癌因性厌食诊疗中国专家共识

doi:10.3760/cma.j.cn371439-20241223-00011

摘要/Abstract

摘要：

癌因性厌食是指因肿瘤本身和（或）其治疗所引发的食欲减退或丧失，其症状包括厌食、恶心、味觉改变、早饱或吞咽困难等，不仅影响患者的营养状态，还与生存期缩短、抗肿瘤治疗依从性降低、治疗相关不良反应增加、生命质量下降等多种严重不良事件紧密相关。癌因性厌食在肿瘤患者中普遍存在，在防治方面存在紧迫性，但医患对其认识和管理有待进一步深化和完善。因此，中国临床肿瘤学会肿瘤支持和康复专家委员会邀请我国相关领域专家，结合中国临床实践现状并基于现有的研究证据，总结了癌因性厌食的筛查和诊断标准，系统性地提出了综合管理策略。本共识将成为临床医生诊疗癌因性厌食的重要参考，可更好地规范癌因性厌食诊疗措施，做到积极筛查、早期干预和规范治疗，使更多患者获益。

关键词: 厌食, 诊断, 治疗, 综合管理, 专家共识

Abstract:

Cancer-related anorexia refers to the loss or reduction of appetite caused by cancer itself and/or anticancer treatments. This condition encompasses a spectrum of symptoms， including anorexia， nausea， gustatory alteration， early satiety or dysphagia， etc. Cancer-related anorexia not only affects the nutritional status of patients， but is also closely associated with severe adverse outcomes， such as reduced survival， decreased compliance with anti-tumor treatment， increased treatment-related side effects， and diminished quality of life. Despite its widespread prevalence among patients and the urgency of its prevention and treatment， the understanding and management of both doctors and patients need to be further deepened and improved. Recognizing these challenges， Chinese Society of Clinical Oncology-Supportive Care and Rehabilitation Committee convened a panel of experts across relevant fields in China to summarize the screening and diagnosis criteria of cancer-related anorexia based on the current status of clinical practice and the existing research evidence， and to systematically propose a comprehensive management strategy. This consensus will become an important reference for clinicians in the diagnosis and treatment of cancer-related anorexia， which can better standardize the diagnosis and treatment measures for cancer-related anorexia， achieve active screening， early intervention and standardized treatment， so as to benefit more patients.

Key words: Anorexia, Diagnosis, Therapy, Comprehensive management, Expert consensus

中国临床肿瘤学会肿瘤支持与康复治疗专家委员会, 癌因性厌食诊疗中国专家共识工作组. 癌因性厌食诊疗中国专家共识[J]. 国际肿瘤学杂志, 2025, 52(2): 67-78.

Chinese Society of Clinical Oncology-Supportive Care and Rehabilitation Committee, Chinese Expert Consensus Working Group on Cancer-related Anorexia . Chinese expert consensus on the diagnosis and treatment of cancer-related anorexia[J]. Journal of International Oncology, 2025, 52(2): 67-78.

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类别	水平	来源	专家共识度
1A	高	严谨的Meta分析、大型随机对照研究	一致共识（支持意见≥80%）
1B	高	严谨的Meta分析、大型随机对照研究	基本一致共识，争议小（支持意见60%~80%）
2A	稍低	一般质量的Meta分析、小型随机对照研究、设计良好的大型回顾性研究、病例对照研究	一致共识（支持意见≥80%）
2B	稍低	一般质量的Meta分析、小型随机对照研究、设计良好的大型回顾性研究、病例对照研究	基本一致共识，争议小（支持意见60%~80%）
3	低	非对照的单臂临床研究、病例报道、专家观点	无共识，且争议大（支持意见<60%）

推荐等级	推荐标准
Ⅰ级推荐	1A类证据和部分2A类证据将1A类证据，以及部分专家共识度高且在中国可及性好的2A类证据作为Ⅰ级推荐
Ⅱ级推荐	1B 类证据和部分2A类证据将1B类证据，以及部分在中国可及性欠佳，但专家共识度较高的2A类证据，作为Ⅱ级推荐
Ⅲ级推荐	2B类证据和3类证据对于某些临床上习惯使用，或有探索价值的诊治措施，虽然循证医学证据相对不足，但专家组意见认为可以接受的，作为Ⅲ级推荐

在过去7天内出现的状况	没有	很少	有时	经常	很多
我的食欲很好	0	1	2	3	4
我摄入的食物量能满足我的需求	0	1	2	3	4
我担心我的体重下降	4	3	2	1	0
我觉得大多数食物味道不好	4	3	2	1	0
我担心自己看起来太瘦	4	3	2	1	0
每当进食时，我的食欲就会下降	4	3	2	1	0
我吃不下高热量或油腻的食物	4	3	2	1	0
我的家人及朋友很想让我吃东西	4	3	2	1	0
我有呕吐的症状	4	3	2	1	0
我吃东西时很快就饱了	4	3	2	1	0
我腹部感到疼痛	4	3	2	1	0
我的健康状况有改善	0	1	2	3	4

评分	能量（kcal）	特征描述
1分	<300	三餐清流质，无肉、缺油
2分	300~<600	三餐半流质，无肉、缺油
3分	600~<900	一餐普食，两餐半流质，基本无肉、少油
4分	900~<1 200	两餐普食，一餐半流质，少肉、少油
5分	1 200~1 500	三餐普食，主食、肉蛋、油脂充足

干预措施	推荐等级			证据等级
干预措施	Ⅰ级推荐	Ⅱ级推荐	Ⅲ级推荐	证据等级
药物治疗
促食欲药物
甲地孕酮	√			1A类
糖皮质激素		√		1B类
奥氮平		√		2A类
阿那莫林		√		2A类
沙利度胺			√	3类
促胃肠动力药物
甲氧氯普胺或多潘立酮		√		2A类
其他干预措施
营养干预	√			1A类
康复锻炼	√			2A类
心理干预		√		2A类
中医治疗			√	3类