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Mathies V, Kipp AP, Hammersen J, Schrenk KG, Scholl S, Schnetzke U, Hochhaus A, Ernst T. Standardizing Nutritional Care for Cancer Patients: Implementation and Evaluation of a Malnutrition Risk Screening. Oncol Res Treat 2024:1-10. [PMID: 39510054 DOI: 10.1159/000542460] [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: 01/25/2024] [Accepted: 10/29/2024] [Indexed: 11/15/2024]
Abstract
INTRODUCTION Cancer-related malnutrition is a highly prevalent, yet often overlooked concern in clinical practice. Although cancer-related management guidelines recommend standardized nutritional care, its implementation is scarce. The aim of this study was to investigate the prevalence of malnutrition and the medical need for nutrition counseling in cancer patients employing a novel standardized nutritional management program (containing malnutrition risk screening, nutritional assessment, and counseling). Furthermore, differences of malnutrition parameters in different cancer patient cohorts were examined. METHODS Cancer patients were screened for malnutrition using the Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF) on the first day of their inpatient admission to the internal oncology or hematology wards. PG-SGA total score and classification into the three PG-SGA nutrition stages (A, B, C) were used to determine nutritional status. In case of a positive screening, nutritional assessment and individualized counseling by a nutritionist followed. For group comparisons, patients were divided into different groups (e.g., age, gender, tumor entity) and were evaluated accordingly. RESULTS A total of 1,100 inpatients were included. 56.8% of the patients had suspected or already existing malnutrition. The most common nutrition impact symptom was loss of appetite (26.7%), followed by fatigue (16.5%) and pain (16.0%). Female (p < 0.001), elderly (p < 0.001), and patients with upper gastrointestinal tract tumors (p < 0.001) showed an unfavorable nutritional status and higher need for counseling. Despite suffering from malnutrition, patients had body mass indices within the upper end of the normal range. CONCLUSION This study shows a high prevalence of malnutrition in hospitalized cancer patients and highlights the need for a standardized nutritional management in the clinical setting. Therefore, it is recommended to provide a malnutrition risk screening for all cancer patients and a following adequate assessment and personalized nutritional care if needed.
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Affiliation(s)
- Viktoria Mathies
- Department of Hematology and Internal Oncology, Jena University Hospital, Jena, Germany
- Comprehensive Cancer Center Central Germany, Campus Jena, Jena, Germany
| | - Anna P Kipp
- Department of Nutritional Physiology, Institute of Nutritional Sciences, Friedrich Schiller University Jena, Jena, Germany
| | - Jakob Hammersen
- Department of Hematology and Internal Oncology, Jena University Hospital, Jena, Germany
- Comprehensive Cancer Center Central Germany, Campus Jena, Jena, Germany
| | - Karin G Schrenk
- Department of Hematology and Internal Oncology, Jena University Hospital, Jena, Germany
- Comprehensive Cancer Center Central Germany, Campus Jena, Jena, Germany
| | - Sebastian Scholl
- Department of Hematology and Internal Oncology, Jena University Hospital, Jena, Germany
- Comprehensive Cancer Center Central Germany, Campus Jena, Jena, Germany
| | - Ulf Schnetzke
- Department of Hematology and Internal Oncology, Jena University Hospital, Jena, Germany
- Comprehensive Cancer Center Central Germany, Campus Jena, Jena, Germany
| | - Andreas Hochhaus
- Department of Hematology and Internal Oncology, Jena University Hospital, Jena, Germany
- Comprehensive Cancer Center Central Germany, Campus Jena, Jena, Germany
| | - Thomas Ernst
- Department of Hematology and Internal Oncology, Jena University Hospital, Jena, Germany
- Comprehensive Cancer Center Central Germany, Campus Jena, Jena, Germany
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Porciello G, Coluccia S, Vitale S, Palumbo E, Luongo A, Grimaldi M, Pica R, Prete M, Calabrese I, Cubisino S, Montagnese C, Falzone L, Martinuzzo V, Poletto L, Rotondo E, Di Gennaro P, De Laurentiis M, D’Aiuto M, Rinaldo M, Thomas G, Messina F, Catalano F, Ferraù F, Montesarchio V, Serraino D, Crispo A, Libra M, Celentano E, Augustin LSA. Baseline Association between Healthy Eating Index-2015 and Health-Related Quality of Life in Breast Cancer Patients Enrolled in a Randomized Trial. Cancers (Basel) 2024; 16:2576. [PMID: 39061215 PMCID: PMC11274909 DOI: 10.3390/cancers16142576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
Health-related quality of life (HRQoL) represents one of the most concerning aspects for cancer patients. The Healthy Eating Index (HEI) is an a priori diet quality index directly associated with health outcomes and HRQoL in cancer survivors in North American populations. We evaluated, in a Mediterranean population, the baseline associations between HEI-2015 and HRQoL in 492 women with breast cancer recruited in a DEDiCa lifestyle trial. Dietary data were obtained from 7-day food records; HRQoL was assessed through the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ C30) and the C30 Summary Score (SumSc). Analysis of variance and multivariable linear and log-gamma regression models were performed. Mean and standard deviation for HEI-2015 score was 68.8 ± 11.2; SumSc was 81.5 ± 12.9. Women with lower HEI-2015 score had higher BMI, were more frequently exposed to tobacco smoke and had fewer years of education. Patients with a HEI-2015 score greater than 68.7 (median value) showed a significant increase in SumSc of 4% (p = 0.02). HEI-2015 components also associated with SumSc were beans and greens (β = 1.04; p = 0.02). Weak associations were found for total vegetables and saturated fats. Higher diet quality in breast cancer survivors was associated with higher overall HRQoL in this cross-sectional analysis.
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Affiliation(s)
- Giuseppe Porciello
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (S.C.); (E.P.); (A.L.); (M.G.); (R.P.); (M.P.); (E.R.); (E.C.); (L.S.A.A.)
| | - Sergio Coluccia
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (S.C.); (E.P.); (A.L.); (M.G.); (R.P.); (M.P.); (E.R.); (E.C.); (L.S.A.A.)
| | - Sara Vitale
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (S.C.); (E.P.); (A.L.); (M.G.); (R.P.); (M.P.); (E.R.); (E.C.); (L.S.A.A.)
| | - Elvira Palumbo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (S.C.); (E.P.); (A.L.); (M.G.); (R.P.); (M.P.); (E.R.); (E.C.); (L.S.A.A.)
| | - Assunta Luongo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (S.C.); (E.P.); (A.L.); (M.G.); (R.P.); (M.P.); (E.R.); (E.C.); (L.S.A.A.)
| | - Maria Grimaldi
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (S.C.); (E.P.); (A.L.); (M.G.); (R.P.); (M.P.); (E.R.); (E.C.); (L.S.A.A.)
| | - Rosa Pica
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (S.C.); (E.P.); (A.L.); (M.G.); (R.P.); (M.P.); (E.R.); (E.C.); (L.S.A.A.)
| | - Melania Prete
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (S.C.); (E.P.); (A.L.); (M.G.); (R.P.); (M.P.); (E.R.); (E.C.); (L.S.A.A.)
| | - Ilaria Calabrese
- Healthcare Direction, “A. Cardarelli” Hospital, 80131 Naples, Italy;
| | - Serena Cubisino
- Humanitas Istituto Clinico Catanese, 95045 Misterbianco, Italy;
| | | | - Luca Falzone
- Department of Biomedical and Biotechnological Sciences, Oncologic, Clinical and General Pathology Section, University of Catania, 95124 Catania, Italy;
| | - Valentina Martinuzzo
- Cancer Epidemiology Unit, National Cancer Institute, CRO, IRCCS, 33081 Aviano, Italy; (V.M.); (L.P.); (D.S.)
| | - Luigina Poletto
- Cancer Epidemiology Unit, National Cancer Institute, CRO, IRCCS, 33081 Aviano, Italy; (V.M.); (L.P.); (D.S.)
| | - Emanuela Rotondo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (S.C.); (E.P.); (A.L.); (M.G.); (R.P.); (M.P.); (E.R.); (E.C.); (L.S.A.A.)
| | - Piergiacomo Di Gennaro
- Medical Statistics Unit, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Michelino De Laurentiis
- Department of Breast and Thoracic Oncology, Division of Breast Medical Oncology, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy;
| | | | | | | | | | | | | | - Vincenzo Montesarchio
- UOC Oncologia, AORN dei Colli (Monaldi-Cotugno-CTO), 80131 Naples, Italy; (V.M.); (M.L.)
| | - Diego Serraino
- Cancer Epidemiology Unit, National Cancer Institute, CRO, IRCCS, 33081 Aviano, Italy; (V.M.); (L.P.); (D.S.)
| | - Anna Crispo
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (S.C.); (E.P.); (A.L.); (M.G.); (R.P.); (M.P.); (E.R.); (E.C.); (L.S.A.A.)
| | - Massimo Libra
- UOC Oncologia, AORN dei Colli (Monaldi-Cotugno-CTO), 80131 Naples, Italy; (V.M.); (M.L.)
| | - Egidio Celentano
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (S.C.); (E.P.); (A.L.); (M.G.); (R.P.); (M.P.); (E.R.); (E.C.); (L.S.A.A.)
| | - Livia S. A. Augustin
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (S.C.); (E.P.); (A.L.); (M.G.); (R.P.); (M.P.); (E.R.); (E.C.); (L.S.A.A.)
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Medina Cruz E, Palenzuela Luis N, Rodríguez Novo N, González Suarez M, Casas Hernández R, Novo Muñoz MM. Instruments for Evaluating the Nutritional Status of Cancer Patients Undergoing Antineoplastic Treatment: A Scoping Review. NURSING REPORTS 2024; 14:1312-1323. [PMID: 38921709 PMCID: PMC11206374 DOI: 10.3390/nursrep14020099] [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: 03/24/2024] [Revised: 05/17/2024] [Accepted: 05/21/2024] [Indexed: 06/27/2024] Open
Abstract
The use of validated tools to evaluate the nutritional status of the cancer patient provides guaranteed precision and reliability in their nutritional evaluation, ensuring that the information is accurate and reflects the patient's situation. The aim of this study was to identify the valid and reliable instruments in the evaluation of the nutritional status of cancer patients with a diagnosis of solid tumor undergoing antineoplastic treatment (chemotherapy and/or immunotherapy). A scoping review was conducted to search for original articles published in scientific journals in English, Spanish, or Portuguese in the past five years. In order to identify potentially relevant documents, searches were performed in the following databases: SCOPUS, WOS, CINAHL, MEDLINE, BVS, and PUBMED. DECS-MeSH descriptors and Boolean operators were used. In addition, the Arksey and O'Malley protocol, the Joanne Briggs Institute (JBI) method, and the flow chart of the Preferred Information Elements for Systematic Reviews and Meta-Analyses, known as PRISMA, were followed. The initial search strategy identified a total of 164 references, which were examined successively, leaving a final selection of ten studies. It was found that the most used instrument for nutritional evaluation was the Patient-Generated Subjective Global Assessment (PG-SGA). Other questionnaires also stood out such as the Mini Nutritional Assessment (MNA), the Malnutrition Universal Screening Tool (MUST), the Nutritional Risk Screening (NRS 2002), and the Functional Assessment of Anorexia/Cachexia Therapy (FAACT). The variation in the tools used ranges from subjective assessments to objective measurements, thus underlining the need for a comprehensive and individualized approach.
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Affiliation(s)
- Erik Medina Cruz
- University Hospital of the Canary Islands, 38320 Santa Cruz de Tenerife, Spain; (N.P.L.); (M.G.S.)
| | - Natacha Palenzuela Luis
- University Hospital of the Canary Islands, 38320 Santa Cruz de Tenerife, Spain; (N.P.L.); (M.G.S.)
| | - Natalia Rodríguez Novo
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de La Laguna, 38200 Santa Cruz de Tenerife, Spain; (N.R.N.); (M.M.N.M.)
| | - Miriam González Suarez
- University Hospital of the Canary Islands, 38320 Santa Cruz de Tenerife, Spain; (N.P.L.); (M.G.S.)
| | - Raquel Casas Hernández
- Nuestra Señora de La Candelaria University Hospital, 38010 Santa Cruz de Tenerife, Spain;
| | - María Mercedes Novo Muñoz
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de La Laguna, 38200 Santa Cruz de Tenerife, Spain; (N.R.N.); (M.M.N.M.)
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Gil-Andrés D, Cabañas-Alite L. A Narrative Review Comparing Nutritional Screening Tools in Outpatient Management of Cancer Patients. Nutrients 2024; 16:752. [PMID: 38474880 DOI: 10.3390/nu16050752] [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: 02/19/2024] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 03/14/2024] Open
Abstract
Malnutrition during cancer has a negative impact on prognosis and quality of life. Therefore, it is important to identify those patients at higher nutritional risk to prevent its development. There are nutritional screening tools, such as MUST and NRS-2002, that focus on the patient on admission to hospital. However, most patients will develop malnutrition in the outpatient or ambulatory setting. This study aims to determine which nutritional screening tool is most effective in assessing nutritional risk in the outpatient oncology patient, highlighting the parameters analysed by these tools. Seventeen articles were reviewed, with the most important variables being tumour location, tumour stage, age, and gender, as well as recent weight loss, dietary intake, and digestive disorders. The Nutriscore, NRS-2002, and MUST tools are considered suitable, but the choice varies depending on these parameters. MNA is suitable for elderly patients, while SNAQ was not considered reliable in this population. In conclusion, MUST, NRS-2002, and Nutriscore are suitable tools, but their choice depends on specific characteristics. There is currently no universal tool for nutritional risk assessment in outpatients.
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Affiliation(s)
- Delia Gil-Andrés
- Internal Medicine Department, Manises' Hospital, Av. De la Generalitat Valenciana, 50, 46940 Manises, Spain
| | - Luis Cabañas-Alite
- Faculty of Health Sciences, Miguel de Cervantes European University, C. del Padre Julio Chevalier, 2, 47012 Valladolid, Spain
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Staxen CS, Andersen SE, Pedersen LM, Poulsen CB, Andersen JR. Nutrition and Lifestyle-Related Factors as Predictors of Muscle Atrophy in Hematological Cancer Patients. Nutrients 2024; 16:283. [PMID: 38257176 PMCID: PMC10819894 DOI: 10.3390/nu16020283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Cancer and side effects from cytostatic treatment commonly affect nutritional status manifested as a decrease in muscle mass. We aimed to investigate the impact of nutrition and lifestyle-related factors on muscle mass in patients with hematological cancer. METHODS Dietary intake, food preferences, quality of life (QoL), and physical activity level (PAL) were monitored during 1-2 cytostatic treatment series. Body composition was estimated using bioelectrical impedance analysis (BIA). RESULTS 61 patients were included. Weight loss and loss of muscle mass were detected in 64% and 59% of the patients, respectively. Muscle mass was significantly positively correlated to increasing PAL (p = 0.003), while negatively correlated to increasing age (p = 0.03), physical QoL (p = 0.007), functional QoL (p = 0.05), self-perceived health (p = 0.004), and self-perceived QoL (p = 0.007). Weight was significantly positively correlated to increased intake of soft drinks (p = 0.02) as well as the favoring of bitter grain and cereal products (p = 0.03), while negatively correlated to increasing age (p = 0.03) and increasing meat intake (p = 0.009) Conclusions: Several nutritional and lifestyle-related factors affected change in body composition. The clinical significance of these changes should be investigated in controlled, interventional studies.
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Affiliation(s)
- Christiane S. Staxen
- Department of Hematology, Zealand University Hospital, 4000 Roskilde, Denmark
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg, Denmark
| | - Sara E. Andersen
- Department of Hematology, Zealand University Hospital, 4000 Roskilde, Denmark
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg, Denmark
| | - Lars M. Pedersen
- Department of Hematology, Zealand University Hospital, 4000 Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Christian B. Poulsen
- Department of Hematology, Zealand University Hospital, 4000 Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Jens R. Andersen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg, Denmark
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Dingemans AM, van Walree N, Schramel F, Soud MYE, Baltruškevičienė E, Lybaert W, Veldhorst M, van den Berg CA, Kaasa S. High Protein Oral Nutritional Supplements Enable the Majority of Cancer Patients to Meet Protein Intake Recommendations during Systemic Anti-Cancer Treatment: A Randomised Controlled Parallel-Group Study. Nutrients 2023; 15:5030. [PMID: 38140289 PMCID: PMC10745925 DOI: 10.3390/nu15245030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/08/2023] [Accepted: 11/17/2023] [Indexed: 12/24/2023] Open
Abstract
ESPEN guidelines recommend a minimum protein intake of 1.0 g/kg body weight (BW) per day to maintain or restore lean body mass in patients with cancer. During anti-cancer treatment, optimal protein intake is difficult to achieve. We investigated whether a high-protein, low-volume oral nutritional supplement (ONS) supports patients in meeting recommendations. A multi-centre, randomised, controlled, open-label, parallel-group study was carried out in nine hospitals (five countries) between January 2019 and July 2021 in colorectal and lung cancer patients undergoing first-line systemic treatment with chemo(radio-) or immunotherapy. Subjects were randomised (2:1) to receive Fortimel Compact Protein® or standard care. Protein intake was assessed with a 3-day food diary (primary outcome). BW was a secondary outcome. Due to challenges in recruitment, the study was terminated prematurely with 42 patients randomised (intervention group (IG) 28; control group (CG) 14). At T1 and T2, protein intake was statistically significantly higher in the IG compared to the CG (1.40 vs. 1.07 g/kg/day at T1, p = 0.008; 1.32 vs. 0.94 g/kg/day at T2, p = 0.002). At baseline, only 65% (IG) and 45% (CG) of patients met ESPEN minimum protein intake recommendations. However, at T1 and T2 in the IG, a higher proportion of patients met recommendations than in the CG (88% vs. 55% and 40%). No statistically significant difference between study groups was observed for BW. Mean compliance to the ONS was 73.4%. A high-protein, low-volume ONS consumed twice daily enables the majority of patients to reach minimal ESPEN protein recommendations.
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Affiliation(s)
- Anne-Marie Dingemans
- Department of Pulmonology, Erasmus Medical Center Cancer Institute, 3015 CN Rotterdam, The Netherlands
| | - Nico van Walree
- Department of Pulmonary Diseases, Amphia Hospital, 4818 CK Breda, The Netherlands;
| | - Franz Schramel
- Department of Pulmonary Diseases, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands;
| | | | | | - Willem Lybaert
- Department of Medical Oncology, VITAZ, 9100 Sint-Niklaas, Belgium;
| | - Margriet Veldhorst
- Nutricia Research, 3584 CT Utrecht, The Netherlands; (M.V.); (C.A.v.d.B.)
| | | | - Stein Kaasa
- Department of Oncology, Oslo University Hospital, 0379 Oslo, Norway;
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Tang H, Wang R, Liu W, Xiao H, Jing H, Song F, Guo S, Li T, Yi L, Zhang Y, Bai X, Shang L. The influence of nutrition literacy, self-care self-efficacy and social support on the dietary practices of breast cancer patients undergoing chemotherapy: A multicentre study. Eur J Oncol Nurs 2023; 64:102344. [PMID: 37290159 DOI: 10.1016/j.ejon.2023.102344] [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: 02/10/2023] [Revised: 03/27/2023] [Accepted: 04/29/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE Breast cancer patients undergoing chemotherapy experience adverse reactions, which lead to poor nutritional status. The objective of this study was to explore the dietary practice of Chinese breast cancer patients undergoing chemotherapy and to analyse the influence of nutrition literacy, self-care self-efficacy and perceived social support on dietary practice. METHOD A total of 295 participants from three hospitals in China were enrolled. The Dietary Nutritional Knowledge, Attitude and Practice Questionnaire; Nutrition Literacy Measurement Scale for Chinese Adults; Strategies Used by People to Promote Health and Perceived Social Support Scale were administered. Multiple linear regressions were used to identify influencing factors. RESULTS The dietary practice of patients were generally satisfactory. Nutrition literacy (r = 0.460, p < 0.001), self-care self-efficacy (r = 0.513, p < 0.001) and perceived social support (r = 0.703, p < 0.001) were positively correlated with dietary practice. The main factors influencing participants' dietary practice were nutrition literacy, self-care self-efficacy, perceived social support, living environment, cancer stage, body mass index, chemotherapy cycle and average monthly household income (all p < 0.05). The model explained 59.0% of the variance in dietary practice. CONCLUSIONS Health professionals should emphasize breast cancer patients' dietary practice throughout the entire chemotherapy course, and dietary interventions should be designed by oncology nurses based on patients' nutrition literacy, self-care self-efficacy and perceived social support. Female patients who have a higher body mass index and income, live in rural areas, have a lower education level, have stage I cancer and have undergone numerous chemotherapy cycles are the focus population of intervention.
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Affiliation(s)
- Han Tang
- Department of Health Statistics, School of Public Health, The Fourth Military Medical University, 710032, Xi'an, China; Department of Clinical Nursing, School of Nursing, The Fourth Military Medical University, 710032, Xi'an, China
| | - Ruibo Wang
- School of Nursing and Health, Zhengzhou University, 450001, Zhengzhou, China
| | - Wei Liu
- Department of Breast Surgery 2 (Area 1), The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
| | - Han Xiao
- Department of Breast Surgery 2 (Area 1), The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
| | - Haihong Jing
- Department of Breast Surgery 2 (Area 1), The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
| | - Fangxia Song
- Department of Breast Surgery 2 (Area 1), The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
| | - Shengjie Guo
- School of Nursing and Health, Zhengzhou University, 450001, Zhengzhou, China
| | - Ting Li
- School of Nursing and Health, Zhengzhou University, 450001, Zhengzhou, China
| | - Luanxing Yi
- School of Nursing, Fujian University of Traditional Chinese Medicine, 350025, Fuzhou, China
| | - Yuhai Zhang
- Department of Health Statistics, School of Public Health, The Fourth Military Medical University, 710032, Xi'an, China
| | - Xue Bai
- Puyang Oilfield General Hospital, 457001, Puyang, China
| | - Lei Shang
- Department of Health Statistics, School of Public Health, The Fourth Military Medical University, 710032, Xi'an, China.
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Fuhse K. [Weight, nutrition, quality of life-Perspective of oncological patients]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2023:10.1007/s00108-023-01528-8. [PMID: 37221380 DOI: 10.1007/s00108-023-01528-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 05/25/2023]
Abstract
Nutrition is associated with pleasure and quality of life. The majority of oncological patients experience tumor-associated and treatment-associated nutrition-related symptoms and malnutrition. Consequently, the perception of nutrition during the course of the disease is increasingly more characterized by negative associations, which may persist for years after the end of treatment. This leads to a decreased quality of life, social isolation and a burden for relatives. In contrast, weight loss is initially positively perceived, especially by patients who previously perceived themselves as being overweight, until malnutrition becomes evident and leads to a decreased quality of life. Nutritional counseling can prevent weight loss, relieve adverse side effects, improve the quality of life and reduce mortality. Patients are not aware of this and the German healthcare system lacks structured and firmly established access pathways to nutritional counseling. Therefore, oncological patients need to be informed about the consequences of weight loss at an early stage and low-threshold access to nutritional counseling needs to be comprehensively implemented. Thus, malnutrition can be recognized and treated at an early stage and nutrition can contribute to a higher quality of life as a positively perceived daily activity.
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Affiliation(s)
- Katrin Fuhse
- Klinikum Bremen Mitte, Medizinische Klinik II, St.-Jürgen-Str. 1, 28205, Bremen, Deutschland.
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Physicians' Perception of Oral Nutritional Supplement Acceptance and Tolerability in Malnourished Outpatients: PerceptiONS Study. Nutrients 2023; 15:nu15051219. [PMID: 36904218 PMCID: PMC10005370 DOI: 10.3390/nu15051219] [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: 02/01/2023] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 03/05/2023] Open
Abstract
Malnutrition is a common condition associated with various pathologies such as infections, neoplasms and digestive system disorders. Patients can be managed using different strategies, which include dietary modifications or oral nutritional supplements (ONS). It is important to promote good ONS adherence in order to attain clinical efficacy and cost-effectiveness. Several factors (amount, type, duration and tolerability) may have an impact on ONS adherence. PerceptiONS is a descriptive, cross-sectional observational study based on an ad hoc electronic survey designed to explore physicians' perception of malnourished outpatients prescribed ONS. The survey considered adherence, acceptance/satisfaction, tolerability and benefits within the context of Spain's healthcare system. The perceptions of 548 physicians regarding the experience of 2516 patients were analyzed. From the physicians' perspective, 57.11% of patients adhered to over 75% of the prescribed ONS. The organoleptic properties of ONS represented the aspect with the most positive impact on adherence, with smell (43.72%) ranking as the top characteristic. In general, patients were satisfied (90.10%) with the ONS, with their related benefits (88.51%) and their organoleptic properties (90.42%), and accepted ONS in their daily diet (88.63%). ONS improved patients' general condition (87.04%), quality of life (QoL) (81.96%) and vitality/energy (81.28%). Physicians would prescribe the same ONS again in 96.4% of the cases.
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HOPPE CATALINA, BUNTZEL JENS, VON WEIKERSTHAL LUDWIGFISCHER, JUNGHANS CONSTANZE, ZOMORODBAKHSCH BIJAN, STOLL CHRISTOPH, PROTT FRANZJOPSEF, FUXIUS STEFAN, MICKE OLIVER, RICHTER ACHIM, SALLMANN DOREEN, HUBNER JUTTA. Usage of Complementary and Alternative Methods, Lifestyle, and Psychological Variables in Cancer Care. In Vivo 2023; 37:106-114. [PMID: 36593056 PMCID: PMC9843784 DOI: 10.21873/invivo.13059] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/28/2022] [Accepted: 11/01/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND/AIM People who are undergoing cancer treatment often ask themselves what they can do in addition to conventional medical therapy with regard to nutrition, activity, and complementary methods. However, we know little about the motivation why people opt for one or the other measure. The aim of this study was therefore to examine the extent of physical activity (PA), healthy nutrition, and the use of complementary methods in relation to both demographic and psychological data. MATERIALS AND METHODS A questionnaire was used to collect data on demographic data, resilience, coherence, self-efficacy, spirituality, satisfaction, and complementary and alternative medicine (CAM) behavior, PA, and diet. Between March and July 2021, data from 446 patients were collected. Regression models and correlation analyzes were used to examine the associations between CAM use, diet and PA with the other variables surveyed. RESULTS CAM usage could only be predicted based on the patient's spirituality. Women used CAM more often and ate more healthily. Healthy eating was also related to younger age, shorter medical history, resilience, satisfaction, and coherence. In addition, the results showed that daily PA was related to the level of resilience, spirituality, and self-efficacy. CONCLUSION Which people or why patients use CAM remains a question to be further investigated. Our data suggest that CAM seeks to address similar needs that others find in spirituality. In order to promote a healthy diet and PA in cancer patients in the future, various psychological variables seem conceivable. Resilience stands out, which is related to an overall healthier lifestyle.
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Affiliation(s)
- CATALINA HOPPE
- Klinik für Innere Medizin II, Hämatologie und Internistische, Internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - JENS BUNTZEL
- Klinik für HNO-Erkrankungen, Kopf-Hals-Chirurgie, Interdisziplinäre Palliativstation Südharz Klinikum Nordhausen, Nordhausen, Germany
| | | | | | | | | | | | - STEFAN FUXIUS
- Onkologische Schwerpunktpraxis Heidelberg, Heidelberg, Germany
| | | | - ACHIM RICHTER
- Inselsberg Klinik Wicker GmbH & Co. OHG, Bad Tabarz, Germany
| | | | - JUTTA HUBNER
- Klinik für Innere Medizin II, Hämatologie und Internistische, Internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
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Vitaloni M, Caccialanza R, Ravasco P, Carrato A, Kapala A, de van der Schueren M, Constantinides D, Backman E, Chuter D, Santangelo C, Maravic Z. The impact of nutrition on the lives of patients with digestive cancers: a position paper. Support Care Cancer 2022; 30:7991-7996. [PMID: 35761102 PMCID: PMC9512936 DOI: 10.1007/s00520-022-07241-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/20/2022] [Indexed: 11/29/2022]
Abstract
Nutritional intervention is an essential part of cancer treatments. Research and clinical evidence in cancer have shown that nutritional support can reduce length of hospitalisation, diminish treatment-related toxicity, and improve nutrient intake, quality of life, and physical function. Nutritional intervention can improve outcomes and help patients in the successful completion of oncological treatments by preventing malnutrition. Malnutrition is a very common hallmark in patients with cancers. Almost one-fourth of cancer patients are at risk of dying because of the consequences of malnutrition, rather than cancer itself. Patients with digestive cancers are at higher risk of suffering malnutrition due to the gastrointestinal impairment caused by their disease. They are at high nutritional risk by definition, yet the majority of them have insufficient or null access to nutritional intervention.Inadequate resources are dedicated to implementing nutritional services in Europe. Universal access to nutritional support for digestive cancer patients is not a reality in many European countries. To change this situation, health systems should invest in qualified staff to reinforce or create nutritional teams’ experts in digestive cancer treatments. We aim to share the patient community’s perspective on the status and the importance of nutritional intervention. This is an advocacy manuscript presenting data on the topic and analysing the current situations and the challenges for nutrition in digestive cancers. It highlights the importance of integrative nutrition in the treatment of digestive cancers and advocates for equitable and universal access to nutritional intervention for all patients.
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Affiliation(s)
| | - Riccardo Caccialanza
- UOC Dietetics and Clinical Nutrition, IRCCS San Matteo Polyclinic Foundation, Pavia, Italy
| | - Paula Ravasco
- Medicine and Scientific Research, Catolica Medical School & Centre for Interdisciplinary Research in Health - Universidade Católica Portuguesa (UCP); Centre for Interdiscipinary Research Egas Moniz, (CiiEM), Egas Moniz Cooperativa de Ensino Superior, CRL, Lisbon, Portugal
| | - Alfredo Carrato
- Pancreatic Cancer Europe, Brussels, Belgium.,Alcalá University, Madrid, Spain
| | - Aleksandra Kapala
- Clinic of Oncological Diagnostics, Cardio-Oncology and Palliative Medicine, National Oncology Institute Maria Skłodowska-Curie, State Research Institute, Warsaw, Poland
| | | | - Dora Constantinides
- PASYKAF, the Cyprus Association of Cancer Patients and Friends, Nicosia, Cyprus
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Johnston EA, Ekberg S, Jennings B, Jagasia N, van der Pols JC, Webb PM. Dietary practices after primary treatment for ovarian cancer: A qualitative analysis from the OPAL Study. J Acad Nutr Diet 2022; 122:1607-1628.e12. [PMID: 35595188 DOI: 10.1016/j.jand.2022.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 04/22/2022] [Accepted: 05/12/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Little is known about dietary practices of women who have completed primary treatment for ovarian cancer, many of whom will go on to experience cancer recurrence and have further treatment. Knowledge of dietary practices is needed to optimize care. OBJECTIVE To identify dietary practices after primary treatment for ovarian cancer and evaluate how these practices differ by disease recurrence and treatment status. DESIGN Women with invasive epithelial ovarian cancer were provided with an open-ended question after completing a food frequency questionnaire (FFQ): "Is there anything we haven't asked you about your diet in the last 1-2 months that you feel is important?" PARTICIPANTS/SETTING Participants in the Ovarian cancer Prognosis And Lifestyle (OPAL) Study in Australia. MAIN OUTCOMES Dietary practices after primary treatment for ovarian cancer and factors affecting these practices. ANALYSIS Participants' responses were analyzed using content analysis. Individual content codes were categorized and reported by recurrence and treatment status at questionnaire completion. RESULTS 286 women provided responses on 363 questionnaires. Those undergoing further treatment for recurrence commonly reported dietary regimens with clinical indications (e.g., low fiber to avoid bowel obstructions, high energy/protein to minimize nutritional deficits). Those not undergoing further treatment frequently reported 'popular' diets (e.g., organic, plant-based, alkaline). For women with cancer recurrence, dietary practices were affected by poor appetite and treatment late effects. For women without recurrence, other comorbidities, geographical location, family and friends appeared to influence dietary practices. In both groups, nutrition information sources and personal beliefs informed dietary practices. Participant responses that referenced media or online sources often included misinformation. CONCLUSIONS Following primary treatment for ovarian cancer, women report dietary practices that may not be captured in standard FFQs. Dietary practices and factors affecting these practices likely differ by treatment and recurrence status. Improved access to evidence-based dietary information and support is needed.
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Affiliation(s)
- Elizabeth A Johnston
- PhD Candidate, Queensland University of Technology, School of Exercise and Nutrition Sciences, Brisbane, Queensland, Australia; Visiting PhD Student, QIMR Berghofer Medical Research Institute, Population Health Department, Brisbane, Queensland, Australia; Early Career Research Fellow, Viertel Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, Queensland, Australia
| | - Stuart Ekberg
- Queensland University of Technology, School of Psychology and Counselling, Brisbane, Queensland, Australia
| | - Bronwyn Jennings
- Gynecology Oncology Clinical Nurse Consultant, Mater Hospital Brisbane, Department of Gynaeoncology, Brisbane, Queensland, Australia
| | - Nisha Jagasia
- Gynecological Oncologist, Mater Hospital Brisbane, Department of Gynaeoncology, Brisbane, Queensland, Australia
| | - Jolieke C van der Pols
- Queensland University of Technology, School of Exercise and Nutrition Sciences, Brisbane, Queensland, Australia; Visiting Scientist, QIMR Berghofer Medical Research Institute, Population Health Department, Brisbane, Queensland, Australia
| | - Penelope M Webb
- QIMR Berghofer Medical Research Institute, Population Health Department, Brisbane, Queensland, Australia;; Adjunct Professor, Queensland University of Technology, School of Public Health and Social Work, Brisbane, Queensland, Australia
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Hassanin IA, Salih RFM, Fathy MHM, Hassanin EA, Selim DH. Implications of inappropriate prescription of oral nutritional supplements on the quality of life of cancer outpatients: a cross-sectional comparative study. Support Care Cancer 2022; 30:4149-4155. [PMID: 35075490 PMCID: PMC8942909 DOI: 10.1007/s00520-022-06837-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/13/2022] [Indexed: 11/27/2022]
Abstract
Background and aims Oral nutritional supplements (ONS) are considered a cornerstone in the treatment plan of malnutrition in cancer patients. However, the prevalence of inappropriate prescription of ONS is high. In this study, we aim to investigate the effect of inappropriate oral nutritional supplementation (consisting of prescription of ONS without evident clinical indication, or the absence of ONS when at risk of malnutrition) on the quality of life of cancer outpatients. Methods A cross-sectional comparative study was conducted in 104 cancer outpatients, receiving ONS without prior malnutrition risk screening (n = 51), and patients not receiving ONS (n = 53). Nutritional risk screening was performed using the abridged patient-generated subjective global assessment (ab-PG-SGA). The quality of life was assessed using EORTC QLQ-C30 version 3.0 questionnaire. Multivariate analysis was conducted to determine the predictors of quality-of-life scales. Age (years), malnutrition (ab-PG-SGA scores), BMI (kg/m2), TSF (mm), MUAC (cm), ONS (yes, no) were entered into the linear regression analysis as predictors (backward stepwise linear regression analysis). Results The prevalence of malnutrition risk (ab-PG-SGA ≥ 6) was 74%. The median score of the ab-PG-SGA for ONS receiving group was significantly higher (p = 0.045). Furthermore, univariate analysis showed that the scores of the global health status (QoL) and the role functioning (RF) scales were significantly lower for the ONS receiving group (p = 0.020 and p = 0.016, respectively). Multivariately, malnutrition, inappropriate ONS prescription, and triceps skin fold were found to be predictors of the RF scale, while malnutrition was the only predictor for the QoL. Conclusion The inappropriate ONS prescription does not improve nutritional status or quality of life of cancer outpatients.
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Affiliation(s)
- Islam A Hassanin
- Faculty of Pharmacy, Alexandria University, Alexandria, 21521, Egypt
| | - Reem F M Salih
- Faculty of Pharmacy, Alexandria University, Alexandria, 21521, Egypt
| | - Marwa H M Fathy
- Faculty of Pharmacy, Alexandria University, Alexandria, 21521, Egypt
| | - Eman A Hassanin
- Faculty of Pharmacy, Alexandria University, Alexandria, 21521, Egypt
| | - Dina H Selim
- Faculty of Pharmacy, Alexandria University, Alexandria, 21521, Egypt.
- Educational and Medical Complex, Al Mawasah University Hospital, Alexandria University, Alexandria, 21526, Egypt.
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Gliwska E, Guzek D, Przekop Z, Sobocki J, Głąbska D. Quality of Life of Cancer Patients Receiving Enteral Nutrition: A Systematic Review of Randomized Controlled Trials. Nutrients 2021; 13:nu13124551. [PMID: 34960103 PMCID: PMC8705712 DOI: 10.3390/nu13124551] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/08/2021] [Accepted: 12/15/2021] [Indexed: 11/27/2022] Open
Abstract
Most studies confirm the beneficial effects of enteral nutrition on the quality of life, but some studies indicate an inverse association and its detrimental impacts. However, there are insufficient data on the effects of enteral nutrition on the quality of life of cancer patients. This systematic review aimed to describe the influence of applied enteral nutrition on the quality of life of cancer patients, based on the results of randomized controlled trials. It was registered in the PROSPERO database (CRD42021261226) and conducted based on the PRISMA guidelines. The searching procedure was conducted using the PubMed and Web of Science databases, as well as Cochrane Library, and it included studies published until June 2021. It was conducted to select randomized controlled trials assessing the influence of enteral nutrition (compared with the other model of nutrition) on the quality of life of cancer patients. A general number of 761 records were screened and a final number of 16 studies were included in the systematic review. The studies were included and assessed by two independent researchers, while the risk of bias was analyzed using the Newcastle–Ottawa Scale (NOS). Studies compared patients treated with and without enteral nutrition, patients treated with various methods of enteral nutrition or with enteral diets of various content, as well as patients treated with enteral and parenteral nutrition. Within the included studies, the majority were conducted in patients with cancers located in various parts of the body, or diverse areas within the gastrointestinal system, while some studies were conducted in specific populations of patients with a defined cancer location—esophagus, stomach, or ovary. The duration of applied enteral nutrition within the included studies was diversified—from two weeks or less to half a year or even more. The vast majority of studies used well-known and validated tools to assess the quality of life, either developed for a specific group of head/neck, esophagus/stomach, and ovary cancer patients or developed for more general patient populations. Most studies concerning patients treated with and without enteral nutrition supported applying enteral nutrition, which was concluded in seven studies out of ten (including four studies with a low risk of bias). The other important observations to be emphasized—formulated based on the studies with a low risk of bias—presented the role of oral supportive nutrition guided by a dietitian, as well as the beneficial role of enteral and parenteral nutrition, combined. In spite of a relatively low number of randomized controlled trials assessing the influence of enteral nutrition on the quality of life of cancer patients, which should be considered as a limitation, the results were promising. Most studies supported the positive influence of enteral nutrition on the quality of life, either assessed based on the psychological measures of the quality of life or by considering the other potential determinants (e.g., malnutrition, complications, etc.). Taking this into account, enteral nutrition should be applied whenever possible, both to prevent and treat malnutrition in cancer patients. However, considering the limited number of studies conducted so far, further research conducted in homogenic populations of patients is necessary.
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Affiliation(s)
- Elwira Gliwska
- Department of Food Market and Consumer Research, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (WULS-SGGW), 159C Nowoursynowska Street, 02-776 Warsaw, Poland;
- Cancer Epidemiology and Primary Prevention Department, The Maria Sklodowska-Curie National Research Institute of Oncology, 15B Wawelska Street, 02-034 Warsaw, Poland
| | - Dominika Guzek
- Department of Food Market and Consumer Research, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (WULS-SGGW), 159C Nowoursynowska Street, 02-776 Warsaw, Poland;
- Correspondence: ; Tel.: +48-225-937-134
| | - Zuzanna Przekop
- Department of Clinical Dietetics, Faculty of Health Sciences, Medical University of Warsaw, 27 Ciołka Street, 01-445 Warsaw, Poland;
| | - Jacek Sobocki
- Department of General Surgery and Clinical Nutrition, Centre of Postgraduate Medical Education in Warsaw, 231 Czerniakowska Street, 00-416 Warsaw, Poland;
| | - Dominika Głąbska
- Department of Dietetics, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (WULS-SGGW), 159C Nowoursynowska Street, 02-776 Warsaw, Poland;
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