Geriatrik Üroonkoloji Hastalarında Nütrisyonun Rolü
Özet
Yaşlanan nüfusla birlikte, 65 yaş üzeri bireylerde kanser sıklığı artmaktadır. Üroonkoloji hastalarında malnütrisyon, sarkopeni ve kaşeksi yaygın olup kırılganlığı artırır, tedaviye toleransı ve sağkalımı olumsuz etkiler. Yaşla azalan kas kütlesi, immün yanıtın zayıflaması ve fizyolojik rezerv kaybı bu durumu ağırlaştırır. Malnütrisyon; yetersiz enerji-protein alımı, emilim bozukluğu veya inflamasyonla gelişebilirken erken tanıyla düzeltilebilir; kaşeksi ise daha karmaşık metabolik mekanizmalarla seyreder Beslenme desteğinde öncelik yeterli enerji-protein alımıdır; gerekirse oral destek, enteral veya parenteral beslenme uygulanır. Günlük 25–30 kcal/kg enerji ve ≥1–1,5 g/kg protein hedeflenir. Sarkopeni yönetiminde mümkünse beslenme fiziksel aktivite ile desteklenmelidir. İleri evrede invaziv yöntemler yaşam beklentisine göre planlanır. Mikronutrient desteği, sıvı dengesi ve refeeding sendromuna tedavi takibinde dikkat edilmelidir. Ameliyat öncesi immünonütrisyon ve ERAS protokolleri cerrahi sonuçları iyileştirir. Multidisipliner yaklaşım, beslenme optimizasyonu ve fonksiyonel kapasitenin korunması morbidite ve mortaliteyi azaltarak yaşam kalitesini artırır.
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