肿瘤患者治疗期间如何饮食、运动、体重管理?ASCO指南来指导

2022-08-14 美中嘉和肿瘤防治 美中嘉和肿瘤防治

肿瘤患者在确诊后,近75%都会主动改变饮食和运动习惯,这些改变也的确能帮助他们保持健康体重、降低心血管疾病、代谢紊乱和其他慢性疾病风险。

常识or误区

运动有助于骨骼发育,还能预防老年骨质疏松是一个公认的常识。但骨折后,大多数人往往都认为这个时期身体非常脆弱一定要静养至少100天,不可做任何运动。

其实不然,骨折后2周内就需要开始做肌肉静态收缩,而后逐渐增加主动活动和负重活动,以促进消肿和骨骼愈合。

对待肿瘤,也是一样。

我们都知道合理膳食和规律运动有助于抗癌,而肥胖、不良生活习惯的长期积累会增加患癌风险,癌症患者在康复期或者稳定期也一直被倡导运动、营养膳食等生活方式。然而在肿瘤治疗期间,患者们应该如何从这些方面获益一直缺乏科学的指导。

最近美国临床肿瘤学会(ASCO)对包括乳腺癌、肺癌、结直肠癌和前列腺癌在内的文献报道进行系统综述,并设立随机对照试验,旨在为成年人在癌症治疗期间的运动、饮食和体重管理提供指导,解决了三个主要的临床问题。

1、肿瘤治疗期间的锻炼是否能改善与生活质量、治疗毒性或癌症控制相关结果?

建议肿瘤患者在治疗期间进行有氧和抗阻力运动,以减轻癌症治疗的副作用。(证据质量:中等,推荐强度:强)

建议接受肺癌手术的患者进行术前锻炼,以减少住院时间和术后并发症。(证据质量:低,推荐强度:弱)

注意:治疗期间的运动干预可减少疲劳,保持心肺健康、身体机能和力量,还能在一定程度上改善生活质量,减少焦虑和抑郁。此外,治疗期间的运动干预发生不良事件风险的概率较低。但并没有足够的证据推荐在治疗期间进行锻炼可以改善癌症结局或治疗完成率。 

2、肿瘤治疗期间某种特定的饮食模式或特定食物是否能改善与生活质量、治疗毒性或癌症控制相关结果?

目前没有足够的证据推荐或反对膳食干预措施,包括生酮或低碳水化合物饮食、低脂饮食、功能性食品或禁食,能够改善与生活质量、治疗毒性或癌症控制相关结果。

不推荐使用中性粒细胞减少饮食(烹饪所有原材料,包括水果和蔬菜,也就是不吃生的)来预防癌症患者在治疗期间的感染。(证据质量:低,推荐强度:弱)

3、肿瘤治疗期间进行有意减肥或避免体重增加的干预措施是否能够改善与生活质量、治疗毒性或癌症控制相关结果?

目前没有足够的证据推荐或反对在治疗期间进行有意减肥或采取防止体重增加的干预,可以改善与生活质量、治疗毒性或癌症控制相关结果。

注意:专家小组强烈认为,饮食和体重管理能够带来健康益处,因此,并不应该阻止临床医生与病人进行这方面的讨论。考虑到目前仍然缺乏关于癌症治疗期间饮食和体重管理干预的证据,尚不能提出具体的建议。

总结来看

治疗期间的肿瘤患者应定期进行有氧和抗阻力运动,并建议接受肺癌手术的患者在术前进行运动;不建议使用中性粒细胞减少饮食来预防治疗期间的感染。

关于特定饮食和减肥干预措施目前不推荐也不反对。

即便有了ASCO指南的推荐,相信还有很多患者朋友存在以下的疑虑,让小编来一一解答。

有氧和抗阻力运动有哪些?

有氧运动包括散步、快走、慢跑、上下楼梯、骑自行车、广场舞、太极拳、八段锦、游泳等,患者们可自行选择适合自己的运动,运动最好养成规律,运动时间以每次20~30分钟为宜。

抗阻力运动难度相对高一些,需要调动肌肉收缩来对抗外部阻力,可通过弹力带、杠铃、哑铃等器械来完成,也可从简单的下蹲、仰卧起坐等对抗自身重力的运动入手,一定注意量力而行。

中性粒细胞减少饮食是什么?

一些肿瘤治疗具有骨髓抑制等副作用,造成患者中性粒细胞减少,而这里所说的不推荐中性粒细胞减少饮食主要指的是,为了减少治疗期的感染风险而过度加工食物,以追求无菌,例如把所有的蔬菜和水果等食材全部进行煮熟才食用。

晚期和进展期的患者也建议运动吗?

关于晚期癌症患者运动的可行性和安全性及潜在益处的文献相对有限,但是一项涉及约100例晚期肺癌患者的荟萃分析报告显示,运动确实能够改善6分钟步行测试(6MWT)能力和生活质量。因此,建议晚期患者在条件允许的情况下,可适当做一些身体活动。

写在最后

肿瘤患者在确诊后,近75%都会主动改变饮食和运动习惯,这些改变也的确能帮助他们保持健康体重、降低心血管疾病、代谢紊乱和其他慢性疾病风险。

虽然肿瘤治疗期间的积极改变不一定能确保我们收获健康,但能在生命天平的健康端多增加了一个砝码。

参考文献

Ligibel JA, Bohlke K, May AM, Clinton SK, Demark-Wahnefried W, Gilchrist SC, Irwin ML, Late M, Mansfield S, Marshall TF, Meyerhardt JA, Thomson CA, Wood WA, Alfano CM. Exercise, Diet, and Weight Management During Cancer Treatment: ASCO Guideline. J Clin Oncol. 2022 May 16:JCO2200687.

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  2. [GetPortalCommentsPageByObjectIdResponse(id=1648833, encodeId=a616164883379, content=<a href='/topic/show?id=4265266982a' target=_blank style='color:#2F92EE;'>#体重管理#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26698, encryptionId=4265266982a, topicName=体重管理)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=xugumin, createdTime=Tue Jun 27 13:11:02 CST 2023, time=2023-06-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1238720, encodeId=a34d1238e20c9, content=good, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9e864798401, createdName=292468151, createdTime=Mon Aug 15 05:23:04 CST 2022, time=2022-08-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1238715, encodeId=2d691238e150d, content=哇,好, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2de35128628, createdName=1464f4bcm74(暂无昵称), createdTime=Mon Aug 15 01:42:20 CST 2022, time=2022-08-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1939478, encodeId=dcb319394e8cd, content=<a href='/topic/show?id=1c292818fd' target=_blank style='color:#2F92EE;'>#ASC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2818, encryptionId=1c292818fd, topicName=ASC)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74808, createdName=quxin068, createdTime=Fri Sep 09 06:11:02 CST 2022, time=2022-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1424370, encodeId=16ad14243e057, content=<a href='/topic/show?id=94c182929d0' target=_blank style='color:#2F92EE;'>#肿瘤患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=123, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82929, encryptionId=94c182929d0, topicName=肿瘤患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=60943920553, createdName=lanyan20020087, createdTime=Sat Jul 30 02:11:02 CST 2022, time=2022-07-30, status=1, ipAttribution=)]
    2022-08-15 292468151

    good

    0

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    2022-08-15 1464f4bcm74(暂无昵称)

    哇,好

    0

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    2022-09-09 quxin068
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完整组织的实时成像为了解免疫耐受动力学和自身免疫机制提供了一个窗口。帮助我们揭示了淋巴结中T细胞激活和耐受的机制,T细胞进入自身免疫性疾病部位的机制,这将有助于我们针对性地开发治疗自身免疫疾病的药物。

百奥赛图与LiberoThera共同开发全人GPCR抗体药物取得里程碑式进展

机制上,这些克隆可通过增强的ADCC效应来耗竭肿瘤微环境中的Treg,也可通过抑制其配体CCL1介导的CCR8信号通路来抑制肿瘤微环境中的Treg活性,进而达到增强抗肿瘤免疫反应的目的

不仅仅风湿免疫!羟氯喹在肿瘤领域也大显身手

肿瘤复发、化疗耐药和转移仍然是癌症治疗中未解决的问题。最近的一种方法是仔细检查临床上用于治疗其他疾病的药物,并修改它们的结构以增加对癌细胞的选择性。