cancer J Clin 2006;56:323-53
Re v i s t a B r a s i l e i r a d e C u i d a d o s Pa l i a t i v o s 2 011; 3 (3) - S u p l e m e n t o
:fej\ejf9iXj`c\`if[\:Xhl\o`X&8efi\o`X )'(( +(
SUPLEMENTO 1
26. Jones LW, Eves ND, Courneya KS, et al. Effects of exercise training on antitumor efficacy of doxorubicin in MDA-MB-231 breast cancer xenografts.
Clin Cancer Res 2005;11:6695-8
27. Dimeo F, Stieglitz RD, Novelli-Fischer U, Fetscher S, Mertelsmann R, Keul J. Correlation between physical performance and fatigue in cancer patients.
Ann Oncol 1997; 8:1251-5.
28. Deuster PA, Morrison SD, Ahrens RA. Endurance exercise modifies cachexia of tumor growth in rats. Med Sci Sports Exerc 1985;17:385-92
29. Lira FS, Tavares FL, Yamashita AS, Koyama CH, Alves MJ, Caperuto EC, Batista ML Jr, Seelaender M. Effect of endurance training upon lipid
metabolism in the liver of cachectic tumour-bearing rats. Cell Biochem Funct 2008;26:701-8.
30. Lira FS, Yamashita A, Carnevali LC Jr, Gonçalves DC, Lima WP, Rosa JC, Caperuto EC, Rosa LF, Seelaender M. Exercise training reduces PGE2
levels and induces recovery from steatosis in tumor-bearing rats. Horm Metab Res 2010;42:944-9.
31. Elter T, Stipanov M, Heuser E, von Bergwelt-Baildon M, Bloch W, Hallek M, Baumann F. Is physical exercise possible in patients with critical cytopenia
undergoing intensive chemotherapy for acute leukaemia or aggressive lymphoma? Int J Hematol 2009; 90:199-4.
REFERÊNCIAS BIBLIOGRÁFICAS-PEDIATRIA
1- Tisdale, M.J. Cancer anorexia and cachexia. Nutrition 2001;17:438-442.
2- Inui, A. Cancer anorexia-cachexia syndrome: Are neuropeptides the key? Cancer Res 1999;59(18):4493-501.
3- Miller SDM; Bayran, et al. Nutritional Supplementation for Pediatric Cancer Cachexia: What Can We Feed Back? Pediatr Blood Cancer 2009;
52:557–558.
4- Barber MD, Fearon KC, Tisdale MJ, McMillan DC, Ross JA. Effect of a Fish Oil-Enriched Nutritional Supplement on Metabolic Mediators in Patients
with Pancreatic Cancer Cachexia. Nutr Cancer 2001; 40(2):118-124.
5- Lai J-S, Cella D, Peterman A, Barocas J, Goldman S. Cancer 2005; 104 (7).
6- Bayram I, Erbey F, Celik N, Nelson L J, Tanyeli A. The Use of a Protein and Energy Dense Eicosapentaenoic Acid Containing Supplement for Malig-
nancy-Related Weight Loss in Children.Pediatr Blood Cancer 2009; 52(5):571-574.
7- Silva MPN. Síndrome da Anorexia Caquexia em Portadores de Câncer. Revista Brasileira de Cancerologia 2006; 52(1): 59-77.
8- Garófolo, A. Diretrizes para terapia nutricional em crianças com câncer em situação crítica. Nutr 2005; 18(4): 513-527.
9- Houlston A, Buttery E, Powell B.Cook to Order: Meeting the Nutritional Needs of Children with Cancer in Hospital. Paediatr Nurs 2009; 21(4):25-27.
10- Karwacki MW, Gastrointestinal Symptoms: Cachexia and anorexia syndrome. In: Goldman A, Hain R, Liben S, editors. Oxford Textbook of Palliative
Care for Children. Oxford: University Press; 2006.p.362-5.
11- ASPEN. Board of Directions and the Clinical Guidelines Task Force. Guidelines for the Use of Parenteral and Enteral Nutrition. JPEN 2002; 261
(1): 15A-1385A:144.
12- Heubi, JE. Whenever possible, Use the Gut! J Pediatr Hematol Oncol 1999 12 (2).
13- Maia PS, Tsutsumi RC, São Pedro BMO, Garófolo A, Petrilli AS Lopez FA. Suplementação oral em pacientes pediátricos com câncer. Nutrire: rev.
Soc. Bras. Alim. Nutr. J. Brazilian Soc Food Nutr 2010, 35 (1): 85-96.
14- Bayram I, Erbey F, Celik N, Nelson L J, Tanyeli A. The Use of a Protein and Energy Dense Eicosapentaenoic Acid Containing Supplement for Ma-
lignancy-Related Weight Loss in Children.Pediatr Blood Cancer 2009; 52(5):571-574.
15- Ovesen L, Allingstrup L, Hannibal J, et al. Effect of Dietary Counseling on Food Intake, Body Weight, Response Rate, Survival, and Quality of Life
in Cancer Patients Undergoing Chemotherapy: A Prospective, Randomized Study. J Clin Oncol 1993; 11:2043–2049.
16- Smith DE, Stevens MCG, Booth IW. Malnutrition at Diagnosis of Malignancy Inchildood: Common but Mostly Missed. Eur J Pediatr 1991; 150:318- 322.
17- Colomer R, Moreno-Nogueira JM, Garcia-Luna PP, et al. N-3 Fatty
Acids, Cancer and Cachexia: A systematic Review of The Literature. Br J Nutr 2007; 97:823–831.
18- Fearon KC, Barber MD, Moses AG, et al. Double-blind, Placebocontrolled, Randomized Study of Eicosapentaenoic Acid Diester in Patients with
Cancer Cachexia. J Clin Oncol 2006; 24:3401–3407.
19- Koutkia PD, Apovian CM, Blackburn GL. Nutrition support. In: Berger AM, Portenoy RK, Weissmann DE. Principles & practice of palliative care &
supportive oncology. Philadelphia: Lippincott Willians & Wilkings 2002; 2 ed: 933-55.
20- Tayek JA. Improved Protein Kinetics and Albumin Synthesis by Branched Chain Amino Acid-Enriched Total Parenteral Nutrition in Cancer Cachexia:
A Prospective Randomized Crossover Trial. Cancer 1986; 58:147-157.
21- Jody E N. L-Glutamine Use in the Treatment and Prevention of Mucositis and Cachexia: A Naturopathic Perspective. Integr Canc Ther 2009; 8 (4): 409-412.
22- Kuskonmaz B, Yalcin S, Kucukbayrak O, Cetin N, Cetin M, Tezcan I,Uckan D.The Effect of Glutamine Supplementation Onhematopoietic Stem Cell
Transplant Outcome in Children: A case–control study. Pediatr Transplantation 2008; 12: 47–51.
23- Xiao Y,Bi C, Fan Y, Cui C, Zhang X, Dou QP. L-Glutamine Schiff base Copper Complex as a Proteasome Inhibitor and an Apoptosis Inducer in
Human Cancer Cells. Int J Oncol 2008; 33(5):1073-9.
24- Aquino VM, Harvey AR, Garvin JH, Godder KT, Nieder ML, Adams RH, Jackson GB, Sandler ES. A Double-Blind Randomized Placebo-Controlled
Study of Oral Glutamine in the Prevention of Mucositis in Children Undergoing Hematopoietic Stem Cell Transplantation: a Pediatric Blood and Marrow
Transplant Consortium Study. Bone Marrow Transplant 2005; 36(7):611-616.
25- Yoshida S, Kaibara A, Ishibashi N, Shirouzu K. Glutamine Supplementation in Cancer Patients. Elsevier Science Inc Nutrition 2001; 17:766 –768.
26- Gordon A, Hultman E, Kaijser L, Kristjansson S, Rolfe CJ, Nyquista O, Sylvén C. Creatine Supplementation in Chronic Heart Failure Increases
Skeletal Muscle Creatine Phosphate and Muscle Performance. Cardiovasc Res 1995; 30 (3): 413-418.
27- Malvy DJM, Arnaud J, Burtschy B, Sommelet D, Leverger G, Dostalova L, Manesme OA. Antioxidant Micronutrients and Childhood Malignancy
During Oncological Treatment. Medical and Pediatric Oncology 1997; 29:213-217.
28- DRI (Dietary Reference Intakes) for Vitamin C, Vitamin E, Seleniumand Carotenoids. A Report of the Panel on Dietary Antioxidants and Related
Compounds, Subcommittees on Upper Reference Levels of Nutrients and Interpretation and Uses of Dietary References Intakes, and Standing Committee
on the Scientific Evaluation of Dietary Reference Intakes. Food and Nutrition Board. Institute of Medicine 2000:1 – 506.
29- Meacham LR, Mazewski C, Krawiecki N. Mechanism of transient adrenal insufficiency with megestrol acetate treatment of caquexia in children
with cancer. J Pediatr Hematol Oncol 2003;25(5):414-7.
30- Orme LM, Bound JD, Humphrey MS, Zacharin MR, Downie PA, Jamsen KM, Mitchell SL, Robinson JM, Grapsas NA, Ashley DM. Megestrol acetate
in pediatric oncology patients may lead to severe, symptomatic adrenal suppression. Cancer 2003;98(2):397-405.
31- McKone EF, Tonelli MR, Aitken ML. Adrenal insufficiency and testicular failure secondary to megestrol acetate therapy in a patient with cystic fibrosis.
Pediatr Pulmonol 2002;34(5):381-3.
32- Stockheim JA, Daaboul JJ, Yogev R, Scully SP, Binns HJ, Chadwick EG. Adrenal suppression in children with the human immunodeficiency virus
treated with megestrol acetate. J Pediatr 1999;134(3):368-70.
33- Di Marzo V, Goparaju SK, Wang L, Liu J, Batkai S, Jarai Z, Fezza F, Miura GI, Palmiter RD, Sugiura T, Kunos G. Leptin-regulated endocannabinoids
are involved in maintaining food intake. Nature 2001;410(6830):822-5.
34- Meguid MM, Fetissov SO, Varma M, Sato T, Zhang L, Laviano A, Rossi-Fanelli F. Hypothalamic dopamine and serotonin in the regulation of food
intake. Nutrition 2000;16(10):843-57.
1 Re v i s t a B r a s i l e i r a d e C u i d a d o s Pa l i a t i v o s 2 011; 3 (3) - S u p l e m e n t o 1
+) )'(( :fej\ejf9iXj`c\`if[\:Xhl\o`X&8efi\o`X

SUPLEMENTO1
35- Moertel CG, Kvols LK, Rubin J. A study of cyproheptadine in the treatment of metastatic carcinoid tumor and the malignant carcinoid syndrome.
Cancer 1991;67:33-36.
36- Couluris M, Mayer JL, Freyer DR, Sandler E, Xu P, Krischer JP. The effect of cyproheptadine hydrochloride (Periactin®) and megestrol acetate
(Megace®) on weight in children with cancer/treatment-related cachexia. J Pediatr Hematol Oncol. 2008;30(11):791–797.
37- Argiles JM, Meijsing SH, Pallares-Trujillo J, Guirao X, Lopez-Soriano FJ. Cancer cachexia: a therapeutic approach. Med Res Rev 2001;21(1):83-101.
38- Carroll PV. Treatment with growth hormone and insulin-like growth factor-I in critical illness. Best Pract Res Clin. Endocrinol Metab 2001;15(4):435-51.
39- Rosenbaum K, Wang J, Pierson RN Jr, Kotler DP. Time-dependent variation in weight and body composition in healthy adults. JPEN 2000;24(2):52-5.
40- Ruokonen E, Takala J. Dangers of growth hormone therapy in critically ill patients. Curr Opin Clin Nutr Metab Care 2002;5(2):199-209.
41- Chlebowski RT, Herrold J, Ali L, Oktay E, Chlebowski JS, Ponce AT, Heber D, Block JB. Influence of nandrolone decanoate on weight loss in advanced
non-small cell lung cancer. Cancer 1986;58(1):183-6.
42- Inui A. Cancer anorexia-cachexia syndrome. Are neuropeptides the key? Cancer Res 1999;59(18):4493-501.
43- Coats, AJ. Origin of symptoms in patients with cachexia with special reference to weakness and shortness of breath. Int J Cardiol. 2002;85(1):133-9.
44- Fanelli M, Sarmiento R, Gattuso D, Carillio G, Capaccetti B, Vacca A, Roccaro AM, Gasparini G. Thalidomide: A new anti-cancer drug? Expert
Opin Investing Drugs 2003;12(7):1211-25.
45- Okafor MC. Thalidomide for erythema nodosum leprosum and other applications. Pharmacotherapy 2003;23(4):481-93.
46- Marchand V, Baker SS, Stark TJ, Baker RD. Randomised, double-blind, placebo-controlled pilot trial of megestrol acetate in malnourished children
with cystic fibrosis. J Pediatr Gastroenterol Nutr 2000;31(3):264-9.
47- Lissoni, P. Is there a role for melatonin in supportive care? Support Care Cancer 2002;10(2):110-6.

REFERÊNCIAS BIBLIOGRÁFICAS - BIOETICA

1. Jorge-Filho I. Cuidados Paliativos. In Jorge-Filho I. Pré e Pós-Operatório. Capítulo 87. Editora Atheneu, 2011 (In press).
2. D’Assumpção EA. Os que partem, os que ficam: a morte não é problema para os que partem, e sim para os que ficam. Oitava Edição. Belo
Horizonte: FUMARC, 2007.
3. Conselho Federal de Medicina. Resolução CFM n0 1.931, de 17 de setembro de 2009.
4. Carvalho RT, Taquemori LY – Hidratação e nutrição- In Cuidado Paliativo – Grupo de Trabalho sobre cuidados paliativos do Cremesp. / Coordenação
institucional de Reinaldo Ayer. 2008, p.221-257.
5. Sacred congregation for the doctrine of the faith. Vatican declaration on euthanasia. Origins 1980; 10:154-7.
6. United States Conference of Catholic Bishops. Ethical and religious directives for catholic health care services. 4th ed. Washington , DC.: Catholic
Health Association, 2001.
7. John Paul II. Care for patients in a “permanent” vegetative state. Origins 2004; 33:43.
8. Paris JJ. Terri Schiavo and the use of artificial nutrition and fluids: Insights from catholic tradition on end-of-life-care. Palliative and Supportive Care
2006; 4:117-20.
9. Diário Oficial da União; Poder Executivo, Brasília, DF, 28 nov. 2006. Seção 1, p. 169
10. Moynihan T, Kelly DG, Fisch MJ. To Feed or Not to Feed: Is That the Right Question? J Clin Oncol, 23:6256-9. 2005.
11. Löbbe VA -Nutrition in the last days of life. Curr Opin Support Palliat Care 3:195-202, 2009.
12. Mcmahon MM,Hurley DL, Kamath PS, Mueller PS. Medical and ethical aspects of long-term enteral tube feeding . Mayo Clin Proc. 2005;80(11):1461-
76. (Palecek EJ, Teno JM, Casarett DJ,
13. Hanson LC, Rhodes RL, Mitchell SL. Comfort Feeding Only: A Proposal to Bring Clarity to Decision- Making Regarding Difficulty with Eating for
Persons with Advanced Dementia. J Am Geriatr Soc. 2010; 58(3): 580–584.)

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ABCP
Associação
Brasileira
de Cuidados
Paliativos

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