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There are 2375 thousand people per one Polish center providing enteral and parenteral nutrition at home. patients. In the case of the Czech Republic, this number is almost six times smaller and amounts to 400. people. Despite the fact that our country has 4 times more inhabitants, we have definitely fewer establishments. According to experts, there is a gap between the two health care systems.
In Poland, there are 16 clinics with specialized home nutrition, while in the Czech Republic there are 25. There are no queues, there is access to parenteral nutrition pumps and 314 certified nurses. In our country, many patients are still waiting for nutritional treatment under the supervision of properly trained medical personnel.
Another issue is specialized nurses, which are simply missing in Poland. There are also no portable pumps for parenteral patients, which have been available in the Czech Republic since 2015.
The topic of patient nutrition was raised during this year’s Congress of the Polish Society of Parenteral, Enteral and Metabolism (POLSPEN) in Jachranka. The issues related to the congress referred to the decision of the Minister of Health regarding the piloting of nutrition standards in hospitals for pregnant and puerperal women. During the meeting, the topic of insufficient nutritional care of Polish cancer patients in Poland was discussed, based on examples from the Czech Republic.
– It is high time that Polish decision-makers saw the need to create coordinated nutritional care for cancer patients, using the experience of our southern neighbors. It’s time to catch up with Europe – says prof. Stanisław Kłęk, President of POLSPEN.
– A larger number of specialist home nutrition clinics, providing patients with the help of qualified medical personnel and educating the medical community about the role of medical nutrition would significantly improve the cancer care system and increase the effectiveness of treating patients – he adds.
Facts about malnutrition in oncology
Symptoms of malnutrition or cachexia occur in 30-85 percent. oncological patients. U 5-20 percent of them, cachexia is the direct cause of death in the terminal stage of the disease. The most common problem with malnutrition occurs in patients with pancreatic (67%), abdominal (60%), kidney (52%), head and neck (49%), bladder and ovarian cancers (41%). , intestines (39%), breasts (21%) and prostate (14%). According to research, 30 percent. patients who are properly nourished, malnutrition develops after admission to hospital, and in 70 percent. on admission, it is further aggravated during hospitalization.
Nutritional treatment (i.e. clinical nutrition including both enteral and parenteral nutrition) is the only solution to the problem of malnutrition in cancer patients, in addition to disease treatment or symptomatic therapy. The choice of the type of nutritional therapy (enteral or parenteral) depends on the clinical condition of the patient, the degree and type of malnutrition, and the planned period of nutrition. The patient may undergo nutritional treatment in the hospital or at home.
Properly started nutrition, a high-protein and low-energy diet is important
The topic of the influence of protein supply on the treatment of cancer patients and the wound healing process was also discussed at the meeting. In the light of current medical reports, protein plays a key role in the process of oncological treatment. It is a building block used by the body to renew and strengthen muscles. Its lack or deficiency affects, among others to extend the duration of therapy, the development of pressure ulcers, immune disorders and surgical complications.
The latest high-protein, low-glucose formulation for parenteral nutrition is now available in Poland. Increasing the supply of protein in cancer patients and in critically ill patients is of great importance, because adult patients during their stay in the intensive care unit may lose almost 1 kg of muscle mass per day.
The proper protein and energy requirements should be calculated by measuring energy expenditure. Patients should be provided with 1,2–1,5 g of protein / kg / day. Studies show that the use of a high-protein and low-energy diet (administration of more than 1,2 g of protein / kg / day) from the beginning of treatment translates into lower mortality of patients. On the other hand, in the treatment of chronic or extensive wounds, the supply of protein may even reach 2 g / kg / day. In order to provide the right amount of nutrients, high-protein products should be used (both in enteral and parenteral nutrition).