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Furness K, Huggins CE, Hanna L, Croagh D, Sarkies M, Haines TP. Effect of Communication Mode on Disclosure of Nutrition Impact Symptoms During Nutrition Intervention Delivered to People With Upper Gastrointestinal Cancer. Eval Health Prof 2024:1632787241267051. [PMID: 39045879 DOI: 10.1177/01632787241267051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
Individuals diagnosed with upper gastrointestinal cancers experience a myriad of nutrition impact symptoms (NIS) compromise a person's ability to adequately meet their nutritional requirements leading to malnutrition, reduced quality of life and poorer survival. Electronic health (eHealth) is a potential strategy for improving the delivery of nutrition interventions by improving early and sustained access to dietitians to address both NIS and malnutrition. This study aimed to explore whether the mode of delivery affected participant disclosure of NIS during a nutrition intervention. Participants in the intervention groups received a nutrition intervention for 18 weeks from a dietitian via telephone or mobile application (app) using behaviour change techniques to assist in goal achievement. Poisson regression determined the proportion of individuals who reported NIS compared between groups. Univariate and multiple regression analyses of demographic variables explored the relationship between demographics and reporting of NIS. The incidence of reporting of NIS was more than 1.8 times higher in the telephone group (n = 38) compared to the mobile group (n = 36). Telephone predicted a higher likelihood of disclosure of self-reported symptoms of fatigue, nausea, and anorexia throughout the intervention period. A trusting therapeutic relationship built on human connection is fundamental and may not be achieved with current models of mobile health technologies.
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Affiliation(s)
- Kate Furness
- Department of Nutrition and Dietetics, Monash Health, Monash Medical Centre, Clayton, VIC, Australia
- Dietetics, Department of Nursing and Allied Health, Swinburne University of Technology, Hawthorn, VIC, Australia
- Department Sport, Exercise and Nutrition Sciences, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, VIC, Australia
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Catherine E Huggins
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
- Global Centre for Preventative Health and Nutrition, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Burwood, VIC, Australia
| | - Lauren Hanna
- Department of Nutrition and Dietetics, Monash Health, Monash Medical Centre, Clayton, VIC, Australia
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Daniel Croagh
- Upper Gastrointestinal and Hepatobiliary Surgery, Monash Medical Centre, Clayton, VIC, Australia
- Department of Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Mitchell Sarkies
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Terry P Haines
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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Wang F, Zhen HN, Wang HP, Yu K. Measurement of sarcopenia in lung cancer inpatients and its association with frailty, nutritional risk, and malnutrition. Front Nutr 2023; 10:1143213. [PMID: 37139454 PMCID: PMC10149728 DOI: 10.3389/fnut.2023.1143213] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 03/29/2023] [Indexed: 05/05/2023] Open
Abstract
Background Sarcopenia, frailty, and malnutrition are associated with undesirable clinical outcomes in cancer patients. Sarcopenia-related measurements may be promising fast biomarkers for frailty. Our objectives were to assess the prevalence of nutritional risk, malnutrition, frailty, and sarcopenia in lung cancer inpatients, and describe the relationship of them. Methods Stage III and IV lung cancer inpatients were recruited before chemotherapy. The skeletal muscle index (SMI) was assessed by multi-frequency bioelectric impedance analysis (m-BIA). Sarcopenia, frailty, nutritional risk, and malnutrition were diagnosed according to the Asian Working Group for Sarcopenia 2019 (AWGS 2019), Fried Frailty Phenotype (FFP), nutritional risk screening-2002 (NRS-2002), and Global Leadership Initiative on Malnutrition criteria (GLIM), and correlation analysis was performed between them with Pearson's r correlation coefficients. A univariate and multivariate logistic regression analysis was conducted for all patients, gender and age-stratified subgroups to obtain odds ratios (ORs) and 95% confidence intervals (95%CIs). Results The cohort included 97 men (77%) and 29 women (23%), with mean age of 64.8 ± 8.7 years. Among the 126 patients, 32 (25.4%) and 41 (32.5%) had sarcopenia and frailty, and the prevalence of nutritional risk and malnutrition was 31.0% (n = 39) and 25.4% (n = 32). Adjusted for age and gender, SMI was correlated with FFP (r = -0.204, p = 0.027), and did not remain significantly when stratified by gender. Stratification according to age revealed in ≥65-years-old population, SMI and FFP were significantly correlated (r = -0.297, p = 0.016), which is not seen in <65-years-old group (r = 0.048, p = 0.748). The multivariate regression analysis showed FFP, BMI, and ECOG were the independent variables associated with sarcopenia (OR 1.536, 95%CI 1.062-2.452, p = 0.042; OR 0.625, 95%CI 0.479-0.815, p = 0.001; OR 7.286, 95%CI 1.779-29.838, p = 0.004). Conclusion Comprehensively assessed sarcopenia is independently associated with frailty based on FFP questionnaire, BMI, and ECOG. Therefore, sarcopenia assessment including m-BIA based SMI, and muscle strength and function could be used to indicate frailty to help select the targeting patients for care. Moreover, in addition to muscle mass, muscle quality should not be ignored in clinical practice.
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Affiliation(s)
- Fang Wang
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong-nan Zhen
- Department of Radiotherapy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Han-ping Wang
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kang Yu
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Kang Yu,
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Takeda T, Sasaki T, Okamoto T, Ishitsuka T, Yamada M, Nakagawa H, Mie T, Furukawa T, Kasuga A, Matsuyama M, Ozaka M, Sasahira N. Impact of the Extent of Weight Loss before Administration on the Efficacy of Anamorelin in Advanced Pancreatic Cancer Patients with Cachexia. Intern Med 2022. [PMID: 36418096 PMCID: PMC10372274 DOI: 10.2169/internalmedicine.0730-22] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective Anamorelin, a novel selective ghrelin receptor agonist, was approved in Japan for the treatment of cachexia in pancreatic cancer (PC), albeit with limited evidence. This study evaluated the efficacy and safety of anamorelin in PC and examined the impact of the extent of weight loss on the efficacy of anamorelin. Methods We retrospectively investigated consecutive PC patients with cachexia who received anamorelin at our institution between June 2021 and January 2022. Patients were divided into two groups: moderate-weight-loss group (5%-10%) and severe-weight-loss group (> 10%). The primary outcome was changes in body weight. The secondary outcomes were changes in appetite and laboratory measures as well as treatment-related severe adverse events. Results A total of 24 patients were included (moderate/severe weight loss: 8/16). The moderate-weight-loss group showed significantly more weight gain than the severe-weight-loss group. Improvements in appetite were consistently observed in each weight-loss group. Changes in laboratory markers were not significantly different between groups. Hyperglycemia (four patients) was the most common cause of severe adverse events, followed by abdominal distension, nausea, elevated liver function tests, and bulimia. Conclusions The efficacy of anamorelin was associated with the extent of weight loss. Although anamorelin improved appetite in each weight-loss group, it increased body weight only in the moderate-weight-loss group. Anamorelin was well-tolerated among advanced PC patients, although caution must be practiced when it is used in patients with concomitant diabetes mellitus.
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Affiliation(s)
- Tsuyoshi Takeda
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Japan
| | - Takashi Sasaki
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Japan
| | - Takeshi Okamoto
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Japan
| | - Takahiro Ishitsuka
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Japan
| | - Manabu Yamada
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Japan
| | - Hiroki Nakagawa
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Japan
| | - Takafumi Mie
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Japan
| | - Takaaki Furukawa
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Japan
| | - Akiyoshi Kasuga
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Japan
| | - Masato Matsuyama
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Japan
| | - Masato Ozaka
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Japan
| | - Naoki Sasahira
- Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Japan
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Huang L, Shi Y, Wang L, Rong L, Ren Y, Xu C, Wu J, Zhang M, Zhu L, Zhang J, Xu X, Hu W, Zhang J. Characteristics and in-hospital outcomes of elderly patients with cancer in a top-ranked hospital in China, 2016-2020: Real-world study. Cancer Med 2022; 12:2885-2905. [PMID: 36164280 PMCID: PMC9939123 DOI: 10.1002/cam4.5203] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/08/2022] [Accepted: 08/23/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Cancer is mostly a disease of aging, and older patients with cancer are generally frailer. This study aimed to describe the characteristics and in-hospital outcomes and explore factors associated with duration, cost, and mortality during first hospitalization, in older patients with cancer admitted to a top-ranked hospital in China. METHODS Data on patients with solid cancer ≥65 years consecutively hospitalized in 2016-2020 were retrieved from the electronic medical records of Ruijin Hospital in Shanghai, China. Baseline characteristics, duration, cost, and mortality during hospitalization were described. Factors associated with duration, cost, and mortality during first hospitalization were explored using multivariable-adjusted logistic regression. RESULTS 20,650 eligible patients with male proportion of 59% and median age of 70 years were analyzed. 45% of the patients underwent resection in our hospital. Upon first admission, 49% of patients had hypertension, 19% diabetes, 22% weight loss, and 28% risks of malnutrition. The median duration and cost of first hospitalization were 9 days and 32,000 RMB, respectively. 118 (0.6%) and 228 (1.1%) deaths occurred during first and any hospitalization, respectively. For first hospitalization, longer duration and higher cost were positively associated with older ages, male gender, emergency admission, certain tumor locations and histology, histories of diabetes, cirrhosis, and anticoagulant intake, higher body mass index, weight loss, reduced food intake, risk of falling, and worse self-care ability; in-hospital mortality was positively associated with age ≥85 years, emergency admission, certain cancer types, histories of hypertension and psychotropic intake, reduced food intake, and worse self-care ability. CONCLUSIONS This study identified certain baseline patient and tumor characteristics, medical and medication histories, changes of weight and food intake, diet, and self-care ability which were independently associated with in-hospital outcomes among older patients with cancer admitted to our hospital and which should be paid special attention to. While the factors might not be easily modifiable, our study can help identify patients at higher risks of inferior in-hospital outcomes.
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Affiliation(s)
- Lei Huang
- Department of OncologyRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina,Medical Center on Aging of Ruijin Hospital, MCARJH, Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Yan Shi
- Department of OncologyRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Lei Wang
- Medical Center on Aging of Ruijin Hospital, MCARJH, Shanghai Jiaotong University School of MedicineShanghaiChina,Department of GastroenterologyRuijin Hospital, Shanghai Jiaotong University School of MedicineShanghaiPeople's Republic of China
| | - Lan Rong
- Department of GeriatricsRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yan Ren
- Medical Center on Aging of Ruijin Hospital, MCARJH, Shanghai Jiaotong University School of MedicineShanghaiChina,Department of GeriatricsRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Chenying Xu
- Medical Center on Aging of Ruijin Hospital, MCARJH, Shanghai Jiaotong University School of MedicineShanghaiChina,Department of GeriatricsRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Junwei Wu
- Department of OncologyRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Mingmin Zhang
- Computer Center, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Lifeng Zhu
- Computer Center, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of MedicineShanghaiChina
| | | | - Xiaofeng Xu
- Shanghai Chief Technician Studio (Information & Technology)ShanghaiChina
| | - Weiguo Hu
- Medical Center on Aging of Ruijin Hospital, MCARJH, Shanghai Jiaotong University School of MedicineShanghaiChina,Department of GeriatricsRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina,Department of SurgeryRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Jun Zhang
- Department of OncologyRuijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina,State Key Laboratory of Oncogenes and Related GenesShanghai Jiao Tong UniversityShanghaiChina
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Gouez M, Delrieu L, Bouleuc C, Girard N, Raynard B, Marchal T. Association between Nutritional Status and Treatment Response and Survival in Patients Treated with Immunotherapy for Lung Cancer: A Retrospective French Study. Cancers (Basel) 2022; 14:cancers14143439. [PMID: 35884500 PMCID: PMC9322139 DOI: 10.3390/cancers14143439] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/07/2022] [Accepted: 07/13/2022] [Indexed: 02/05/2023] Open
Abstract
Simple Summary It is estimated that 73% of advanced non-small cell lung cancers (NSCLC) will become malnourished and develop cachexia which is considered as an independent prognostic factor. Therefore, this study aimed to investigate the association between nutritional assessments and (i) immunotherapy efficacy, (ii) tolerance, and (iii) survival in patients with an advanced NSCLC stage of lung cancer treated with immunotherapy. In total, 67% of the 120 patients analysed were not malnourished, 20% presented with moderate malnutrition, and 13% presented with severe malnutrition. There was no significant link between the nutritional status and the toxicity of immunotherapy. However, severe malnutrition was significantly associated with treatment efficacy and with a lower survival rate. Malnutrition appears to have a negative impact in the case of immunotherapy, in contrast to a high body mass index, which seems to be protective. In addition to confirming the benefits of early and appropriate nutritional management, research must also focus on catabolism and the uncontrolled inflammatory mechanisms. Abstract Malnutrition is associated with a greater risk of morbidity and mortality and lower tolerance to chemotherapy. Our purpose was to study the association between nutritional status and the efficiency and tolerance of immunotherapy in non-small cell lung cancer (NSCLC). Nutritional and oncological data were reported at 2 months (M2) and 4 months (M4) after the initiation of immunotherapy (M0). The influence of nutritional status at M0 was estimated with the efficacy and toxicity of immunotherapy at M2 to M4. In total, 127 patients were included in the study, and nutritional status was estimated at M0 for 120 patients: 67% were not malnourished, 20% presented with moderate malnutrition, and 13% presented with severe malnutrition. There was no significant link between the nutritional status at M0 and the toxicity of immunotherapy at M2 and M4. However, severe malnutrition was significantly associated with treatment efficacy at M2 (p = 0.04) and with a lower survival rate with an HR (Hazard Ratio) = 2.32–95% C.I: 1.13–4.75 (p = 0.02). Furthermore, a monthly decrease of 1% of the weight had an HR = 1.17–95% C.I: 1.13–1.21 (p = 0.0001). Severe malnutrition and weight loss are independent factors associated with lower survival. Studies integrating the systemic detection of sarcopenia with a closer nutritional follow-up could highlight an improvement in survival.
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Affiliation(s)
- Manon Gouez
- Department of Prevention Cancer Environment, Léon Bérard Cancer Centre, 69008 Lyon, France;
| | - Lidia Delrieu
- Residual Tumour & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Institut Curie, Paris University, 75005 Paris, France;
| | - Carole Bouleuc
- Department of Supportive Care, Institut Curie, 75005 Paris, France;
| | - Nicolas Girard
- Institut Curie, Institut du Thorax Curie Montsouris, 75005 Paris, France;
| | - Bruno Raynard
- Department of Supportive Care, Unité Transversale de Diététique et de Nutrition Centre Gustave-Roussy, 94800 Villejuif, France;
| | - Timothée Marchal
- Department of Supportive Care, Institut Curie, 75005 Paris, France;
- Correspondence:
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Zheng K, Liu X, Ji W, Lu J, Cui J, Li W. The Efficacy of Different Inflammatory Markers for the Prognosis of Patients with Malignant Tumors. J Inflamm Res 2021; 14:5769-5785. [PMID: 34764670 PMCID: PMC8573157 DOI: 10.2147/jir.s334941] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/16/2021] [Indexed: 12/20/2022] Open
Abstract
Background Inflammation is considered essential in cancer progression, as it affects the nutritional status and prognosis of patients. In this study, we aim to analyze the efficacy of various inflammatory markers in predicting prognosis in cancer patients. Methods Patients with malignant tumor were included as primary and validation cohort. Basic clinical information, anthropometric indicators, body composition analysis, and serological indicators were recorded. After proposing the optimal thresholds by time-dependent receiver operating characteristic (ROC), univariate and multivariate Cox regression analyses were performed to analyze the association between inflammatory markers and overall survival (OS). A nomogram was established to develop a scored-inflammatory marker system. Eight inflammatory models based on combinations of inflammatory markers were assessed. Cox regression analysis was used to analyze the relationship of each inflammatory model and mortality of participants. Then, subanalysis of specific tumor types was conducted by Cox regression. Logistic regression models were used to analyze the relationship between different inflammatory models and malnutrition. Results Univariate and multivariate Cox regression analyses indicated that pack-years of cigarette smoking, C-reactive protein (CRP), and systemic immune-inflammation index (SII) were related to the OS of cancer patients. A nomogram was constructed to develop a scored-inflammatory marker system. Among the eight inflammatory models, patients in model A had worst prognosis compared with patients in other models. Subanalysis next showed lung cancer, breast cancer and digestive system neoplasms patients in model A suffered the worst prognosis. Logistic regression indicated that model A was also with predictive value for malnutrition. Conclusion A scored-inflammatory marker system was established to predict the OS of cancer patients. The inflammatory models established in this study can be used to predict prognosis, as well as cancer-related malnutrition. Inflammatory model A suffered the worst OS and was with the predictive efficacy for malnutrition.
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Affiliation(s)
- Kaiwen Zheng
- Cancer Center, the First Hospital of JiLin University, Changchun, Jilin, People's Republic of China
| | - Xiangliang Liu
- Cancer Center, the First Hospital of JiLin University, Changchun, Jilin, People's Republic of China
| | - Wei Ji
- Cancer Center, the First Hospital of JiLin University, Changchun, Jilin, People's Republic of China
| | - Jin Lu
- Cancer Center, the First Hospital of JiLin University, Changchun, Jilin, People's Republic of China
| | - Jiuwei Cui
- Cancer Center, the First Hospital of JiLin University, Changchun, Jilin, People's Republic of China
| | - Wei Li
- Cancer Center, the First Hospital of JiLin University, Changchun, Jilin, People's Republic of China
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Sayın E, Özlüer YE, Şeker Yaşar K. Evaluating malnutrition in cancer patients in the emergency department. Am J Emerg Med 2021; 51:197-201. [PMID: 34763239 DOI: 10.1016/j.ajem.2021.10.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/21/2021] [Accepted: 10/25/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Malnutrition is an important contributing factor to mortality in cancer patients. Several scoring systems can be used to evaluate malnutrition in cancer patients. We hypothesized that one or more of these scoring systems should be used to assess malnutrition in emergency departments (EDs). METHODS This prospective observational study was conducted in the ED of a tertiary care center. From October 1, 2019, to March 31, 2020, we prospectively collected data on cancer patients aged 18 and over who were evaluated in the ED but did not present with any nutrition-related complaint, and not had any prior nutritional support. Malnutrition levels were determined using the Patient-Generated Subjective Global Assessment (PG-SGA1) instrument. The patients were grouped according to the presence and degree of malnutrition (PG-SGA categories A and B vs PG-SGA category C) and their need for nutritional intervention according to the Nutritional Triage Recommendation Scores (NTRS2 < 9 vs NTRS ≥9). RESULTS Twelve female (31.5%) and 26 male (68.5%) cancer patients, with a mean age of 70.29 ± 11.49 years, were enrolled in the study. According to the PG-SGA, 84.2% of the patients were at risk for malnutrition, and 97.4% required nutritional intervention. Thirty patients (78.9%) had experienced problems with eating in the preceding two weeks. There were statistically significant differences in these patients' body mass indexes (BMIs) (25.46 ± 4.3 kg/m2 vs 20.95 ± 3.66 kg/m2, p < 0.05) and ages (64.6 ± 10.5 years vs 74.9 ± 10.3 years, p < 0.05) according to the PG-SGA. There were also statistically significant differences between the patients' BMIs (25.73 ± 3.51 kg/m2 vs 22.11 ± 4.50 kg/m2, p < 0.05), according to the NTRS. There was no relationship between whether the patients had undergone surgery to remove tumors (p > 0.05), chemotherapy (p > 0.05), or radiotherapy (p > 0.05) according to the PG-SGA and NTRS. CONCLUSION Malnutrition is common in cancer patients. These patients may be malnourished even if their BMI is within normal limits. Malnutrition can be detected and evaluated in the ED using instruments such as the PG-SGA. We suggest that evaluation for malnutrition should be a standard component of patient care in the ED.
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Affiliation(s)
- Evrim Sayın
- Adnan Menderes University Hospital, Department of Emergency Medicine, Efeler, Aydın, Turkey
| | - Yunus Emre Özlüer
- Adnan Menderes University Hospital, Department of Emergency Medicine, Efeler, Aydın, Turkey.
| | - Kezban Şeker Yaşar
- Adnan Menderes University Hospital, Department of Emergency Medicine, Efeler, Aydın, Turkey
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Liu X, Ji W, Zheng K, Lu J, Li L, Cui J, Li W. The correlation between skeletal muscle index of the L3 vertebral body and malnutrition in patients with advanced lung cancer. BMC Cancer 2021; 21:1148. [PMID: 34702196 PMCID: PMC8549206 DOI: 10.1186/s12885-021-08876-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 10/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies have shown that the skeletal muscle index at the third lumbar vertebra (L3 SMI) had reasonable specificity and sensitivity in nutritional assessment and prognostic prediction in digestive system cancers, but its performance in lung cancer needs further investigation. METHODS A retrospective study was performed on 110 patients with advanced lung cancer. The L3 SMI, the Patient-Generated Subjective Global Assessment score (PG-SGA score), body mass index (BMI), and serological indicators were analyzed. According to PG-SGA scores, patients were divided into severe malnutrition (≥9 points), mild to moderate malnutrition (≥3 points and ≤ 8 points), and no malnutrition (≤2 points) groups. Pearson correlation and logistic regression analysis were adopted to find factors related to malnutrition, and a forest plot was drawn. The receiver operating characteristic (ROC) curve was performed to compare the diagnostic values of malnutrition among factors, which were expressed by the area under curve (AUC). RESULTS 1. The age of patients in the severe malnutrition group, the mild to moderate malnutrition group, and the no malnutrition group significantly differed, with mean ages of 63.46 ± 10.01 years, 60.42 ± 8.76 years, and 55.03 ± 10.40 years, respectively (OR = 1.062, 95%CI: 1.008 ~ 1.118, P = 0.024; OR = 1.100, 95%CI: 1.034 ~ 1.170, P = 0.002). Furthermore, the neutrophil to lymphocyte ratio (NLR) of the severe malnutrition group was significantly higher than that of the no malnutrition group, with statistical significance. The difference between the mild to moderate malnutrition group and the no malnutrition group were not statistically significant, with NLR of 4.07 ± 3.34 and 2.47 ± 0.92, respectively (OR = 1.657,95%CI: 1.036 ~ 2.649, P = 0.035). The L3 SMI of patients in the severe malnutrition and mild to moderate malnutrition groups were significantly lower than that of the patients in the no malnutrition group, with statistical significance. The L3 SMI of patients in the severe malnutrition group, mild to moderate malnutrition group, and no malnutrition group were 27.40 ± 4.25 cm2/m2, 38.19 ± 6.17 cm2/m2, and 47.96 ± 5.02 cm2/m2, respectively (OR = 0.600, 95%CI: 0.462 ~ 0.777, P < 0.001; OR = 0.431, 95%CI: 0.320 ~ 0.581, P < 0.001). 2. The Pearson correlation analysis showed that the PG-SGA score positively correlated with age (r = 0.296, P < 0.05) but negatively correlated with L3 SMI (r = - 0.857, P < 0.05). The L3 SMI was also negatively correlated with age (r = - 0.240, P < 0.05). 3. The multivariate analysis showed that the L3 SMI was an independent risk factor for malnutrition (OR = 0.446, 95%CI: 0.258 ~ 0.773, P = 0.004; OR = 0.289, 95%CI: 0.159 ~ 0.524, P < 0.001). CONCLUSION 1. The differences in the L3 SMI was statistically significant among advanced lung cancer patients with different nutritional statuses. 2. In the nutritional assessment of patients with lung cancer, the L3 SMI was consistent with the PG-SGA. 3. The L3 SMI is an independent predictor of malnutrition in patients with advanced lung cancer.
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Affiliation(s)
- Xiangliang Liu
- the First Hospital of Jilin University, Xinmin St No 126, Changchun, 130021 Jilin China
| | - Wei Ji
- the First Hospital of Jilin University, Xinmin St No 126, Changchun, 130021 Jilin China
| | - Kaiwen Zheng
- the First Hospital of Jilin University, Xinmin St No 126, Changchun, 130021 Jilin China
| | - Jin Lu
- the First Hospital of Jilin University, Xinmin St No 126, Changchun, 130021 Jilin China
| | - Lingyu Li
- the First Hospital of Jilin University, Xinmin St No 126, Changchun, 130021 Jilin China
| | - Jiuwei Cui
- the First Hospital of Jilin University, Xinmin St No 126, Changchun, 130021 Jilin China
| | - Wei Li
- the First Hospital of Jilin University, Xinmin St No 126, Changchun, 130021 Jilin China
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Gaspar P, Bessa F, Antunes Meireles P, Parreira I, Mota C. Sweet Taste Dysgeusia in a Patient with Indapamide-Related Hyponatremia: Case Report and Review of the Literature. Cureus 2021; 13:e13079. [PMID: 33680619 PMCID: PMC7931776 DOI: 10.7759/cureus.13079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Sweet taste dysgeusia is a rare symptom where patients experience all food as having a sweet taste. While its cause is still unknown, it has been increasingly reported in the setting of lung cancer and syndrome of inappropriate secretion of antidiuretic hormone-related hyponatremia. In this case report, we present what we believe to be the first case of sweet taste dysgeusia in a non-cancer context. We will briefly review and summarize all published cases describing this symptom and also reflect upon the nature of this condition focusing on the role of serum sodium levels in sweet taste receptor modulation.
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Affiliation(s)
- Pedro Gaspar
- Internal Medicine, Serviço de Medicina 2, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa, PRT.,Internal Medicine, Faculdade de Medicina, Universidade de Lisboa, Lisboa, PRT
| | - Filipe Bessa
- Internal Medicine, Serviço de Medicina 2, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa, PRT.,Internal Medicine, Faculdade de Medicina, Universidade de Lisboa, Lisboa, PRT
| | - Pedro Antunes Meireles
- Oncology, Serviço de Oncologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, PRT.,Oncology, Serviço de Medicina 2, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa, PRT
| | - Inês Parreira
- Internal Medicine, Serviço de Medicina 2, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa, PRT
| | - Catarina Mota
- Internal Medicine, Serviço de Medicina 2, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa, PRT.,Internal Medicine, Faculdade de Medicina, Universidade de Lisboa, Lisboa, PRT
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10
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Viana ECRDM, Oliveira IDS, Rechinelli AB, Marques IL, de Souza VF, Spexoto MCB, Pereira TSS, Guandalini VR. Malnutrition and nutrition impact symptoms (NIS) in surgical patients with cancer. PLoS One 2020; 15:e0241305. [PMID: 33320857 PMCID: PMC7737886 DOI: 10.1371/journal.pone.0241305] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 10/12/2020] [Indexed: 01/29/2023] Open
Abstract
Background and aim Nutrition impact symptoms (NIS) are common in cancer patients and the negative impacts on nutritional status indicate the need for research, diagnosis and nutritional intervention in order to reduce the risk of malnutrition. We aimed to verify the presence of malnutrition, the need for nutritional intervention, NIS and their influence on the nutritional status of surgical patients with cancer. Methods This cross-sectional study was carried out in a public tertiary hospital, from March 2017 to October 2019. Nutritional status, the need for nutritional intervention and NIS were assessed through the Patient-Generated Subjective Global Assessment (PG-SGA) in the first 48 hours of hospital admission. Results Among the 135 patients evaluated, 55.6% were elderly and 51.1% were male; patients had a median age of 62 years and a predominance of cancer located in the lower gastrointestinal tract (35.6%). Malnutrition and the need for nutritional intervention were identified in 60.0% and 90.4% of cases, respectively. The presence of three or more NIS was reported by 51.9% of patients. Significant differences in NIS were observed according to sex, PG-SGA classification and PG-SGA score. After logistic regression analysis, it was determined that the symptoms that increased the chances of malnutrition were anorexia, constipation, strange taste, mouth sores and others (depression, dental or financial problems). Conclusion Malnutrition, the need for nutritional intervention and the presence of three or more NIS were elevated in the patients evaluated. Malnutrition was associated with the presence of NIS, indicating the need for attention and care in antineoplastic treatment.
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Affiliation(s)
| | | | - Ana Beatriz Rechinelli
- Department of Integrated Education, Federal University of Espirito Santo, Vitoria, ES, Brazil
| | - Isabele Lessa Marques
- Department of Integrated Education, Federal University of Espirito Santo, Vitoria, ES, Brazil
| | - Vanusa Felício de Souza
- Department of Integrated Education, Federal University of Espirito Santo, Vitoria, ES, Brazil
| | - Maria Cláudia Bernardes Spexoto
- Faculty of Pharmaceutical Sciences, Nutrition Course, Federal University of Grande Dourados, Dourados, Mato Grosso do Sul, Brazil
| | | | - Valdete Regina Guandalini
- Department of Integrated Education, Federal University of Espirito Santo, Vitoria, ES, Brazil
- Postgraduate Program in Nutrition and Health, Federal University of Espirito Santo, Vitoria, ES, Brazil
- * E-mail:
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11
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Williams GR, Al-Obaidi M, Dai C, Mir N, Challa SA, Daniel M, Patel H, Barlow B, Young-Smith C, Gbolahan O, Paluri R, Bhatia S, Giri S. Association of malnutrition with geriatric assessment impairments and health-related quality of life among older adults with gastrointestinal malignancies. Cancer 2020; 126:5147-5155. [PMID: 32885848 PMCID: PMC7747231 DOI: 10.1002/cncr.33122] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND A majority of older adults with cancer develop malnutrition; however, the implications of malnutrition among this vulnerable population are poorly understood. The goal of this study was to quantify the prevalence of nutrition related-symptoms and malnutrition among older adults with gastrointestinal (GI) malignancies and the association of malnutrition with geriatric assessment (GA) impairment, health-related quality of life (HRQoL), and health care utilization. METHODS We performed a cross-sectional study of older adults (≥60 years) who were referred to the GI Oncology clinic at the University of Alabama at Birmingham. Participants underwent the Cancer & Aging Resilience Evaluation survey that includes the abbreviated Patient-Generated Subjective Global Assessment of nutrition. Nutrition scores were dichotomized into normal (0-5) and malnourished (≥6), and multivariate analyses adjusted for demographics, cancer type, and cancer stage were used to examine associations with GA impairment, HRQoL, and health care utilization. RESULTS A total of 336 participants were included (men, 56.8%; women, 43.2%), with a mean age of 70 years (standard deviation, ±7.2 years) and colorectal cancer (33.6%) and pancreatic cancer (24.4%) being the most common diagnoses. Overall, 52.1% of participants were identified as malnourished. Malnutrition was associated with a higher prevalence of several GA impairments, including 1 or more falls (adjusted odds ratio [aOR], 2.1), instrumental activities of daily living impairment (aOR, 4.1), and frailty (aOR, 8.2). Malnutrition was also associated with impaired HRQoL domains; both physical (aOR, 8.7) and mental (aOR, 5.0), and prior hospitalizations (aOR, 2.2). CONCLUSION We found a high prevalence of malnutrition among older adults with GI malignancies that was associated with increased GA impairments, reduced HRQoL, and increased health care utilization.
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Affiliation(s)
- Grant R. Williams
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
- Division of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Mustafa Al-Obaidi
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Chen Dai
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Nabiel Mir
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Sai Alekha Challa
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Michael Daniel
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL
- Department of Genetics, University of Alabama at Birmingham, Birmingham, AL
| | - Harita Patel
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Brett Barlow
- Division of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Crystal Young-Smith
- Division of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Olumide Gbolahan
- Division of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Ravi Paluri
- Division of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Smita Bhatia
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Smith Giri
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
- Division of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL
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12
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Mele MC, Rinninella E, Cintoni M, Pulcini G, Di Donato A, Grassi F, Trestini I, Pozzo C, Tortora G, Gasbarrini A, Bria E. Nutritional Support in Lung Cancer Patients: The State of the Art. Clin Lung Cancer 2020; 22:e584-e594. [PMID: 33303399 DOI: 10.1016/j.cllc.2020.10.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 10/07/2020] [Accepted: 10/15/2020] [Indexed: 12/18/2022]
Abstract
Lung cancer (LC) represents the most commonly diagnosed neoplasm worldwide for both sexes and is the leading cause of cancer mortality. Malnutrition is a comorbidity frequently found in neoplastic patients, but it remains often underestimated and thus undertreated. In this review, we aimed to investigate the incidence of malnutrition among LC patients according to different screening and assessment tools, to evaluate the impact of weight loss and body composition on survival, and to analyze the efficacy of different nutritional interventions in this setting. Although malnutrition, weight loss, and body composition changes can affect survival and other clinical outcomes in LC patients, the role of nutritional interventions is not yet strongly proven, and further studies are recommended. Nevertheless, screening, assessing, and eventually treating malnutrition in LC patients are strongly recommended, according to the most recent nutritional intervention guidelines for oncology patients.
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Affiliation(s)
- Maria Cristina Mele
- UOSD di Nutrizione Avanzata in Oncologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Emanuele Rinninella
- UOC di Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Cintoni
- Scuola di Specializzazione in Scienza dell'Alimentazione, Università di Roma Tor Vergata, Rome, Italy.
| | - Gabriele Pulcini
- UOSD di Nutrizione Avanzata in Oncologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Agnese Di Donato
- UOSD di Nutrizione Avanzata in Oncologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Futura Grassi
- UOC di Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Ilaria Trestini
- Oncologia Medica, Università di Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Carmelo Pozzo
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Oncologia Medica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giampaolo Tortora
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Oncologia Medica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Gasbarrini
- UOC di Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Emilio Bria
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Oncologia Medica, Università Cattolica del Sacro Cuore, Rome, Italy
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13
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Mikkelsen S, Østergaard T, Zacher N, Holst M. Unintended weight loss in hematology outpatients - Work to do. Clin Nutr ESPEN 2020; 37:202-206. [PMID: 32359744 DOI: 10.1016/j.clnesp.2020.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/15/2020] [Accepted: 02/20/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Malnutrition frequently occurs in hematology diseases and may threaten the course of treatment and patient outcomes. While screening for nutritional risk is often done in hospitalized patients, it is rarely described in the outpatient setting. Hematology patients are often followed in outpatient settings before hospitalization and for a longer time after. AIMS The primary aim of this study was to investigate the prevalence of nutritional risk measured by unintended weight loss within three months and reduced food intake within one week among patients in a hematology outpatient clinic. The second purpose was to investigate the two variables as a quick initial screening tool. METHODS All patients visiting the outpatient clinic within one week were invited to participate in this study, designed as a questionnaire-based cross-sectional study, consisting of nine questions. Descriptive statistical analyses, chi2 test and simple logistic regression analyses were performed. RESULTS Of the 219 included patients, 23.7% had an unintended weight loss of mean 13.7% of body weight within the last three months and 13.2% had eaten less than usual within the past week. Patients who had significantly increased odds for unintended weight loss were >80 years of age [CI95%: 1274; 6084], patients visiting for examinations [CI95%: 1.105; 7.227], patients visiting for treatment [CI95%: 1.383; 6598] and patients visiting as part of a course of investigations [CI95%: 1.112; 34.184] as well as patients who had eaten less [CI95%: 2.731; 14.224]. Patients visiting the outpatient clinic for examination had significantly increased odds of having eaten less [CI95%: 1.783; 14.629]. CONCLUSIONS Based on the statistical analyses, almost one fourth of the patients had a significant unintended weight loss, about 15% had reduced food intake and only 7.8% had both unintended weight loss and reduced food intake. These results indicate that unintended weight loss can be used as a quick screening tool to identify and detect patients at risk of malnutrition and that guidelines should be drawn up for managing patients at nutritional risk in hematology outpatient clinics.
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Affiliation(s)
- Sabina Mikkelsen
- Centre for Nutrition and Bowel Disease, Aalborg University Hospital, Mølleparkvej 4, 9000, Aalborg, Denmark.
| | - Trine Østergaard
- Centre for Nutrition and Bowel Disease, Aalborg University Hospital, Mølleparkvej 4, 9000, Aalborg, Denmark.
| | - Nina Zacher
- Centre for Nutrition and Bowel Disease, Aalborg University Hospital, Mølleparkvej 4, 9000, Aalborg, Denmark.
| | - Mette Holst
- Centre for Nutrition and Bowel Disease, Aalborg University Hospital, Mølleparkvej 4, 9000, Aalborg, Denmark.
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14
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Lorton CM, Griffin O, Higgins K, Roulston F, Stewart G, Gough N, Barnes E, Aktas A, Walsh TD. Late referral of cancer patients with malnutrition to dietitians: a prospective study of clinical practice. Support Care Cancer 2019; 28:2351-2360. [PMID: 31485981 DOI: 10.1007/s00520-019-05042-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 08/12/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE Malnutrition (MN) in cancer is common but underdiagnosed. Dietitian referrals may not occur until MN is established. We investigated cancer patient characteristics (demographics, nutritional status, and nutrition barriers) on referral to oncology dietitians. We also examined referral practices and prevalence of missed referral opportunities. METHODS This was a naturalistic multi-site study of clinical practice. Data from consecutive referrals were collected in inpatient and outpatient settings. Demographics, nutritional status (weight, body mass index (BMI), weight loss in the preceding 3-6 months, oral intake, nutrition barriers), referral reasons, and use of screening were recorded. Missed opportunities for earlier referral were also noted. RESULTS Two hundred patients were included (60% male, 51% inpatients). Half had gastrointestinal and hepatobiliary cancers. The majority were on antitumor treatment. Two-thirds had lost ≥ 5% body weight. Forty percent were overweight or obese. Seventy percent had ≥ 2 nutritional barriers. Most common nutrition barriers were anorexia, nausea, and early satiety. Greater weight loss and lower food intake were associated with ≥ 2 barriers. Weight loss was the most common referral reason. Screening was used in 35%. Referrals should have occurred sooner in nearly half (45%, n = 89). CONCLUSIONS Cancer patients were referred late to a dietitian, with multiple nutritional barriers. Most referrals were for established weight loss (WL). WL may be masked by pre-existing obesity. Almost half had missed earlier referral opportunities; screening was infrequent. Over one-quarter should have been re-referred sooner. There is a clear need for clinician education. Future research should investigate the optimal timing of dietitian referral and the best nutrition screening tools for use in cancer.
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Affiliation(s)
- Cliona M Lorton
- Academic Department of Palliative Medicine, Our Lady's Hospice & Care Services, Harold's Cross, Dublin, D6W EV82, Ireland.
- Trinity College Dublin, Dublin, Ireland.
| | - O Griffin
- Trinity College Dublin, Dublin, Ireland
- St Vincent's University Hospital, Dublin, Ireland
| | - K Higgins
- Tallaght University Hospital, Dublin, Ireland
| | - F Roulston
- St Luke's Radiation Oncology Network, Dublin, Ireland
| | - G Stewart
- St Vincent's Private Hospital, Dublin, Ireland
| | - N Gough
- Mater Private Mid-Western Radiation Oncology Centre, Limerick, Ireland
| | - E Barnes
- St Vincent's University Hospital, Dublin, Ireland
| | - A Aktas
- Department of Supportive Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - T D Walsh
- Academic Department of Palliative Medicine, Our Lady's Hospice & Care Services, Harold's Cross, Dublin, D6W EV82, Ireland
- Trinity College Dublin, Dublin, Ireland
- Department of Supportive Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
- University College Dublin, Dublin, Ireland
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15
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Trestini I, Gkountakos A, Carbognin L, Avancini A, Lanza M, Molfino A, Friso S, Corbo V, Tortora G, Scarpa A, Milella M, Bria E, Pilotto S. Muscle derangement and alteration of the nutritional machinery in NSCLC. Crit Rev Oncol Hematol 2019; 141:43-53. [DOI: 10.1016/j.critrevonc.2019.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/08/2019] [Accepted: 06/09/2019] [Indexed: 01/06/2023] Open
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16
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Association of colorectal polyps and cancer with low-dose persistent organic pollutants: A case-control study. PLoS One 2018; 13:e0208546. [PMID: 30521631 PMCID: PMC6283632 DOI: 10.1371/journal.pone.0208546] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 11/19/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Low-dose persistent organic pollutants (POPs) have recently been linked to immunosenescence, a key mechanism in carcinogenesis, as well as many aging-related chronic diseases. Since feces are the main excretion route of POPs, the large intestine is a potential target organ for these pollutants. We performed a case-control study to evaluate whether exposure to low-dose POPs is related to the risk of colorectal polyps and cancer. METHODS A total of 277 participants were recruited from one hospital: 99 cancer patients, 102 polyp patients, and 76 control subjects. As typical examples of POPs, we measured the serum concentrations of organochlorine pesticides (OCPs) and polychlorinated biphenyls (PCBs). RESULTS Across the tertiles of the summary measure of POPs, the adjusted odds ratios (ORs) of colorectal polyps and cancer were 2.8 (1.2-6.8) (Ptrend = 0.01) and 3.0 (1.0-8.8) (Ptrend = 0.02), respectively, for subjects in the highest tertile. When OCPs and PCBs were analyzed separately, OCPs were linked to an increased risk of both polyps and cancer; the adjusted ORs were 2.3 (0.9-5.7) (Ptrend = 0.05) for polyps and 3.6 (1.1-11.8) (Ptrend< 0.01) for cancer. However, PCBs were only significantly associated with a high risk of polyps but not cancer; the adjusted OR was 2.8 (1.2-6.6) (Ptrend = 0.01). CONCLUSION Chronic exposure to low-dose POPs may be associated with an increased risk of colorectal polyps and cancer. Our findings suggest the carcinogenic potential of strong lipophilic chemical mixtures such as POPs which are accumulated in adipose tissue, released to circulation, and eliminated through feces.
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17
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Anandavadivelan P, Martin L, Djärv T, Johar A, Lagergren P. Nutrition Impact Symptoms Are Prognostic of Quality of Life and Mortality after Surgery for Oesophageal Cancer. Cancers (Basel) 2018; 10:cancers10090318. [PMID: 30205530 PMCID: PMC6162430 DOI: 10.3390/cancers10090318] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 08/28/2018] [Accepted: 09/04/2018] [Indexed: 01/03/2023] Open
Abstract
We aimed to clarify the influence of nutritional problems after surgery for oesophageal cancer on functional health related quality of life (HRQOL) and survival. A prospective nationwide cohort of oesophageal cancer patients operated 2001–2005 in Sweden with 6 months postoperative follow up was used. Nutritional problems were categorized as low/moderate/severe/very severe based on weight loss and nutrition impact symptoms. An ANCOVA model calculated mean score differences (MD) with 95% confidence intervals (CI) of global quality of life (QOL), social and physical function scores, stratified by preoperative body mass index (BMI) <25 and ≥25. A Cox proportional hazards model produced hazard ratios (HR) with 95% CI for overall 5-year survival. Of 358 patients, 196 (55%) had preoperative BMI ≥25. Very severe and severe nutritional problems were associated with worse HRQOL in both BMI groups. E.g. MD’s for global QOL among ‘very severe’ group was −29 (95% CI −39–−19) and −20 (95% CI −29–−11) for <25 and ≥25 BMI, respectively, compared to the ‘low’ group. Overall 5-year survival among ‘very severe’ and BMI ≥ 25 was worse; HR 4.6 (95% CI 1.4–15.6). Intense nutritional problems negatively impact postoperative HRQOL and combined with preoperative BMI ≥ 25 are associated with poorer 5-year overall survival representing a group needing greater clinical attention.
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Affiliation(s)
- Poorna Anandavadivelan
- Surgical Care Sciences, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 17176 Stockholm, Sweden.
| | - Lena Martin
- Department of Biosciences and Nutrition, Karolinska Institutet, 171 76 Stockholm, Sweden.
- Function Area Clinical Nutrition, Karolinska University Hospital, 141 86 Stockholm, Sweden.
| | - Therese Djärv
- Department of Medicine, Solna, Karolinska Institutet, 171 76 Stockholm, Sweden.
| | - Asif Johar
- Surgical Care Sciences, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 17176 Stockholm, Sweden.
| | - Pernilla Lagergren
- Surgical Care Sciences, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 17176 Stockholm, Sweden.
- Department of Surgery and Cancer, Imperial College London, SW7 2AZ London, UK.
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18
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Grace EM, Shaw C, Lalji A, Mohammed K, Andreyev HJN, Whelan K. Nutritional status, the development and persistence of malnutrition and dietary intake in oesophago-gastric cancer: a longitudinal cohort study. J Hum Nutr Diet 2018; 31:785-792. [PMID: 30033545 DOI: 10.1111/jhn.12588] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Patients with oesophago-gastric (OG) cancer may be at risk of malnutrition, troublesome gastrointestinal symptoms (GI) and reduced dietary intake in view of the tumour location and multimodality curative treatment approach. Longitudinal research is lacking. The present study aimed to assess (i) nutritional status and how it evolved over the first year; (ii) the association between nutritional status scores and GI symptom scores; and (iii) the nutrient and food group intake pattern. METHODS This was a prospective, observational study of patients with an OG lesion planned for radical treatment, with assessment at diagnosis, 3 months and 12 months after the start of treatment. Nutritional assessment was performed using the Patient-Generated Subjective Global Assessment, GI symptoms measured using the modified Gastrointestinal Symptom Rating Scale and dietary intake assessed using a semi-quantitative food frequency approach. RESULTS Eighty patients (61 males, 19 females; aged 46-89 years) were recruited. At baseline, 3 (n = 68) and 12 months (n = 57), 61%, 62% and 60%, respectively, were moderately/severely malnourished. Higher symptom burden was associated with poorer nutritional status at baseline (r = 0.55, P < 0.001), 3 months (r = 0.51, P < 0.001) and 12 months (r = 0.42, P = 0.001). At each respective time point, 37%, 38% and 42% were meeting their estimated average requirement for energy. No change in mean (SD) intake of energy, fibre, nutrient and food groups was observed over time. CONCLUSIONS Patients with OG cancer have progressive weight loss, with malnutrition present over the majority of the 12-month study period. Optimising nutritional status and symptom management throughout the treatment pathway should be a clinical priority.
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Affiliation(s)
- E M Grace
- Department of Clinical Nutrition, St James's Hospital, Dublin, Ireland
| | - C Shaw
- Department of Nutrition and Dietetics, The Royal Marsden NHS Foundation Trust, London, UK
| | - A Lalji
- The GI Unit, Department of Medicine, The Royal Marsden NHS Foundation Trust, London, UK
| | - K Mohammed
- Research Data and Statistics Unit, Department of Research and Development, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - H J N Andreyev
- Department of Gastroenterology, Lincoln County Hospital, United Lincolnshire Hospitals, Lincoln, UK
| | - K Whelan
- Diabetes and Nutritional Sciences Division, King's College London, London, UK
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19
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van der Meij BS, Teleni L, Engelen MPKJ, Deutz NEP. Amino acid kinetics and the response to nutrition in patients with cancer. Int J Radiat Biol 2018; 95:480-492. [PMID: 29667485 DOI: 10.1080/09553002.2018.1466209] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE Amino acids are involved in many physiological processes in the body and serve as building blocks of proteins which are the main component of muscle mass. Often patients with cancer experience muscle wasting, which is associated with poor outcomes. The purpose of this paper is to discuss amino acid kinetics in cancer, review the evidence on the response to nutrition in patients with cancer, and to give recommendations on the appropriate level of amino acid or protein intake in cancer. Current evidence shows that amino acid kinetics in patients with cancer are disturbed, as reflected by increased and decreased levels of plasma amino acids, an increased whole body turnover of protein and muscle protein breakdown. A few studies show beneficial effects of acute and short-term supplementation of high protein meals or essential amino acid mixtures on muscle protein synthesis. CONCLUSIONS Cancer is associated with disturbances in amino acid kinetics. A high protein intake or supplementation of amino acids may improve muscle protein synthesis. Future research needs to identify the optimal level and amino acid mixtures for patients with cancer, in particular for those who are malnourished.
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Affiliation(s)
- Barbara S van der Meij
- a Faculty of Health Sciences and Medicine , Bond University , Gold Coast , Australia.,b Nutrition and Dietetics , Mater Group , Brisbane , Australia
| | - Laisa Teleni
- a Faculty of Health Sciences and Medicine , Bond University , Gold Coast , Australia
| | - Marielle P K J Engelen
- c Department Health and Kinesiology , Center for Translational Research in Aging & Longevity, Texas A&M University , College Station , TX , USA
| | - Nicolaas E P Deutz
- c Department Health and Kinesiology , Center for Translational Research in Aging & Longevity, Texas A&M University , College Station , TX , USA
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20
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Lacau St Guily J, Bouvard É, Raynard B, Goldwasser F, Maget B, Prevost A, Seguy D, Romano O, Narciso B, Couet C, Balon JM, Vansteene D, Salas S, Grandval P, Gyan E, Hebuterne X. NutriCancer: A French observational multicentre cross-sectional study of malnutrition in elderly patients with cancer. J Geriatr Oncol 2018; 9:74-80. [DOI: 10.1016/j.jgo.2017.08.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/11/2017] [Accepted: 08/11/2017] [Indexed: 01/19/2023]
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Bye A, Sjøblom B, Wentzel‐Larsen T, Grønberg BH, Baracos VE, Hjermstad MJ, Aass N, Bremnes RM, Fløtten Ø, Jordhøy M. Muscle mass and association to quality of life in non-small cell lung cancer patients. J Cachexia Sarcopenia Muscle 2017; 8:759-767. [PMID: 28493418 PMCID: PMC5659054 DOI: 10.1002/jcsm.12206] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 02/09/2017] [Accepted: 03/07/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Cancer wasting is characterized by muscle loss and may contribute to fatigue and poor quality of life (QoL). Our aim was to investigate associations between skeletal muscle index (SMI) and skeletal muscle radiodensity (SMD) and selected QoL outcomes in advanced non-small cell lung cancer (NSCLC) at diagnosis. METHODS Baseline data from patients with stage IIIB/IV NSCLC and performance status 0-2 enrolled in three randomized trials of first-line chemotherapy (n = 1305) were analysed. Associations between SMI (cm2 /m2 ) and SMD (Hounsfield units) based on computed tomography-images at the third lumbar level and self-reported physical function (PF), role function (RF), global QoL, fatigue, and dyspnoea were investigated by linear regression using flexible non-linear modelling. RESULTS Complete data were available for 734 patients, mean age 65 years. Mean SMI was 47.7 cm2 /m2 in men (n = 420) and 39.6 cm2 /m2 in women (n = 314). Low SMI values were non-linearly associated with low PF and RF (men P = 0.016/0.020, women P = 0.004/0.012) and with low global QoL (P = 0.001) in men. Low SMI was significantly associated with high fatigue (P = 0.002) and more pain (P = 0.015), in both genders, but not with dyspnoea. All regression analyses showed poorer physical outcomes below an SMI breakpoint of about 42-45 cm2 /m2 for men and 37-40 cm2 /m2 for women. In both genders, poor PF and more dyspnoea were significantly associated with low SMD. CONCLUSIONS Low muscle mass in NSCLC negatively affects the patients' PF, RF, and global QoL, possibly more so in men than in women. However, muscle mass must be below a threshold value before this effect can be detected.
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Affiliation(s)
- Asta Bye
- Regional Advisory Unit for Palliative Care, Department of OncologyOslo University HospitalOsloNorway
- Department of Nursing and Health Promotion, Faculty of Health SciencesOslo and Akershus University College of Applied SciencesOsloNorway
| | - Bjørg Sjøblom
- Department of Internal MedicineInnlandet Hospital TrustHamarNorway
- Department of OncologyOslo University HospitalOsloNorway
- Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway
| | - Tore Wentzel‐Larsen
- Norwegian Centre for Violence and Traumatic Stress StudiesOsloNorway
- Centre for Child and Adolescent Mental HealthEastern and Southern NorwayOsloNorway
- Centre for Clinical ResearchHaukeland University HospitalBergenNorway
| | - Bjørn H. Grønberg
- Cancer Clinic, St. Olavs HospitalTrondheim University HospitalTrondheimNorway
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, NTNUNorwegian University of Science and TechnologyTrondheimNorway
| | - Vickie E. Baracos
- Department of Oncology, Division of Palliative Care MedicineUniversity of AlbertaEdmontonCanada
| | - Marianne J. Hjermstad
- Regional Advisory Unit for Palliative Care, Department of OncologyOslo University HospitalOsloNorway
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, NTNUNorwegian University of Science and TechnologyTrondheimNorway
| | - Nina Aass
- Regional Advisory Unit for Palliative Care, Department of OncologyOslo University HospitalOsloNorway
- Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway
| | - Roy M. Bremnes
- Department of OncologyUniversity Hospital North NorwayTromsøNorway
- Department of Clinical Medicine, Faculty of MedicineUniversity of TromsøTromsøNorway
| | - Øystein Fløtten
- Department of Thoracic MedicineHaukeland University HospitalBergenNorway
| | - Marit Jordhøy
- Department of Internal MedicineInnlandet Hospital TrustHamarNorway
- Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway
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Abstract
PURPOSE OF REVIEW Cancer anorexia is a negative prognostic factor and is broadly defined as the loss of the interest in food. However, multiple clinical domains contribute to the phenotype of cancer anorexia. The characterization of the clinical and molecular pathophysiology of cancer anorexia may enhance the efficacy of preventive and therapeutic strategies. RECENT FINDINGS Clinical trials showed that cancer anorexia should be considered as an umbrella encompassing different signs and symptoms contributing to appetite disruption in cancer patients. Loss of appetite, early satiety, changes in taste and smell are determinants of cancer anorexia, whose presence should be assessed in cancer patients. Interestingly, neuronal correlates of cancer anorexia-related symptoms have been revealed by brain imaging techniques. SUMMARY The pathophysiology of cancer anorexia is complex and involves different domains influencing eating behavior. Limiting the assessment of cancer anorexia to questions investigating changes in appetite may impede correct identification of the targets to address.
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Affiliation(s)
- Alessandro Laviano
- aDepartment of Clinical Medicine bDepartment of Clinical and Molecular Medicine, Sapienza University, Rome, Italy cCancer Metabolism Research Group, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo, Brazil
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Alterations in inflammatory biomarkers and energy intake in cancer cachexia: a prospective study in patients with inoperable pancreatic cancer. Med Oncol 2016; 33:54. [PMID: 27119533 DOI: 10.1007/s12032-016-0768-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 04/19/2016] [Indexed: 12/18/2022]
Abstract
Chronic systemic inflammatory response is proposed as an underlying mechanism for development of cancer cachexia. We conducted a prospective study to examine changes in inflammatory biomarkers during the disease course and the relationship between inflammatory biomarkers and cachexia in patients with inoperable pancreatic cancer. Twenty patients, median (range) age 67.5 (35-79) years, 5 females, were followed for median 5.5 (1-12) months. Cachexia was diagnosed according to the 2011 consensus-based classification system (weight loss >5 % past six months, BMI < 20 kg/m(2) and weight loss >2 %, or sarcopenia) and the modified Glasgow Prognostic score (mGPS) that combines CRP and albumin levels. Inflammatory biomarkers were measured by enzyme immunoassays. The patients had increased levels of most inflammatory biomarkers, albeit not all statistically significant, both at study entry and close to death, indicating ongoing inflammation. According to the consensus-based classification system, eleven (55 %) patients were classified as cachectic upon inclusion. They did not differ from non-cachectic patients with regard to inflammatory biomarkers or energy intake. According to the mGPS, seven (35 %) were defined as cachectic and had a higher IL-6 (p < 0.001) than the non-cachectic patients. They also had a slightly, but insignificantly longer survival than non-cachectic patients (p = 0.08). The mGPS should be considered as an additional framework for identification of cancer cachexia.
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Salihah N, Mazlan N, Lua PL. The effectiveness of inhaled ginger essential oil in improving dietary intake in breast-cancer patients experiencing chemotherapy-induced nausea and vomiting. ACTA ACUST UNITED AC 2016. [DOI: 10.1111/fct.12236] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Noor Salihah
- Community Health Research Cluster; Faculty of Health Sciences; Universiti Sultan Zainal Abidin (UniSZA); Kampus Gong Badak 21300 Kuala Nerus Terengganu Malaysia
| | - Nik Mazlan
- Kulliyyah of Allied Health Sciences; International Islamic University Malaysia (IIUM); Kuantan Campus 25710 Kuantan Pahang Malaysia
| | - Pei Lin Lua
- Community Health Research Cluster; Faculty of Health Sciences; Universiti Sultan Zainal Abidin (UniSZA); Kampus Gong Badak 21300 Kuala Nerus Terengganu Malaysia
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Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF) is a valid screening tool in chemotherapy outpatients. Support Care Cancer 2016; 24:3883-7. [DOI: 10.1007/s00520-016-3196-0] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 03/28/2016] [Indexed: 01/04/2023]
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Turcott JG, Juárez-Hernández E, De la Torre-Vallejo M, Sánchez-Lara K, Luvian-Morales J, Arrieta O. Value: Changes in the Detection and Recognition Thresholds of Three Basic Tastes in Lung Cancer Patients Receiving Cisplatin and Paclitaxel and Its Association with Nutritional and Quality of Life Parameters. Nutr Cancer 2016; 68:241-9. [PMID: 26943275 DOI: 10.1080/01635581.2016.1144075] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We evaluated the effects of cisplatin and paclitaxel on taste acuity and their associations with nutritional and health-related quality of life (HRQL) in patients with advanced non-small-cell lung cancer (NSCLC). Forty chemotherapy (CT)-naïve patients were assessed at baseline and after two cycles of paclitaxel and cisplatin. The taste evaluation was performed using a rinsing technique to identify detection and recognition thresholds (DT and RT) of bitter, sweet, and umami tastes. At baseline, 37.5% of the patients reported dysgeusia. After CT, the patients showed lower medians DT (p = 0.017) and RT (p = 0.028) for umami taste. These decreases were associated with clinical neuropathy, worse HRQL, and a tendency toward increased appetite loss. Additionally, CT did not significantly reduce the median DT for sweet (p = 0.09), which is associated with lower intake of protein (p = 0.015), animal protein (p = 0.010), fat (p = 0.004), and iron (p = 0.047). CT decreased the median DT for bitter (p = 0.035); however, this decrease was not associated with nutritional parameters or with HRQL. Sensitivity to taste increased with paclitaxel and cisplatin CT, making foods more unpleasant, and it was associated with neuropathy, worse HRQL, and reduced nutrient intake in advanced NSCLC patients. The protocol was registered at clinicaltrials.gov (NCT01540045).
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Affiliation(s)
- Jenny G Turcott
- a Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan) , Mexico City , Mexico
| | - Eva Juárez-Hernández
- a Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan) , Mexico City , Mexico
| | | | - Karla Sánchez-Lara
- a Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan) , Mexico City , Mexico
| | - Julissa Luvian-Morales
- a Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan) , Mexico City , Mexico
| | - Oscar Arrieta
- a Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan) , Mexico City , Mexico.,b Universidad Nacional Autónoma de México , Mexico City , Mexico
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Senesse P, Tadmouri A, Culine S, Dufour PR, Seys P, Radji A, Rotarski M, Balian A, Chambrier C. A prospective observational study assessing home parenteral nutrition in patients with gastrointestinal cancer: benefits for quality of life. J Pain Symptom Manage 2015; 49:183-191.e2. [PMID: 24945492 DOI: 10.1016/j.jpainsymman.2014.05.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 05/06/2014] [Accepted: 05/16/2014] [Indexed: 12/16/2022]
Abstract
CONTEXT Patients with gastrointestinal cancer are at high risk for deterioration of nutrition. Home parenteral nutrition (HPN) could improve nutritional status and quality of life (QoL). OBJECTIVES The purpose of this study was 1) to evaluate the impact of HPN on QoL, 2) to assess changes in nutritional status, and 3) to assess proxy perception of patient well-being. METHODS We conducted a prospective, observational, and a multicenter study. Inclusion criteria were adult patients with gastrointestinal cancer, for whom HPN was indicated and prescribed for at least 14 days. The physician, the patient, and a family member completed questionnaires at inclusion and 28 days later. The QoL was assessed by the patients using the Functional Assessment of Cancer Therapy-General questionnaire, at inclusion and 28 days later. RESULTS The study included 370 patients with gastrointestinal cancer. The HPN was indicated for cancer-related undernutrition in 89% of the patients and was used as a complement to oral intake in 84%. After 28 days of parenteral intake, global QoL was significantly increased (48.9 at inclusion vs. 50.3, P=0.007). The patients' weight improved significantly by 2.7% (P<0.001). The nutrition risk screening also decreased significantly (3.2±1.1 vs. 2.8±1.3, P=0.003). CONCLUSION HPN could provide benefit for malnourished patients with gastrointestinal cancer. However, randomized controlled studies are required to confirm this benefit and the safety profile.
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Affiliation(s)
- Pierre Senesse
- SIRIC Montpellier Cancer, Institut régional du Cancer de Montpellier (ICM), Montpellier, France; Laboratory Epsylon, EA 4556 Dynamics of Human Abilities & Health Behaviors, University of Montpellier, Montpellier, France; Department of Clinical Nutrition and Gastroenterology, ICM, Montpellier, France.
| | | | - Stéphane Culine
- Department of Oncology, Hospital Henri Mondor, Créteil, France
| | - Patrick R Dufour
- Centre de Lutte Contre Cancer, Centre Paul Strauss, Strasbourg, France
| | - Patrick Seys
- Department of Oncology, Polyclinique de Blois, Blois, France
| | | | - Maciej Rotarski
- Department of Oncology, Radiation Oncology Centre, Bayonne, France
| | - Axel Balian
- Department of Hepatogastroenterology, Hospital Antoine Béclère, Clarmart, France
| | - Cecile Chambrier
- Clinical Nutrition Intensive Care Unit, Hospices Civils de Lyon, Lyon, France
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28
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Shaw C, Eldridge L. Nutritional considerations for the palliative care patient. Int J Palliat Nurs 2015; 21:7-8, 10, 12-5. [DOI: 10.12968/ijpn.2015.21.1.7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Lucy Eldridge
- Dietetic Team Leader, The Royal Marsden NHS Foundation Trust, London
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Jiang N, Zhao JZ, Chen XC, Li LY, Zhang LJ, Zhao Y. Clinical determinants of weight loss in patients with esophageal carcinoma during radiotherapy: a prospective longitudinal view. Asian Pac J Cancer Prev 2014; 15:1943-8. [PMID: 24716916 DOI: 10.7314/apjcp.2014.15.5.1943] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE The prevalence of weight loss in esophageal carcinoma patients is high and associated with impairment of physical function, increased psychological distress and low quality of life. It is not known which factors may contribute to weight loss in patients with esophageal carcinoma during radiotherapy in China. The objective of this study was to identify the associated demographic and clinical factors influencing weight loss. METHODS We evaluated 159 esophageal carcinoma patients between August 2010 and August 2013 in a cross- sectional, descriptive study. Patient characteristics, tumor and treatment details, psychological status, adverse effects, and dietary intake were evaluated at baseline and during radiotherapy. A multivariate logistic regression analyss was performed to identify the potential factors leading to weight loss. RESULTS 64 (40.3%) patients had weight loss ≥ 5% during radiotherapy. According to logistic regression analysis, depression, esophagitis, and loss of appetite were adverse factors linked to weight loss. Dietary counseling, early stage disease and total energy intake ≥ 1,441.3 (kcal/d) were protective factors. CONCLUSIONS It was found that dietary counseling, TNM stage, total energy intake, depression, esophagitis, and loss of appetite were the most important factors for weight loss. The results underline the importance of maintaining energy intake and providing dietary advice in EC patients during RT. At the same time, by identifying associated factors, medical staff can provide appropriate medical care to reduce weight loss. Further studies should determine the effect of these factors on weight loss and propose a predictive model.
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Affiliation(s)
- Nan Jiang
- School of Nursing, Tianjin Medical University, China E-mail :
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30
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Belqaid K, Orrevall Y, McGreevy J, Månsson-Brahme E, Wismer W, Tishelman C, Bernhardson BM. Self-reported taste and smell alterations in patients under investigation for lung cancer. Acta Oncol 2014; 53:1405-12. [PMID: 24702121 PMCID: PMC4220986 DOI: 10.3109/0284186x.2014.895035] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This study of patients under investigation for lung cancer (LC) aims to: 1) examine the prevalence of self-reported taste and smell alterations (TSAs) and their relationships with demographic and clinical characteristics; and 2) explore nutritional importance of TSAs by examining their associations with patient-reported weight loss, symptoms interfering with food intake, and changes in food intake. Methods Patients were recruited consecutively during investigation for LC from one university hospital in Sweden. Patient-reported information on TSAs, demographics, six-month weight history, symptoms interfering with food intake, and changes in food intake was obtained. Relationships between TSAs and other variables were examined using two-tailed significance tests. In addition, putative explanatory factors for weight loss were explored in those patients diagnosed with LC, since a relationship between TSAs and weight loss was found in this group. Results The final sample consisted of 215 patients, of which 117 were diagnosed with primary LC within four months of study inclusion and 98 did not receive a cancer diagnosis. The 38% prevalence of TSAs was identical in both groups, and were generally reported as mild and not interfering with food intake. However, a statistically significant relationship between TSAs and weight loss was found among patients with LC, with a median weight change of − 5.5% and a higher frequency of weight loss ≥ 10%. Patients with LC and weight loss ≥ 10%, had higher frequency of reporting TSAs, of decreased food intake and of ≥ 1 symptom interfering with food intake compared with those with less weight loss. Conclusion TSAs, although relatively mild, were present in 38% of patients with and without LC. Relationships between TSAs and weight loss were found among patients with LC, but not fully explained by decreased food intake. This highlights the complexity of cancer-related weight loss.
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Affiliation(s)
- Kerstin Belqaid
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet , Stockholm , Sweden
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31
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Shaw C, Fleuret C, Pickard JM, Mohammed K, Black G, Wedlake L. Comparison of a novel, simple nutrition screening tool for adult oncology inpatients and the Malnutrition Screening Tool (MST) against the Patient-Generated Subjective Global Assessment (PG-SGA). Support Care Cancer 2014; 23:47-54. [PMID: 24947056 DOI: 10.1007/s00520-014-2319-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 06/08/2014] [Indexed: 01/04/2023]
Abstract
BACKGROUND Oncology inpatients are at high risk of malnutrition. Identification of at risk patients by nutrition screening requires a practical and easy to use tool. In this study, we have compared a simple, novel nutrition screening tool designed for an oncology inpatient setting and the Malnutrition Screening Tool (MST) against the Patient-Generated Subjective Global Assessment (PG-SGA). METHODS This was an observational study to compare assessment of nutritional status by PG-SGA with nutrition screening using the Royal Marsden Nutrition Screening Tool (RMNST) and the MST. Patients were recruited from a single tertiary cancer centre. RESULTS One hundred and twenty-six oncology inpatients underwent a full nutritional assessment and nutrition screening. The PG-SGA tool identified 90 (71%) patients as malnourished or at risk and 36 (29%) patients as well-nourished. The RMNST had a sensitivity of 93% and a specificity of 53%, and the MST had a sensitivity of 66% and a specificity of 83 %. Predictive value (ROC AUC) of both screening tools was excellent at 0.84 and 0.83 for RMNST and MST, respectively. CONCLUSIONS This study identified a high prevalence of malnutrition in the population with 71% of patients being identified as malnourished or at risk of malnutrition. The RMNST had an excellent sensitivity for identifying patients who were malnourished or at risk of malnutrition in the inpatient setting although it had a poor specificity. The MST had a poorer sensitivity of 66 %. We would recommend that the RMNST is trialled in other oncology inpatient settings and also in the outpatient setting.
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Affiliation(s)
- Clare Shaw
- Department of Nutrition and Dietetics, The Royal Marsden NHS Foundation Trust, London, Sutton, UK,
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Intensive nutritional counseling improves PG-SGA scores and nutritional symptoms during and after radiotherapy in Korean cancer patients. Support Care Cancer 2014; 22:2997-3005. [DOI: 10.1007/s00520-014-2304-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 05/26/2014] [Indexed: 12/30/2022]
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Vigano AL, di Tomasso J, Kilgour RD, Trutschnigg B, Lucar E, Morais JA, Borod M. The abridged patient-generated subjective global assessment is a useful tool for early detection and characterization of cancer cachexia. J Acad Nutr Diet 2014; 114:1088-1098. [PMID: 24462323 DOI: 10.1016/j.jand.2013.09.027] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2012] [Accepted: 09/24/2013] [Indexed: 12/18/2022]
Abstract
Cancer cachexia (CC) is a syndrome characterized by wasting of lean body mass and fat, often driven by decreased food intake, hypermetabolism, and inflammation resulting in decreased lifespan and quality of life. Classification of cancer cachexia has improved, but few clinically relevant diagnostic tools exist for its early identification and characterization. The abridged Patient-Generated Subjective Global Assessment (aPG-SGA) is a modification of the original Patient-Generated Subjective Global Assessment, and consists of a four-part questionnaire that scores patients' weight history, food intake, appetite, and performance status. The purpose of this study was to determine whether the aPG-SGA is associated with both features and clinical sequelae of cancer cachexia. In this prospective cohort study, 207 advanced lung and gastrointestinal cancer patients completed the following tests: aPG-SGA, Edmonton Symptom Assessment System, handgrip strength, a complete blood count, albumin, apolipoprotein A and B, and C-reactive protein. Ninety-four participants with good performance status as assessed by the Eastern Cooperative Oncology Group Performance Status completed additional questionnaires and underwent body composition testing. Of these, 68 patients tested for quadriceps strength and completed a 3-day food recall. Multivariable regression models revealed that higher aPG-SGA scores (≥9 vs 0 to 1) are significantly associated (P<0.05) with the following: unfavorable biological markers of cancer cachexia, such as higher white blood cell counts (10.0 vs 6.7×10(9)/L; lower hemoglobin (115.6 vs 127.7 g/L), elevated C-reactive protein (42.7 vs 18.2 mg/L [406.7 vs 173.3 nmol/L]); decreased anthropometric and physical measures, such as body mass index (22.5 vs 27.1); fat mass (14.4 vs 26.0 kg), handgrip (24.7 vs 34.9 kg) and leg strength; an average 12% greater length of hospital stay; a dose reduction in chemotherapy; and increased mortality. Given its association with the main features of cancer cachexia and its ease of use, the aPG-SGA appears to be a useful tool for detecting and predicting outcomes of cancer cachexia. Additional research is required to determine what impact the aPG-SGA has on quality of care when used in the clinical setting.
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Yao ZH, Tian GY, Wan YY, Kang YM, Guo HS, Liu QH, Lin DJ. Prognostic nutritional index predicts outcomes of malignant pleural mesothelioma. J Cancer Res Clin Oncol 2013; 139:2117-23. [PMID: 24149776 DOI: 10.1007/s00432-013-1523-0] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Accepted: 09/06/2013] [Indexed: 12/23/2022]
Abstract
PURPOSE Nutritional status has been associated with long-time outcomes in cancer patients. We investigated whether the prognostic nutritional index (PNI), an indicator of nutritional status, affects overall survival in patients with malignant pleural mesothelioma (MPM). METHODS We enrolled 121 patients with histologically confirmed MPM, who had successfully undergone biopsy by medical thoracoscopy in this study. Demographic, clinical and laboratory data were collected retrospectively. The PNI was calculated as 10× serum albumin value (g/dl) + 0.005 × total lymphocyte count (per mm(3)) in peripheral blood. Univariate and multivariate analyses were used to identify prognostic factors. RESULTS Mean pretreatment PNI was 44.6. PNI was significantly associated with age (P = 0.031), smoking habits (P = 0.039) and weight loss (P = 0.029). Survival analysis showed PNI to be an independent prognostic factor in MPM. Patients with lower PNIs (PNI < 44.6) had greater risk of death than those with higher PNIs (PNI ≥ 44.6; hazard ratio: 2.290; 95 % confidence interval: 1.415-3.706; P = 0.001). These analyses were adjusted for patient age, gender, smoking habits, dyspnea, chest pain, weight loss, primary site of tumor, histology, platinum-based systemic chemotherapy, hospital and stage. CONCLUSIONS Pretreatment PNI is a novel independent prognostic factor in MPM.
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Affiliation(s)
- Zhou-Hong Yao
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, No. 324 Jingwuweiqi Road, Jinan, 250021, Shandong Province, People's Republic of China
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Saira Chowdhury, Orla Hynes. Nutrition in Upper Gastrointestinal Cancer. Nutr Cancer 2013. [DOI: 10.1002/9781118788707.ch12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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36
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Vickery C. Lung Cancer. Nutr Cancer 2013. [DOI: 10.1002/9781118788707.ch19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Shaw C. Nutrition and Palliative Care. Nutr Cancer 2013. [DOI: 10.1002/9781118788707.ch10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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38
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Shaw C, Power J. Nutritional Support for the Cancer Patient. Nutr Cancer 2013. [DOI: 10.1002/9781118788707.ch8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Denis F, Viger L, Charron A, Voog E, Letellier C. Detecting lung cancer relapse using self-evaluation forms weekly filled at home: the sentinel follow-up. Support Care Cancer 2013; 22:79-85. [PMID: 23995815 DOI: 10.1007/s00520-013-1954-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 08/21/2013] [Indexed: 01/12/2023]
Abstract
PURPOSE We aimed to assess if patients' ratings of symptoms can be used to provide an early indication of disease recurrence or progression in lung cancer. We proposed a simple self-evaluation form made of six clinical parameters weekly scored by patients at home as a follow-up--here named sentinel--to improve relapse detection. Its performances were compared to those of a routine imaging follow-up. METHODS Patients with lung cancer were prospectively recruited to weekly fill a form at home for self-assessing weight, fatigue, pain, appetite, cough, and breathlessness during at least 4 months. Each patient reported weight and assessed the severity of each symptom by grading it from 0 (no symptom) to 3 (major symptom). A score was retrospectively designed for discriminating patients with relapse from those without. Accuracy of relapse detection was then compared to values of the routine planned imaging. RESULTS Forty-three patients were included in our center and recruited for 16 weeks or more follow-up during which at least one tumor imaging assessment was performed (CT scan or PET-CT). Forty-one completed the form weekly. Sensitivity, specificity, and positive and negative predictive values of sentinel were high (86, 93, 86 % and 93 vs 79, 96, 92, and 90 % for routine imaging--p = ns) and well correlated with relapse (pχ2 > 0.001). Moreover, relapses were detectable with sentinel on average 6 weeks earlier than the planned imaging. CONCLUSION This study suggests that a personalized cancer follow-up based on a weekly self-evaluation of six symptoms is feasible and may be accurate for earlier detection of lung cancer relapse, allowing integration in electronic devices for real-time patient outcome follow-up.
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Affiliation(s)
- Fabrice Denis
- Jean Bernard Center/Victor Hugo Clinic, 9 rue Beauverger, Le Mans, France,
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Lang CH, Pruznak A, Navaratnarajah M, Rankine KA, Deiter G, Magne H, Offord EA, Breuillé D. Chronic α-hydroxyisocaproic acid treatment improves muscle recovery after immobilization-induced atrophy. Am J Physiol Endocrinol Metab 2013; 305:E416-28. [PMID: 23757407 DOI: 10.1152/ajpendo.00618.2012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Muscle disuse atrophy is observed routinely in patients recovering from traumatic injury and can be either generalized resulting from extended bed rest or localized resulting from single-limb immobilization. The present study addressed the hypothesis that a diet containing 5% α-hydroxyisocaproic acid (α-HICA), a leucine (Leu) metabolite, will slow the loss and/or improve recovery of muscle mass in response to disuse. Adult 14-wk-old male Wistar rats were provided a control diet or an isonitrogenous isocaloric diet containing either 5% α-HICA or Leu. Disuse atrophy was produced by unilateral hindlimb immobilization ("casting") for 7 days and the contralateral muscle used as control. Rats were also casted for 7 days and permitted to recover for 7 or 14 days. Casting decreased gastrocnemius mass, which was associated with both a reduction in protein synthesis and S6K1 phosphorylation as well as enhanced proteasome activity and increased atrogin-1 and MuRF1 mRNA. Although neither α-HICA nor Leu prevented the casting-induced muscle atrophy, the decreased muscle protein synthesis was not observed in α-HICA-treated rats. Neither α-HICA nor Leu altered the increased proteasome activity and atrogene expression observed with immobilization. After 14 days of recovery, muscle mass had returned to control values only in the rats fed α-HICA, and this was associated with a sustained increase in protein synthesis and phosphorylation of S6K1 and 4E-BP1 of previously immobilized muscle. Proteasome activity and atrogene mRNA content were at control levels after 14 days and not affected by either treatment. These data suggest that whereas α-HICA does not slow the loss of muscle produced by disuse, it does speed recovery at least in part by maintaining an increased rate of protein synthesis.
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Affiliation(s)
- Charles H Lang
- Department of Cellular and Molecular Physiology, Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033, USA.
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Antoun S, Besse B, Planchard D, Raynard B. [Managing nutritional support in thoracic oncology]. Rev Mal Respir 2013; 30:490-7. [PMID: 23835321 DOI: 10.1016/j.rmr.2013.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 01/27/2013] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Cancer treatments are based on specific anticancer chemotherapy. However, there is increasing interest in general aspects of care, which are increasingly evidence based. STATE OF THE ART The importance of muscle mass is becoming increasingly evident. Its role is not only limited to the maintenance of physical performance and quality of life. In oncology, recent studies have shown a close link between sarcopenia (low muscle mass) and mortality as well as between sarcopenia and chemotherapy toxicity. To treat malnutrition and the lack of energy intake, nutritional support is considered, whether through the prescription of oral nutritional supplements, enteral nutrition or even parenteral nutrition. Scientific arguments are often absent and few studies have been carried out in patients with lung cancer. PERSPECTIVES There are many experimental arguments and a few clinical trials that support using omega 3 fatty acids to modulate inflammatory reaction and to reduce its consequences on muscular proteolysis. The benefit of regular physical activity has already been proven in chronic respiratory disease and its use in association with nutritional support must be recommended in oncologic care. CONCLUSION Given the increasing recognition of the role of muscle mass in cancer, the purpose of any nutritional support must be focused on increasing muscle anabolism and decreasing proteolysis.
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Affiliation(s)
- S Antoun
- Service des urgences, CLAN institut Gustave-Roussy, 39, rue Camille-Desmoulins, 94805 Villejuif cedex, France.
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Providing nutritional support to patients with thoracic cancer: Findings of a dedicated rehabilitation service. Respir Med 2013; 107:753-61. [DOI: 10.1016/j.rmed.2013.01.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 01/17/2013] [Accepted: 01/21/2013] [Indexed: 11/23/2022]
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Bovio G, Fonte ML, Baiardi P. Prevalence of upper gastrointestinal symptoms and their influence on nutritional state and performance status in patients with different primary tumors receiving palliative care. Am J Hosp Palliat Care 2013; 31:20-6. [PMID: 23354771 DOI: 10.1177/1049909112474713] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to investigate the relationship between gastrointestinal symptoms, nutritional balance, and performance status in patients receiving palliative care for advanced cancers originating in different sites. We studied a total of 105 patients. Upper gastrointestinal symptoms, Eastern Cooperative Oncology Group Performance Status score (ECOG-PS), dietary intakes, anthropometric measures, and some serum proteins were determined. Unintentional weight loss, alterations in anthropometric measures, and highest number of symptoms were greater in patients with lung and stomach cancer. No differences were found in ECOG-PS according to cancer site. Patients with gastric or lung cancer have most evidence of protein-calorie malnutrition and a higher prevalence of upper gastrointestinal symptoms. The performance status is not affected by tumor site. Early nutritional support should be planned for all patients with cancer, especially for patients with gastric or lung cancer.
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Affiliation(s)
- Giacomo Bovio
- 1Metabolic-Nutritional Unit and Palliative Care Unit, Salvatore Maugeri Foundation, IRCCS, Rehabilitation Institute of Pavia, Pavia, Italy
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Börjeson S, Starkhammar H, Unosson M, Berterö C. Common Symptoms and Distress Experienced Among Patients with Colorectal Cancer: A Qualitative part of Mixed Method Design. Open Nurs J 2012; 6:100-7. [PMID: 22977653 PMCID: PMC3439831 DOI: 10.2174/1874434601206010100] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 06/14/2012] [Accepted: 06/15/2012] [Indexed: 11/25/2022] Open
Abstract
Background :
Colorectal cancer is one of the most common types of tumour in the world. Treatment side effects, together with the tumour symptoms, can result in a ‘symptom burden’. To understand the patient’s burden during chemotherapy treatment and plan effective symptom relief there is a need for more knowledge about the experience of symptoms from the patients’ perspective. Objectives :
The study was designed to qualitatively identify and describe the most common symptoms among patients treated for colorectal cancer, and discover whether there are barriers to reporting symptoms. Methods :
Thirteen Swedish patients diagnosed with colorectal cancer and treated with chemotherapy were interviewed face-to-face. The interviews were audio-taped and transcribed verbatim. The transcripts were analysed by following the principles of qualitative content analysis. Results :
Nine symptoms/forms of distress were identified. Those most frequently expressed were fatigue, changed bowel habits, and affected mental well-being, closely followed by nausea, loss of appetite and neurological problems. Of particular note were the affected mental well-being, the magnitude of the neurological problems described, the symptoms related to skin and mucous membrane problems, and the reports of distressing pain. Barriers to symptom control were only expressed by the patients in passing and very vaguely. Conclusion :
This study confirms other reports on most common symptoms in colorectal cancer. It also highlights the early onset of symptoms and provides data on less well-studied issues that warrant further study, namely affected mental well-being, the magnitude of the neurological problems and symptoms related to the skin and mucous membranes. Nurses need to be sensitive to the patients’ need presented and not only noting symptoms/distresses they have guidelines for.
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Affiliation(s)
- Sussanne Börjeson
- Department of Medical and Health Sciences, Linköping University, Sweden
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Richards CH, Roxburgh CSD, MacMillan MT, Isswiasi S, Robertson EG, Guthrie GK, Horgan PG, McMillan DC. The relationships between body composition and the systemic inflammatory response in patients with primary operable colorectal cancer. PLoS One 2012; 7:e41883. [PMID: 22870258 PMCID: PMC3411715 DOI: 10.1371/journal.pone.0041883] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 06/29/2012] [Indexed: 12/12/2022] Open
Abstract
Background Weight loss is recognised as a marker of poor prognosis in patients with cancer but the aetiology of cancer cachexia remains unclear. The aim of the present study was to examine the relationships between CT measured parameters of body composition and the systemic inflammatory response in patients with primary operable colorectal cancer. Patient and Methods 174 patients with primary operable colorectal cancer who underwent resection with curative intent (2003–2010). Image analysis of CT scans was used to measure total fat index (cm2/m2), subcutaneous fat index (cm2/m2), visceral fat index (cm2/m2) and skeletal muscle index (cm2/m2). Systemic inflammatory response was measured by serum white cell count (WCC), neutrophil:lymphocyte ratio (NLR) and the Glasgow Prognostic Score (mGPS). Results There were no relationships between any parameter of body composition and serum WCC or NLR. There was a significant relationship between low skeletal muscle index and an elevated systemic inflammatory response, as measured by the mGPS (p = 0.001). This was confirmed by linear relationships between skeletal muscle index and both C-reactive protein (r = −0.21, p = 0.005) and albumin (r = 0.31, p<0.001). There was no association between skeletal muscle index and tumour stage. Conclusions The present study highlights a direct relationship between low levels of skeletal muscle and the presence of a systemic inflammatory response in patients with primary operable colorectal cancer.
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Affiliation(s)
- Colin H Richards
- University Department of Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom.
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Khan L, Cramarossa G, Lemke M, Nguyen J, Zhang L, Chen E, Chow E. Symptom clusters using the Spitzer quality of life index in patients with brain metastases—a reanalysis comparing different statistical methods. Support Care Cancer 2012; 21:467-73. [DOI: 10.1007/s00520-012-1540-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 07/05/2012] [Indexed: 11/28/2022]
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Symptoms in advanced pancreatic cancer are of importance for energy intake. Support Care Cancer 2012; 21:219-27. [DOI: 10.1007/s00520-012-1514-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 05/21/2012] [Indexed: 01/27/2023]
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Tarnaud C, Guida F, Papadopoulos A, Cénée S, Cyr D, Schmaus A, Radoï L, Paget-Bailly S, Menvielle G, Buemi A, Woronoff AS, Luce D, Stücker I. Body mass index and lung cancer risk: results from the ICARE study, a large, population-based case-control study. Cancer Causes Control 2012; 23:1113-26. [PMID: 22610667 DOI: 10.1007/s10552-012-9980-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Accepted: 04/23/2012] [Indexed: 12/26/2022]
Abstract
BACKGROUND The association between body mass index (BMI) and lung cancer is still disputed because of possible residual confounding by smoking and preclinical weight loss in case-control studies. We examined this association using data from the multicenter ICARE study in France, a large, population-based case-control study. METHODS A total of 2,625 incident lung cancer cases and 3,381 controls were included. Weight was collected at interview, 2 years before the interview, and at age 30. Lifetime smoking exposure was calculated using the comprehensive smoking index (CSI). Adjusted odds ratios (aORs) and 95 % confidence intervals were estimated by unconditional logistic regression and controlled for age, area, education, CSI, occupational exposure, previous chronic bronchitis, and parental history of lung cancer. We also examined the role of weight change. Analyses were stratified by smoking status and sex. RESULTS When compared with that of men with normal BMI 2 years before the interview, lung cancer aORs (95 % CI) among men with BMIs of <18.5, 25-29.9, 30-32.4, and ≥32.5 kg/m(2) were 2.7 (95 % CI 1.2-6.2), 0.9 (95 % CI 0.7-1.1), 0.8 (95 % CI 0.6-1.1), and 0.8 (95 % CI 0.6-1.0), respectively (p(trend) = 0.02). Results were more pronounced among current smokers and were similar in men and women. Weight gain over time was associated with a significant decreased risk of lung cancer. CONCLUSIONS We found an inverse dose-dependent association between lung cancer risk and BMI 2 years prior to interview in current smokers. IMPACT STATEMENT: BMI might be an individual factor impacting the risk of lung cancer related to smoking's carcinogen-induced DNA damage.
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Affiliation(s)
- Chloé Tarnaud
- Inserm, CESP Centre for Research in Epidemiology and Population Health, Environmental Epidemiology of Cancer Team, UMRS, Villejuif, France
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Validation of the Head and Neck Patient Symptom Checklist as a nutrition impact symptom assessment tool for head and neck cancer patients. Support Care Cancer 2012; 21:27-34. [PMID: 22588710 DOI: 10.1007/s00520-012-1483-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Accepted: 04/22/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE The purpose of this study was to test the validity of the Head and Neck Patient Symptom Checklist (HNSC). METHODS Three hundred and sixty-eight treatment-naive individuals with head and neck cancer prospectively completed the HNSC and the Patient-Generated Symptom Global Assessment (PG-SGA). The predictive validity was determined by comparing the HNSC symptoms interference scores to the PG-SGA scores. Multivariate logistic regression was used to determine the HNSC symptoms scores associated with reduced dietary intake, ≥ 5 % weight loss over 6 months, and reduced functional performance (FP). RESULTS HNSC sensitivity (79-98 %), specificity (99-100 %), positive predictive value (92-100 %), and negative predictive value (94-100 %) were excellent, and the Cronbach's alpha coefficient was 0.92. The multivariate logistic regression showed that advanced tumor stage, pain, loss of appetite (LOA), and difficulty swallowing significantly predicted dietary intake. Advanced tumor stage, LOA, and difficulty swallowing were also significant predictors of ≥ 5 % weight loss over 6 months. LOA, difficulty swallowing, feeling full, and lack of energy were significant predictors of reduced FP. CONCLUSIONS The HNSC appears to be a valid tool for determining symptoms interfering with dietary intake of head and neck cancer (HNC) patients. This instrument may aid in early identification of symptoms that place HNC patients at risk for reductions in dietary intake, weight, and functional performance.
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Sánchez-Lara K, Turcott JG, Juárez E, Guevara P, Núñez-Valencia C, Oñate-Ocaña LF, Flores D, Arrieta O. Association of Nutrition Parameters Including Bioelectrical Impedance and Systemic Inflammatory Response With Quality of Life and Prognosis in Patients With Advanced Non-Small-Cell Lung Cancer: A Prospective Study. Nutr Cancer 2012; 64:526-34. [DOI: 10.1080/01635581.2012.668744] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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