Výživa je nedílnou součástí komplexní péče o pacienta. Příjem stravy je spojován s vitalitou a možností pokračovat v onkologické terapii. Je třeba si uvědomit, že s pokročilým onkologickým onemocněním se mění schopnost těla využívat energii. Váhový úbytek a nechutenství může mít různé příčiny. V mnoha případech lze tyto příčiny ovlivnit vhodnou úpravou medikace, ale i dietními opatřeními. Přiměřená edukace pečujících vede k nižšímu naléhání na "zdravou výživu" a s tímto spojenou snahou o hledání zázračné pilulky. Cílem je správná výživa ve správný čas a s tímto spojený přiměřený komfort paliativních pacientů.

Nutrition is an integral part of comprehensive patient care. Diet intake is associated with vitality and the possibility of continuing cancer therapy. It should be noted that with advanced cancer, the body's ability to use energy changes. Weight loss and anorexia can have various causes. In many cases, these causes can be influenced by appropriate medication adjustment as well as by dietary measures. Adequate education of caregivers leads to less urge for "healthy nutrition" and the associated effort to find a miracle pill. The goal is proper nutrition at the right time, thus providing appropriate comfort to palliative patients.

• MeSH
• Appetite MeSH
• Exercise MeSH
• Dexamethasone administration & dosage   adverse effects   MeSH
• Dysgeusia MeSH
• Energy Metabolism MeSH
• Nutritional Physiological Phenomena MeSH
• Cachexia * drug therapy   MeSH
• Cannabinoids therapeutic use   MeSH
• Humans MeSH
• Megestrol Acetate administration & dosage   adverse effects   MeSH
• Neoplasms MeSH
• Anorexia MeSH
• Nutritional Support psychology   adverse effects   MeSH
• Caregivers psychology   MeSH
• Palliative Medicine * MeSH
• Food, Formulated MeSH
• Terminally Ill psychology   MeSH
• Check Tag
• Humans MeSH

Incidence karcinomu endometria ve věkové skupině žen mladších 40 let narůstá, a proto roste i zájem o fertilitu šetřící léčbu. Nejčastěji používaná konzervativní léčba progestiny může být zvážena u pečlivě selektovaných pacientek s grade 1, stage IA karcinomem endometria bez myometriální invaze, které si přejí zachovat reprodukční funkce, a jsou ochotny podstoupit intenzivní léčbu a sledování a také určité riziko chirurgicky nestážovaného onemocnění. Před léčbou je potřeba co nejpřesněji zhodnotit biologický charakter a rozsah onemocnění. Hormonální terapie je aplikována obvykle 6 měsíců. Response rate se pohybuje přibližně v hodnotách 60–80 %, recurrence rate 25–40 %. Live birth rate je uváděn okolo 30 %. Je potřeba informovat pacientky o reálné možnosti recidivy, obvykle dobře léčitelné, i o výhodě použít metody asistované reprodukce, o potřebě intenzivního follow-up a doporučení definitivní léčby po dokončení reprodukčních plánů.

The diagnosis of endometrial carcinoma in young women of childbearing age is rare, but the incidence in growing. Fertility-preserving therapy of endometrial carcinoma could be considered in patients with a histological diagnosis of grade 1 stage IA endometrial carcinoma without myometrial invasion who wish to preserve their fertility, are willing to accept intensive treatment, close follow-up and risk of unstaged disease. Conservative treatment is based on 6 months medical treatment with high-dose oral progestins. Response rate is referred between 60 and 80 %, recurrence rate 25–40 %; live birth rate around 30 %. Patients should be informed about real risk of recurrence and the need of future hysterectomy.

• MeSH
• Long-Term Care MeSH
• Adult MeSH
• Carcinoma, Endometrioid diagnosis   drug therapy   pathology   MeSH
• Antineoplastic Agents, Hormonal administration & dosage   therapeutic use   MeSH
• Hysterectomy MeSH
• Neoplasm Invasiveness MeSH
• Humans MeSH
• Medroxyprogesterone Acetate administration & dosage   MeSH
• Megestrol Acetate administration & dosage   MeSH
• Pregnancy Complications, Neoplastic MeSH
• Endometrial Neoplasms * diagnosis   drug therapy   pathology   MeSH
• Birth Rate MeSH
• Progestins * administration & dosage   therapeutic use   MeSH
• Recurrence MeSH
• Neoplasm Grading MeSH
• Pregnancy MeSH
• Patient Selection MeSH
• Fertility Preservation * MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Review MeSH

• MeSH
• Androgens administration & dosage   adverse effects   therapeutic use   MeSH
• Estrogen Antagonists administration & dosage   therapeutic use   MeSH
• Drug Resistance, Neoplasm MeSH
• Cyclin-Dependent Kinase 4 administration & dosage   therapeutic use   MeSH
• Cyclin-Dependent Kinase 6 administration & dosage   therapeutic use   MeSH
• Diethylstilbestrol administration & dosage   therapeutic use   MeSH
• Adult MeSH
• Antineoplastic Agents, Hormonal * administration & dosage   therapeutic use   MeSH
• Aromatase Inhibitors administration & dosage   therapeutic use   MeSH
• Carcinoma diagnosis   therapy   MeSH
• Clinical Trials as Topic MeSH
• Humans MeSH
• Megestrol Acetate administration & dosage   therapeutic use   MeSH
• Breast Neoplasms * therapy   MeSH
• Randomized Controlled Trials as Topic MeSH
• Sirolimus analogs & derivatives   therapeutic use   MeSH
• Tamoxifen administration & dosage   therapeutic use   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Case Reports MeSH

Překládáme zde tři kazuistiky pacientů s myeloproliferativní neoplazií, u kterých byl pro nechutenství a váhový úbytek nasazen megestrol acetát ke zlepšení jejich výživy a tím i kvality života. Jako vedlejší účinek po nasazení tohoto gestagenu bylo u všech pozorováno klinicky významné zmenšení splenomegalie a snížení až ztráta transfuzní závislosti. Po vysazení megestrolu se slezina opět začala zvětšovat, avšak nasazení megestrolu vedlo k jejímu opětovnému zmenšení. Jedná se o první popis tohoto významného „vedlejšího účinku“ megestrolu u nemocných s myeloproliferativními neoplaziemi a s výraznou splenomegalií.

We present three cases of patients with myeloproliferative neoplasm that were because of anorexia and weight reduction given megestrol acetate to improve their alimentation and so their life quality. Clinically important reduction of splenomegaly and reduction or loss of transfusion dependence after administration of gestagen were observed as side effect in all patients. After discontinuation the spleen started to grow again, but administration of megestrol has led to its repeated diminution. This is the first description of the important „side effect“ of megestrol in patients with myeloproliferative neoplasms and prominent splenomegaly.

• Keywords
• transfuzní závislost, myeloproliferativní neoplazie, osteomyelofibróza,
• MeSH
• Anemia therapy   MeSH
• Appetite drug effects   MeSH
• Hemoglobins MeSH
• Weight Gain drug effects   MeSH
• Remission Induction MeSH
• Blood Cell Count MeSH
• Middle Aged MeSH
• Humans MeSH
• Megestrol Acetate * administration & dosage   adverse effects   therapeutic use   MeSH
• Myeloproliferative Disorders * drug therapy   MeSH
• Anorexia drug therapy   complications   MeSH
• Polycythemia Vera drug therapy   MeSH
• Aged MeSH
• Spleen drug effects   MeSH
• Splenomegaly complications   MeSH
• Erythrocyte Transfusion MeSH
• Body Weight Changes * MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Case Reports MeSH
• Research Support, Non-U.S. Gov't MeSH

OBJECTIVE: We examined the effects of megestrol acetate versus placebo and progressive resistance physical exercise on weight, lean muscle mass, quality of life, ability to exercise, proinflammatory cytokines, and anti-inflammatory cytokines, and their correlations with one another. DESIGN: We organized a prospective 20-week, randomized, double-blind, placebo-controlled pilot trial of hemodialysis patients. SETTING: This study took place at the Outpatient Unit of the Northport Veteran Affairs Medical Center. SUBJECTS: We studied nine male hemodialysis patients who had two or more of the following: albumin level <4.0 g/dL, total cholesterol <150 mg/dL, protein catabolic rate <0.8 g/kg/day, and predialysis serum urea nitrogen <60 mg/dL. Their ages were 50 to 83 years. Two were diabetic, and seven were nondiabetic. INTERVENTIONS: Interventions included megestrol acetate (MA) or placebo 800 mg oral daily for 20 weeks, along with weight resistance physical therapy with weights twice a week before dialysis. Patients were followed prospectively for an additional 4 weeks. MAIN OUTCOME MEASUREMENTS: Weight, body composition, activities of daily living, ability to exercise, and plasma cytokine levels were measured. RESULTS: At 24 weeks, the MA group had a statistically significant weight gain (11.1-pound increase vs. 1.5-pound decrease for the placebo group, P = .018), body fat gain (6.2-pound increase vs. a 0.4-pound decrease for the placebo group, P = .044) and fat-free mass gain (5-pound increase vs. a 1.2-pound decrease in the placebo group). The MA group also had a greater tendency toward increased appetite and sense of well-being. The MA group showed a greater improvement in ability to exercise (mean change in rate of perceived exertion (RPE), 4.7) vs. the placebo group (mean change in RPE vs. 0.5, P = .02). Elevated cytokine levels were evident at baseline in both groups. In all patients, increases in weight, fat-free mass, sense of well-being, appetite, and ability to exercise were negatively correlated with tumor necrosis factor receptor subunit p75 (P < .05). There was a trend toward all of these parameters to be negatively correlated with tumor necrosis factor receptor subunit p55, although only sense of well-being was statistically significant (P < .05). CONCLUSION: In a pilot trial in dialysis patients, MA showed significant benefits in improving weight and ability to exercise. Cytokine changes were correlated with weight gains and increases in fat-free mass.

• MeSH
• Cholesterol blood   MeSH
• Appetite Stimulants administration & dosage   MeSH
• Activities of Daily Living MeSH
• Exercise MeSH
• Cytokines blood   MeSH
• Renal Dialysis MeSH
• Blood Urea Nitrogen MeSH
• Double-Blind Method MeSH
• Financing, Organized MeSH
• Weight Gain MeSH
• Cachexia diagnosis   drug therapy   therapy   MeSH
• Middle Aged MeSH
• Humans MeSH
• Megestrol Acetate administration & dosage   MeSH
• Resistance Training MeSH
• Pilot Projects MeSH
• Placebos MeSH
• Protein Subunits blood   MeSH
• Prospective Studies MeSH
• Randomized Controlled Trials as Topic MeSH
• Receptors, Tumor Necrosis Factor blood   MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Serum Albumin analysis   MeSH
• Body Composition MeSH
• Body Weight MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH

Klinické důsledky již vyvinuté malnutrice jsou u onkologických nemocných závažné. Na rozvoji malnutrice se podílí nejen samotný nádor, ale také onkologická terapie. Malnutrice však nemusí být nevyhnutelným důsledkem nádorového onemocnění, pokud je včas a správně zhodnoceno riziko podvýživy konkrétního pacienta a podle toho je mu poskytována systematická nutriční podpora. Nutriční intervence s cílem zvrátit ztrátu hmotnosti je nejúčinnější u nemocných s vysokým rizikem malnutrice, pokud je současně možná kurativní protinádorová léčba. U nemocných s pokročilým nádorovým onemocněním je reálný efekt samotné nutriční podpory omezený. Vzhledem k tomu, jakou závažnost přináší malnutrice pro celkovou prognózu choroby, je však dnes třeba považovat nutriční podporu za podstatnou součást léčby nádorového onemocnení, i když vědecké doklady pro její efekt zatím nejsou jednoznačné.

• Keywords
• Megace,
• MeSH
• Anti-Inflammatory Agents, Non-Steroidal administration & dosage   MeSH
• Enteral Nutrition MeSH
• Epidemiologic Studies MeSH
• Nutritional Physiological Phenomena MeSH
• Cachexia MeSH
• Eicosapentaenoic Acid administration & dosage   pharmacology   MeSH
• Humans MeSH
• Megestrol Acetate administration & dosage   pharmacology   MeSH
• Neoplasms MeSH
• Anorexia drug therapy   MeSH
• Nutrition Disorders diagnosis   diet therapy   MeSH
• Dietary Supplements MeSH
• Dronabinol administration & dosage   adverse effects   therapeutic use   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

• MeSH
• Cachexia etiology   drug therapy   MeSH
• Karnofsky Performance Status MeSH
• Quality of Life MeSH
• Humans MeSH
• Megestrol Acetate administration & dosage   therapeutic use   MeSH
• Neoplasms complications   metabolism   MeSH
• Anorexia etiology   drug therapy   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Clinical Trial MeSH
• Geographicals
• Czech Republic MeSH

• MeSH
• Appetite Stimulants administration & dosage   MeSH
• Quality of Life MeSH
• Middle Aged MeSH
• Humans MeSH
• Megestrol Acetate administration & dosage   MeSH
• Neoplasms complications   MeSH
• Anorexia drug therapy   MeSH
• Palliative Care MeSH
• Aged MeSH
• Body Weight drug effects   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Aged MeSH

• MeSH
• Appetite Stimulants administration & dosage   economics   adverse effects   MeSH
• Cachexia diet therapy   etiology   drug therapy   MeSH
• Humans MeSH
• Megestrol Acetate administration & dosage   pharmacology   therapeutic use   MeSH
• Neoplasms MeSH
• Anorexia diet therapy   etiology   drug therapy   MeSH
• Body Weight MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH