Nutrition in advanced digestive cancer.
OBJECTIVE
The provision of nutrition to patients with advanced digestive cancer, especially those with obstruction, has been an issue discussed by physicians, administrators and patients themselves. There is no real consensus about this topic, perhaps because of the fact that this discussion involves medical, emotional, ethical, economical and legal considerations that are not easily encompassed by any single decision. On the other hand, the quality of life or survival of these patients must be thoroughly evaluated because one of the basic tenets of medicine has always been 'primum non nocere' ('above all, do not harm'). Quality of life itself is a complicated concept because it has no specific definition and varies with each individual and depends upon his/her actual living reality, past experiences, future hopes, dreams and even ambitions.


RESULTS
Recent studies have presented controversial results when evaluating the benefits of providing nutritional therapy to patients with advanced digestive cancer with obstruction. Therefore, decision-making should be addressed on an individual basis, but at the same time should be based on defined protocols within each institution. A key factor to be considered is communication among all those involved in the process; most important is the role of the patient and his/her family, who should be able to communicate their feelings, concerns and ethical principles.


CONCLUSIONS
Nutritional therapy in advanced digestive cancer is an instrument that should be evaluated as an extra tool that may offer improved quality of life to those with obstruction, despite the associated increased costs. However, in this delicate matter, our decisions should not be driven by increased pressure by medical system administrators to limit financial expenditure.
Echenique
Miguel
M
Assistant Professor of Surgery, University of Puerto Rico, Hospital Auxilio Mutuo, Hato Rey, Puerto Rico, USA. echegaz@pol.net
Correia
Maria Isabel T D
MI
D003362:Cost-Benefit Analysis; D003657:Decision Making; D005770:Gastrointestinal Neoplasms / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007415:Intestinal Obstruction / Q000601:surgery / Q000628:therapy; D018529:Nutritional Support / Q000941:ethics; D010166:Palliative Care / Q000941:ethics; D026684:Personal Autonomy; D011788:Quality of Life; D018570:Risk Assessment