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Singhal S, Wang Y, Qin Z, Peterson DR, Dunne RF, Culakova E, Hopkins JO, Melnyk N, Onitilo A, Targia V, Mohile S, Loh KP. Nutritional impairment, psychological health and quality of life among older adults with advanced cancer: A secondary analysis of a randomized clinical trial. Cancer Med 2024; 13:e7348. [PMID: 38898664 PMCID: PMC11187162 DOI: 10.1002/cam4.7348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 05/09/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Nutritional impairment is associated with treatment toxicity and worse overall survival in patients with cancer. We aimed to (1) evaluate the association of nutritional impairment with psychological health and quality of life (QOL) and (2) examine which measures of nutrition had the strongest association with psychological health and QOL among older adults receiving cancer treatment with palliative intent. METHODS This secondary analysis was performed on baseline data from a nationwide cluster randomized clinical trial (ClinicalTrials.gov identifier: NCT02107443; PI: Mohile). Adults age ≥70 with advanced cancer and ≥1 geriatric assessment (GA) impairment were enrolled from 2014 to 2017. In line with geriatric oncology standards, we defined nutritional impairment as Mini Nutritional Assessment Short Form (MNA-SF) ≤11, body mass index (BMI) <21 kg/m2, or >10% involuntary weight loss in the past 6 months. We conducted multivariable linear regressions to evaluate the association of nutritional impairment with each measure of psychological health and QOL: Geriatric Depression Scale (GDS-15, range 0-15), Generalized Anxiety Disorder-7 (GAD-7, range 0-21), NCCN Distress Thermometer (NCCN DT, range 0-10), and Functional Assessment of Cancer Therapy-General (FACT-G, range 0-108). Analyses were adjusted for patient demographics, clinical characteristics, and GA. RESULTS Among 541 patients, the mean age was 77 (range 70-96) and 60% had nutritional impairment. Mean baseline scores: GDS-15 3.1 (SD 2.7), GAD-7 2.9 (SD 4.0), NCCN DT 2.9 (SD 2.7), and FACT-G 80 (SD 15). In the adjusted model, compared to those with no nutritional impairment, older adults with nutritional impairment had greater depression (β = 0.79, 95% CI 0.36-1.23) and anxiety severity (β = 0.86, 95% CI 0.19-1.53), and worse QOL (β = -6.31, 95% CI -8.62 to -4.00). Of the measures of nutrition, MNA-SF ≤11 demonstrated the strongest associations with depression, anxiety, distress, and QOL. CONCLUSION Nutritional impairment is associated with impaired psychological health and worse QOL. Clinicians should use the MNA-SF to screen older adults for nutritional impairment and offer tailored supportive interventions.
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Affiliation(s)
- Surbhi Singhal
- Division of Hematology/Oncology, Department of MedicineUniversity of California DavisSacramentoCaliforniaUSA
| | - Ying Wang
- Department of Public Health SciencesUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Zhaoyang Qin
- Department of Biostatistics and Computational BiologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Derick R. Peterson
- Department of Biostatistics and Computational BiologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Richard F. Dunne
- Division of Hematology and OncologyJames P. Wilmot Cancer Institute, University of Rochester Medical CenterRochesterNew YorkUSA
| | - Eva Culakova
- Department of Surgery, Supportive Care in Cancer UnitUniversity of RochesterRochesterNew YorkUSA
| | - Judith O. Hopkins
- Novant Health Cancer Institute/Southeast Clinical Oncology Research ConsortiumWinston‐SalemNorth CarolinaUSA
| | - Natalia Melnyk
- Delaware/Christiana Care NCI Community Oncology Research Program (NCORP)NewarkDelawareUSA
| | | | - Valerie Targia
- Stakeholders for the Care and Research of Oncology Elders (SCOREBoard) Advisory CommitteeDuarteUSA
| | - Supriya Mohile
- Division of Hematology and OncologyJames P. Wilmot Cancer Institute, University of Rochester Medical CenterRochesterNew YorkUSA
| | - Kah Poh Loh
- Division of Hematology and OncologyJames P. Wilmot Cancer Institute, University of Rochester Medical CenterRochesterNew YorkUSA
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Pourhassan M, Daubert D, Laurentius T, Wirth R. Optimized Refeeding vs. Standard Care in Malnourished Older Hospitalized Patients: A Prospective, Non-Randomized Cluster-Controlled Study in Geriatric Acute Care. J Clin Med 2023; 12:7274. [PMID: 38068326 PMCID: PMC10707595 DOI: 10.3390/jcm12237274] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/14/2023] [Accepted: 11/22/2023] [Indexed: 05/25/2024] Open
Abstract
Malnutrition is a prevalent geriatric syndrome with adverse health outcomes. This study aimed to assess the effectiveness of an optimized protocol for treatment of malnutrition in older hospitalized patients. We conducted a prospective, non-randomized cluster-controlled study with 156 malnourished patients in the intervention and 73 in the control group, determined using the Mini Nutritional Assessment-Short-Form. The intervention group received individualized nutritional care, including electrolyte and micronutrients monitoring, while the control received standard care. We primarily focused on complications such as infections, falls, unplanned hospital readmissions, and mortality, and secondarily focused on functional status and mobility improvements. Post-discharge follow-ups occurred at 3 and 6 months. Our findings demonstrated that the intervention group (age 82.3 ± 7.5 y, 69% female), exhibited greater previous weight loss (11.5 kg vs. 4.7 kg), more cognitive impairment and a longer hospital stay (19 days vs. 15 days). Binary logistic regression showed no difference in primary endpoint outcomes between groups during hospitalization. At 3- and 6-month follow-ups, the control group exhibited fewer adverse outcomes, particularly falls and readmissions. Both groups showed in-hospital functional improvements, but only controls maintained post-discharge mobility gains. The study concludes that the nutritional intervention did not outperform standard care, potentially due to study limitations and high-quality standard care in control group geriatric departments.
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Affiliation(s)
- Maryam Pourhassan
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-Universität Bochum, 44625 Herne, Germany; (D.D.); (R.W.)
| | - Diana Daubert
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-Universität Bochum, 44625 Herne, Germany; (D.D.); (R.W.)
| | - Thea Laurentius
- Universitätsklinikum Aachen—Standort Franziskus Anstalt des öffentlichen Rechts (AöR), 52074 Aachen, Germany;
| | - Rainer Wirth
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-Universität Bochum, 44625 Herne, Germany; (D.D.); (R.W.)
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Lorenzon L, Caccialanza R, Casalone V, Santoro G, Delrio P, Izzo F, Tonello M, Mele MC, Pozzo C, Pedrazzoli P, Pietrabissa A, Fenu P, Mellano A, Fenocchio E, Avallone A, Bergamo F, Nardi MT, Persiani R, Biondi A, Tirelli F, Agnes A, Ferraris R, Quarà V, Milanesio M, Ribero D, Rinaldi M, D'Elia P, Rho M, Cenzi C, D'Ugo D. The impact of preoperative nutritional screening, ERAS protocol, and mini-invasive surgery in surgical oncology: A multi-institutional SEM analysis of patients with digestive cancer. Front Nutr 2023; 10:1041153. [PMID: 37006925 PMCID: PMC10063158 DOI: 10.3389/fnut.2023.1041153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 02/20/2023] [Indexed: 03/18/2023] Open
Abstract
BackgroundMini-invasive surgery (MIS), ERAS, and preoperative nutritional screening are currently used to reduce complications and the length of hospital stay (LOS); however, inter-variable correlations have seldom been explored. This research aimed to define inter-variable correlations in a large series of patients with gastrointestinal cancer and their impact on outcomes.MethodsPatients with consecutive cancer who underwent radical gastrointestinal surgery between 2019 and 2020 were analyzed. Age, BMI, comorbidities, ERAS, nutritional screening, and MIS were evaluated to determine their impact on 30-day complications and LOS. Inter-variable correlations were measured, and a latent variable was computed to define the patients' performance status using nutritional screening and comorbidity. Analyses were conducted using structural equation modeling (SEM).ResultsOf the 1,968 eligible patients, 1,648 were analyzed. Univariable analyses documented the benefit of nutritional screening for LOS and MIS and ERAS (≥7 items) for LOS and complications; conversely, being male and comorbidities correlated with complications, while increased age and BMI correlated with worse outcomes. SEM analysis revealed that (a) the latent variable is explained by the use of nutritional screening (p0·004); (b) the variables were correlated (age–comorbidity, ERAS–MIS, and ERAS–nutritional screening, p < 0·001); and (c) their impact on the outcomes was based on direct effects (complications: sex, p0·001), indirect effects (LOS: MIS-ERAS-nutritional screening, p < 0·001; complications: MIS-ERAS, p0·001), and regression-based effects (LOS: ERAS, MIS, p < 0·001, nutritional screening, p0·021; complications: ERAS, MIS, p < 0·001, sex, p0·001). Finally, LOS and complications were correlated (p < 0·001).ConclusionEnhanced recovery after surgery (ERAS), MIS, and nutritional screening are beneficial in surgical oncology; however, the inter-variable correlation is reliable, underlying the importance of the multidisciplinary approach.
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Affiliation(s)
- Laura Lorenzon
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy
- *Correspondence: Laura Lorenzon
| | | | | | - Gloria Santoro
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy
| | - Paolo Delrio
- Istituto Nazionale per lo Studio e la Cura dei Tumori Fondazione Giovanni Pascale IRCCS, Naples, Italy
| | - Francesco Izzo
- Istituto Nazionale per lo Studio e la Cura dei Tumori Fondazione Giovanni Pascale IRCCS, Naples, Italy
| | - Marco Tonello
- Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Maria Cristina Mele
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy
| | - Carmelo Pozzo
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy
| | | | | | - Piero Fenu
- Candiolo Cancer Institute–IRCCS, Turin, Italy
| | | | | | - Antonio Avallone
- Istituto Nazionale per lo Studio e la Cura dei Tumori Fondazione Giovanni Pascale IRCCS, Naples, Italy
| | | | | | - Roberto Persiani
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy
| | - Alberto Biondi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy
| | - Flavio Tirelli
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy
| | - Annamaria Agnes
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy
| | | | | | | | | | | | | | - Maurizio Rho
- Istituto Nazionale per lo Studio e la Cura dei Tumori Fondazione Giovanni Pascale IRCCS, Naples, Italy
| | - Carola Cenzi
- Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Domenico D'Ugo
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy
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Nutritional management of cancer patients in clinical practice in Spain: patients' and multidisciplinary health care professionals' perceptions. Eur J Clin Nutr 2022; 77:454-459. [PMID: 36550218 DOI: 10.1038/s41430-022-01251-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND/OBJECTIVES Malnutrition is a prevalent problem in patients with cancer and is associated with poor prognosis. The European Society for Clinical Nutrition and Metabolism (ESPEN) recommends the provision of nutritional support and evaluation. This study aims to describe the nutritional management of patients with cancer, including assessment of adherence, from the perspective of both patients and healthcare professionals (HCPs). SUBJECTS/METHODS A cross-sectional descriptive observational study was carried out through two surveys addressed to patients and HCPs. RESULTS A total of 230 cancer patients and 461 HCPs completed the questionnaire. The survey found 55.0% of patients experienced eating problems during treatment and 64.0% reported sequelae affecting nourishment. However, 60.1% of patients and 42.6% of HCPs indicated that nutritional status is not generally assessed. While 86.6% of HCPs stated that nutritional information is provided to patients, only 33.5% of patients reported having received it. Regarding nutritional adherence, 87.4% of HCPs stated that it is assessed whereas only 49.2% of patients receiving nutritional supplements confirmed this. General discomfort or gastrointestinal problems were the main issues hampering correct adherence perceived by both patients (41.8%) and HCPs (95.4%). CONCLUSIONS Our study demonstrate that different perceptions exist between patients and HCPs about nutritional management in cancer and suggests that in Spain nutritional approach is suboptimal in terms of screening/assessment of malnutrition, nutritional information provided to the patient, nutritional intervention and assessment of adherence to nutritional support. Therefore, measure should be taken to foster the adoption of ESPEN recommendations in clinical practice and to promote nutritional education of HCPs.
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Torregrosa C, Chorin F, Beltran EEM, Neuzillet C, Cardot-Ruffino V. Physical Activity as the Best Supportive Care in Cancer: The Clinician's and the Researcher's Perspectives. Cancers (Basel) 2022; 14:5402. [PMID: 36358820 PMCID: PMC9655932 DOI: 10.3390/cancers14215402] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/27/2022] [Accepted: 10/31/2022] [Indexed: 08/11/2023] Open
Abstract
Multidisciplinary supportive care, integrating the dimensions of exercise alongside oncological treatments, is now regarded as a new paradigm to improve patient survival and quality of life. Its impact is important on the factors that control tumor development, such as the immune system, inflammation, tissue perfusion, hypoxia, insulin resistance, metabolism, glucocorticoid levels, and cachexia. An increasing amount of research has been published in the last years on the effects of physical activity within the framework of oncology, marking the appearance of a new medical field, commonly known as "exercise oncology". This emerging research field is trying to determine the biological mechanisms by which, aerobic exercise affects the incidence of cancer, the progression and/or the appearance of metastases. We propose an overview of the current state of the art physical exercise interventions in the management of cancer patients, including a pragmatic perspective with tips for routine practice. We then develop the emerging mechanistic views about physical exercise and their potential clinical applications. Moving toward a more personalized, integrated, patient-centered, and multidisciplinary management, by trying to understand the different interactions between the cancer and the host, as well as the impact of the disease and the treatments on the different organs, this seems to be the most promising method to improve the care of cancer patients.
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Affiliation(s)
- Cécile Torregrosa
- Oncologie Digestive, Département d’Oncologie Médicale Institut Curie, Université Versailles Saint-Quentin—Université Paris Saclay, 35, rue Dailly, 92210 Saint-Cloud, France
- Département de Chirurgie Digestive et Oncologique, Hôpital Universitaire Ambroise Paré, Assistance Publique-Hôpitaux de Paris, 9 avenue Charles de Gaulle, 92100 Boulogne Billancourt, France
| | - Frédéric Chorin
- Laboratoire Motricité Humaine, Expertise, Sport, Santé (LAMHESS), HEALTHY Graduate School, Université Côte d’Azur, 06205 Nice, France
- Clinique Gériatrique du Cerveau et du Mouvement, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, 06205 Nice, France
| | - Eva Ester Molina Beltran
- Oncologie Digestive, Département d’Oncologie Médicale Institut Curie, Université Versailles Saint-Quentin—Université Paris Saclay, 35, rue Dailly, 92210 Saint-Cloud, France
| | - Cindy Neuzillet
- Oncologie Digestive, Département d’Oncologie Médicale Institut Curie, Université Versailles Saint-Quentin—Université Paris Saclay, 35, rue Dailly, 92210 Saint-Cloud, France
- GERCOR, 151 rue du Faubourg Saint-Antoine, 75011 Paris, France
| | - Victoire Cardot-Ruffino
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
- Department of Immunology, Harvard Medical School, Boston, MA 02215, USA
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Yurut Caloglu V, Akmansu M, Yalman D, Karabulut Gul S, Kocak Z, Arican Alicikus Z, Serarslan A, Akyurek S, Zoto Mustafayev T, Demiroz C, Colpan Oksuz D, Kanyilmaz G, Altinok P, Kaytan Saglam E, Yentek Balkanay A, Akboru H, Keven E, Yildirim B, Onal C, Igdem S, Ozkan E, Ozdener F, Caloglu M. Evaluation of Nutritional Status and Anxiety Levels in Patients Applying to the Radiation Oncology Outpatient Clinic during the COVID-19 Pandemic: Turkish Society for Radiation Oncology Group Study (TROD 12:02). Nutr Cancer 2022; 74:3601-3610. [DOI: 10.1080/01635581.2022.2093386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
| | - Muge Akmansu
- Department of Radiation Oncology, Gazi University, Ankara, Turkey
| | - Deniz Yalman
- Department of Radiation Oncology, Ege University, Izmir, Turkey
| | - Sule Karabulut Gul
- Department of Radiation Oncology, Dr. Lutfi Kirdar Kartal Research and Training Hospital, Istanbul, Turkey
| | - Zafer Kocak
- Department of Radiation Oncology, Trakya University, Edirne, Turkey
| | | | | | - Serap Akyurek
- Department of Radiation Oncology, Ankara University, Ankara, Turkey
| | | | - Candan Demiroz
- Department of Radiation Oncology, Uludag University, Bursa, Turkey
| | - Didem Colpan Oksuz
- Department of Radiation Oncology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Gul Kanyilmaz
- Department of Radiation Oncology, Necmettin Erbakan University, Konya, Istanbul
| | - Pelin Altinok
- Department of Radiation Oncology, University of Health Sciences Umraniye Research and Training Hospital, Istanbul, Turkey
| | - Esra Kaytan Saglam
- Department of Radiation Oncology, Istanbul University Medical Faculty, Istanbul, Turkey
| | - Ayben Yentek Balkanay
- Department of Radiation Oncology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Halil Akboru
- Department of Radiation Oncology, University of Health Sciences, Okmeydani Hospital, Istanbul, Turkey
| | - Emine Keven
- Department of Radiation Oncology, Dr. Abdurrahman Yurtaslan Ankara Oncology Research and Training Hospital, Ankara, Turkey
| | - Berna Yildirim
- Department of Radiation Oncology, Adana Baskent University, Adana, Istanbul
| | - Cem Onal
- Department of Radiation Oncology, Adana Baskent University, Adana, Istanbul
| | - Sefik Igdem
- Department of Radiation Oncology, Istanbul Bilgi University, Istanbul, Turkey
| | - Emre Ozkan
- Medical Department, Nutricia, Advanced Medical Nutrition, Istanbul, Turkey
| | - Fatih Ozdener
- School of Medicine, Department of Pharmacology, Bahcesehir University, İstanbul, Turkey
| | - Murat Caloglu
- Department of Radiation Oncology, Trakya University, Edirne, Turkey
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Nasrawi D, Reid C, Lee M, Coyne E. Nursing assessment and management of nutrition in older people with cancer: An integrative review. Collegian 2022. [DOI: 10.1016/j.colegn.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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[Opinions and experiences of healthcare professionals in the nutritional management of oncology patients: the ONA study]. NUTR HOSP 2022; 39:615-628. [PMID: 35083915 DOI: 10.20960/nh.03914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVES an inadequate approach to prevent malnutrition in cancer patients may worsen their quality of life and reduce their response to treatment. This study aims to describe the nutritional management of cancer patients in clinical practice, as well as the opinions of the healthcare professionals (HCPs) involved. METHODS this was an observational, descriptive, cross-sectional study addressed to HCPs in the Spanish healthcare setting. The online questionnaire was designed based on a literature review, one focus group of patients (n = 6), and the experience of the multidisciplinary scientific committee (n = 5), and was distributed by the scientific societies endorsing the study. RESULTS a total of 461 HCPs answered the survey. Most of them considered that a nutrition expert (95.0 %) is essential for the nutritional management of patients. However, 22.8 % of HCPs did not have access to this expert, and only 49.0 % had received training. Nutritional screening or patient referral for screening was performed by 58.4 % of HCPs. Of the total of HCPs, 86.6 % stated that nutritional information is provided to patients and considered them moderately satisfied with the information received. In malnourished patients or in those at risk of malnutrition, a complete nutritional assessment was performed by HCPs (73.1 %). Most HCPs (87.4 %) reported prescribing or recommending nutritional support if needed, and assessing adherence (86.8 %). CONCLUSIONS despite malnutrition being a common problem in cancer patients, almost half of professionals do not perform any nutritional screening. In addition, patient information and assessment of nutritional adherence appear to be suboptimal.
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Liu X, Xue Z, Yu J, Ma Z, Kang W, Ye X, Li Z. Risk factors for cancer-specific survival in elderly gastric cancer patients after curative gastrectomy. Nutr Res Pract 2022; 16:604-615. [PMID: 36238382 PMCID: PMC9523207 DOI: 10.4162/nrp.2022.16.5.604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/29/2021] [Accepted: 01/07/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND/OBJECTIVES This study aimed to investigate cancer-specific survival (CSS) and associated risk factors in elderly gastric cancer (EGC) patients. SUBJECTS/METHODS EGC patients (≥ 70 yrs) who underwent curative gastrectomy between January 2013 and December 2017 at our hospital were included. Clinicopathologic characteristics and survival data were collected. Receiver operating characteristic (ROC) analysis was used to extract the best cutoff point for body mass index (BMI). A Cox proportional hazards model was used to determine the risk factors for CSS. RESULTS In total, 290 EGC patients were included, with a median age of 74.7 yrs. The median follow-up time was 31 (1–77) mon. The postoperative 1-yr, 3-yr and 5-yr CSS rates were 93.7%, 75.9% and 65.1%, respectively. Univariate analysis revealed risk factors for CSS, including age (hazard ratio [HR] = 1.08; 95% confidence interval [CI], 1.01–1.15), intensive care unit (ICU) admission (HR = 1.73; 95% CI, 1.08–2.79), nutritional risk screening (NRS 2002) score ≥ 5 (HR = 2.33; 95% CI, 1.49–3.75), and preoperative prognostic nutrition index score < 45 (HR = 2.06; 95% CI, 1.27–3.33). The ROC curve showed that the best BMI cutoff value was 20.6 kg/m2. Multivariate analysis indicated that a BMI ≤ 20.6 kg/m2 (HR = 2.30; 95% CI, 1.36–3.87), ICU admission (HR = 1.97; 95% CI, 1.17–3.30) and TNM stage (stage II: HR = 5.56; 95% CI, 1.59–19.43; stage III: HR = 16.20; 95% CI, 4.99–52.59) were significantly associated with CSS. CONCLUSIONS Low BMI (≤ 20.6 kg/m2), ICU admission and advanced pathological TNM stages (II and III) are independent risk factors for CSS in EGC patients after curative gastrectomy. Nutrition support, better perioperative management and early diagnosis would be helpful for better survival.
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Affiliation(s)
- Xiao Liu
- Department of Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Zhigang Xue
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
- Graduate School, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jianchun Yu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Zhiqiang Ma
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Weiming Kang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xin Ye
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Zijian Li
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
- Graduate School, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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Is sarcopenia a missed factor in the management of patients with metastatic breast cancer? Breast 2021; 61:84-90. [PMID: 34923226 PMCID: PMC8693346 DOI: 10.1016/j.breast.2021.12.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 12/22/2022] Open
Abstract
Background Sarcopenia has emerged as an important parameter to predict outcomes and treatment toxicity. However, limited data are available to assess sarcopenia prevalence in metastatic breast cancer and to evaluate its management. Methods The SCAN study was a cross-sectional multicenter French study that aimed to estimate sarcopenia prevalence in a real-life sample of metastatic cancer patients. Sarcopenia was identified by low muscle mass (estimated from the skeletal muscle index at the third lumbar, via computed tomography) and low muscle strength (defined by handgrip strength). Three populations were distinguished based on EWGSOP criteria: a sarcopenic group with low muscle mass AND strength, a pre-sarcopenic group with low muscle mass OR strength and a normal group with high muscle mass AND strength. Results Among 766 included patients, 139 patients with breast cancer and median age of 61.2 years (29.9–97.8 years) were evaluable; 29.5% were sarcopenic and 41.0% were pre-sarcopenic. Sarcopenic patients were older (P < 0.01), had a worse PS-score (P < 0.05), and a higher number of metastatic sites (P < 0.01), the majority being hepatic and bone. A moderate agreement between the oncologist's diagnosis and sarcopenia evaluation by muscle mass and strength was recognized (Cohen's kappa = 0.45). No associations were found between sarcopenia and adverse event occurrence in the 12 patients for whom these were reported. Sarcopenic patients were underdiagnosed and nutritional care and physical activity were less proposed. Conclusion It is necessary to evaluate sarcopenia due to its impact on patient prognosis, and its utility in guiding patient management in metastatic breast cancer. Sarcopenia prevalence was 29.5% in metastatic breast cancer patients. Pre-sarcopenia was found in 41.0% of metastatic breast cancer patients. Anthropometric parameters or oncologist assessments do not fully assess sarcopenia. Sarcopenia is under-diagnosed in metastatic cancer. Sarcopenic patients are under-referred for nutritional management.
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The prevalence of CT-defined low skeletal muscle mass in patients with metastatic cancer: a cross-sectional multicenter French study (the SCAN study). Support Care Cancer 2021; 30:3119-3129. [PMID: 34862578 PMCID: PMC8857123 DOI: 10.1007/s00520-021-06603-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 09/27/2021] [Indexed: 01/06/2023]
Abstract
Background Cachexia, characterized by involuntary muscle mass loss, negatively impacts survival outcomes, treatment tolerability, and functionality in cancer patients. However, there is a limited appreciation of the true prevalence of low muscle mass due to inconsistent diagnostic methods and limited oncologist awareness. Methods Twenty-nine French healthcare establishments participated in this cross-sectional study, recruiting patients with those metastatic cancers most frequently encountered in routine practice (colon, breast, kidney, lung, prostate). The primary outcome was low skeletal muscle mass prevalence, as diagnosed by estimating the skeletal mass index (SMI) in the middle of the third-lumbar vertebrae (L3) level via computed tomography (CT). Other objectives included an evaluation of nutritional management, physical activity, and toxicities related to ongoing treatment. Results Seven hundred sixty-six patients (49.9% males) were enrolled with a mean age of 65.0 years. Low muscle mass prevalence was 69.1%. Only one-third of patients with low skeletal muscle mass were receiving nutritional counselling and only 28.4% were under nutritional management (oral supplements, enteral or parenteral nutrition). Physicians highly underdiagnosed those patients identified with low skeletal muscle mass, as defined by the primary objective, by 74.3% and 44.9% in obese and non-obese patients, respectively. Multivariate analyses revealed a lower risk of low skeletal muscle mass for females (OR: 0.22, P < 0.01) and those without brain metastasis (OR: 0.34, P < 0.01). Low skeletal muscle mass patients were more likely to have delayed treatment administration due to toxicity (11.9% versus 6.8%, P = 0.04). Conclusions There is a critical need to raise awareness of low skeletal muscle mass diagnosis among oncologists, and for improvements in nutritional management and physical therapies of cancer patients to curb potential cachexia. This calls for cross-disciplinary collaborations among oncologists, nutritionists, physiotherapists, and radiologists. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-021-06603-0.
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Poisson J, Martinez-Tapia C, Heitz D, Geiss R, Albrand G, Falandry C, Gisselbrecht M, Couderc AL, Boulahssass R, Liuu E, Boudou-Rouquette P, Chah Wakilian A, Gaxatte C, Pamoukdjian F, de Decker L, Antoine V, Cattenoz C, Solem-Laviec H, Guillem O, Medjenah H, Natella PA, Canouï-Poitrine F, Laurent M, Paillaud E. Prevalence and prognostic impact of cachexia among older patients with cancer: a nationwide cross-sectional survey (NutriAgeCancer). J Cachexia Sarcopenia Muscle 2021; 12:1477-1488. [PMID: 34519440 PMCID: PMC8718093 DOI: 10.1002/jcsm.12776] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 06/28/2021] [Accepted: 07/13/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Nutritional impairment is common in cancer patients and is associated with poor outcomes. Only few studies focused on cachexia. We assessed the prevalence of cachexia in older cancer patients, identified associated risk factors, and evaluated its impact on 6 month overall mortality. METHODS A French nationwide cross-sectional survey (performed in 55 geriatric oncology clinics) of older cancer patients aged ≥70 referred for geriatric assessment prior to treatment choice and initiation. Demographic, clinical, and nutritional data were collected. The first outcome was cachexia, defined as loss of more than 5% of bodyweight over the previous 6 months, or a body mass index below 20 kg/m2 with weight loss of more than 2%, or sarcopenia (an impaired Strength, Assistance with walking, Rise from chair, Climb stairs and Falls score) with weight loss of more than 2%. The second outcome was 6 month overall mortality. RESULTS Of the 1030 patients included in the analysis [median age (interquartile range): 83 (79-87); males: 48%; metastatic cancer: 42%; main cancer sites: digestive tract (29%) and breast (16%)], 534 [52% (95% confidence interval: 49-55%)] had cachexia. In the multivariate analysis, patients with breast (P < 0.001), gynaecologic (P < 0.001), urinary (P < 0.001), skin (P < 0.001), and haematological cancers (P = 0.006) were less likely to have cachexia than patients with colorectal cancer. Patients with upper gastrointestinal tract cancers (including liver and pancreatic cancers; P = 0.052), with previous surgery for cancer (P = 0.001), with metastases (P = 0.047), poor performance status (≥2; P < 0.001), low food intake (P < 0.001), unfeasible timed up-and-go test (P = 0.002), cognitive disorders (P = 0.03) or risk of depression (P = 0.005), were more likely to have cachexia. At 6 months, 194 (20.5%) deaths were observed. Cachexia was associated with 6 month mortality risk (adjusted hazard ratio = 1.49; 95% confidence interval: 1.05-2.11) independently of age, in/outpatient status, cancer site, metastatic status, cancer treatment, dependency, cognition, and number of daily medications. CONCLUSIONS More than half of older patients with cancer managed in geriatric oncology clinics had cachexia. The factors associated with cachexia were upper gastrointestinal tract cancer, metastases, poor performance status, poor mobility, previous surgery for cancer, cognitive disorders, a risk of depression, and low food intake. Cachexia was independently associated with 6 month mortality.
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Affiliation(s)
- Johanne Poisson
- Assistance Publique - Hôpitaux de Paris (AP-HP), Paris Cancer Institute CARPEM, Geriatric Oncology Unit, Georges Pompidou European Hospital, Paris, France.,Faculty of Health, University of Paris, Paris, France
| | - Claudia Martinez-Tapia
- INSERM-IMRB CEpiA (Clinical Epidemiology and Ageing Unit), Paris-Est University, UPEC, Créteil, France
| | - Damien Heitz
- Oncology and Hematology Unit, Strasbourg University Hospital Center - Hautepierre Hospital, Strasbourg, France
| | - Romain Geiss
- Assistance Publique - Hôpitaux de Paris (AP-HP), Paris Cancer Institute CARPEM, Geriatric Oncology Unit, Georges Pompidou European Hospital, Paris, France
| | - Gilles Albrand
- Geriatric Oncology Unit, Antoine Charial hospital, Hospices Civils de Lyon, Lyon, France
| | - Claire Falandry
- Geriatrics Unit, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Mathilde Gisselbrecht
- Assistance Publique - Hôpitaux de Paris (AP-HP), Paris Cancer Institute CARPEM, Geriatric Oncology Unit, Georges Pompidou European Hospital, Paris, France
| | - Anne-Laure Couderc
- AP-HM, Division of Internal Medicine, Geriatric Medicine and Therapeutic, Sainte Marguerite Hospital, Marseille, France
| | | | - Evelyne Liuu
- Geriatric Department, CHU La Milétrie, Poitiers, France
| | | | - Anne Chah Wakilian
- Geriatric Department, Broca Hospital, Paris Centre Hospitals, Paris Descartes University, Paris, France
| | - Cedric Gaxatte
- Geriatric Oncology Unit, Lille University Hospital, Lille, France
| | - Fréderic Pamoukdjian
- AP-HP, Geriatric Oncology Unit, Avicenne Hospital and Paris 13 University, Sorbonne Paris Cité, Bobigny, France
| | - Laure de Decker
- Clinical Gerontology Department, Nantes University Hospital Center, Nantes, France
| | - Valery Antoine
- Department of Geriatric Medicine, Nimes University Hospital, Nimes, France
| | | | - Heidi Solem-Laviec
- Geriatric Oncology Unit, Oncology Supportive Care Department, François Baclesse Regional Cancer Center, Caen, France
| | - Olivier Guillem
- Geriatric Medicine Unit, Inter-communal Hospital Center from Southern Alps, Gap, France
| | - Hayat Medjenah
- Public Health Department and Clinical Research Unit, APHP, Henri-Mondor Hospital, Creteil, France
| | - Pierre André Natella
- Public Health Department and Clinical Research Unit, APHP, Henri-Mondor Hospital, Creteil, France
| | - Florence Canouï-Poitrine
- INSERM-IMRB CEpiA (Clinical Epidemiology and Ageing Unit), Paris-Est University, UPEC, Créteil, France.,Public Health Department and Clinical Research Unit, APHP, Henri-Mondor Hospital, Creteil, France
| | - Marie Laurent
- Internal Medicine and Geriatric Department, Paris- Sud-Val-de-Marne Geriatric Oncology Clinic, AP-HP, Henri-Mondor Hospital, Créteil, France
| | - Elena Paillaud
- Assistance Publique - Hôpitaux de Paris (AP-HP), Paris Cancer Institute CARPEM, Geriatric Oncology Unit, Georges Pompidou European Hospital, Paris, France.,Faculty of Health, University of Paris, Paris, France.,INSERM-IMRB CEpiA (Clinical Epidemiology and Ageing Unit), Paris-Est University, UPEC, Créteil, France
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Burlui AM, Cardoneanu A, Macovei LA, Rezus C, Boiculese LV, Graur M, Rezus E. Diet in Scleroderma: Is There a Need for Intervention? Diagnostics (Basel) 2021; 11:2118. [PMID: 34829464 PMCID: PMC8620611 DOI: 10.3390/diagnostics11112118] [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] [Received: 10/22/2021] [Revised: 11/10/2021] [Accepted: 11/12/2021] [Indexed: 01/10/2023] Open
Abstract
Systemic sclerosis (SSc) patients exhibit a plethora of risk factors for nutritional decline, including the presence of chronic inflammation and the progressive nature of disease-related multisystem involvement. The prevalence and consequences of nutritional decline in scleroderma are frequently underestimated, its management currently remaining a subject of debate. The main objective of the present study was to perform a detailed assessment of scleroderma patients' diet as well as their eating habits and to describe the relationships with weight loss and malnutrition risk in the absence of professional nutritional counseling. METHODS We used a translated and validated version of the EPIC-Norfolk FFQ (European Prospective Investigation into Cancer and Nutrition Norfolk Food Frequency Questionnaire) to evaluate the patients' diet and MUST (Malnutrition Universal Screening Tool) to investigate the risk of malnutrition. Disease activity was estimated using the EUSTAR-AI (European Scleroderma Trials and Research group Activity Index). RESULTS We included 69 patients with SSc, of which 42 underwent a detailed dietary assessment. Dietary factors were connected to body composition and digestive symptoms. We found high sodium intake and frequent suboptimal energy consumption in our study group, including patients with cardiopulmonary involvement. Liver transaminases were inversely correlated with the consumption of nuts and seeds. Malnutrition and weight loss were significantly associated with pulmonary hypertension, heart failure, albumin levels, and the extent of skin fibrosis, but not advanced age. Although the patients with EUSTAR-AI ≥ 2.5 were more frequently included in the moderate and high malnutrition risk categories, these results did not reach statistical significance. CONCLUSIONS Currently, there is an unmet need for longitudinal and interventional research focusing on the long-term significance, ramifications, and management of nutritional impairment in SSc patients with various clinical manifestations. Our results indicate that scleroderma patients could benefit from personalized nutritional counseling in an interdisciplinary setting.
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Affiliation(s)
- Alexandra Maria Burlui
- Department of Rheumatology and Rehabilitation, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.C.); (L.A.M.); (E.R.)
| | - Anca Cardoneanu
- Department of Rheumatology and Rehabilitation, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.C.); (L.A.M.); (E.R.)
| | - Luana Andreea Macovei
- Department of Rheumatology and Rehabilitation, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.C.); (L.A.M.); (E.R.)
| | - Ciprian Rezus
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Lucian Vasile Boiculese
- Department of Preventive Medicine and Interdisciplinarity, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Mariana Graur
- Department of Diabetes, Nutrition and Metabolic Diseases, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Elena Rezus
- Department of Rheumatology and Rehabilitation, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.C.); (L.A.M.); (E.R.)
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Rehabilitation Concerns in the Geriatric Critically Ill and Injured - Part 2. Crit Care Clin 2021; 37:221-231. [PMID: 33190772 DOI: 10.1016/j.ccc.2020.08.008] [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: 11/20/2022]
Abstract
As life expectancy increases and birth rates decline, the geriatric population continues to grow faster than any other age group. Aging is characterized by a progressive physiologic decline that promotes the onset of functional limitation and disability. With the increasing geriatric population, more elderly patients are presenting to emergency departments after trauma, and intensive care units are being met with increasing demand. Rehabilitation is critical in improving quality of life by maximizing physical, cognitive, and psychological recovery from injury or disease.
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15
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Zhang Q, Yu S, Li Q, Zhang M, Meng L, Hu S. Preoperative Nutritional Status in Elderly Inpatients with Gastrointestinal Cancer and Its Linear Association with Frailty. Nutr Cancer 2021; 74:1376-1387. [PMID: 34309475 DOI: 10.1080/01635581.2021.1955284] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The identification and management of malnutrition is increasingly considered as an important issue in cancer treatment. This study aimed at determining the prevalence of malnutrition among elderly inpatients with gastrointestinal cancer. Meanwhile, the exact relationship between nutrition and frailty was explored. The presence of malnutrition was determined using Mini-Nutritional Assessment Short Form (MNA-SF), Nutrition Risk Screening 2002 (NRS2002), and a batch of laboratory parameters. A cross-sectional study of 265 eligible elderly inpatients with gastrointestinal cancer was conducted. The results showed that the prevalence of malnutrition classified by MNA-SF, NRS2002, albumin, prealbumin, total protein, hemoglobin, and total lymphocyte count were 66.8%, 68.7%, 41.5%, 27.9%, 39.2%, 40.8%, and 15.5%, respectively. There was a fair agreement between MNA-SF and NRS2002 (Kappa = 0.335, P < 0.001) in screening malnutrition. According to the albumin criterion, both MNA-SF and NRS2002 exhibited better sensitivity (72.7% and 76.4%, respectively) but poor specificity (37.4% and 36.8%, respectively) in screening malnutrition. A significant linear correlation between MNA-SF (NRS2002) and frailty was discovered (β=-0.259 and β = 0.412, respectively, P < 0.001). By identifying malnutrition in this elderly population, targeted plans can be developed as a part of cancer treatment and care. A better nutritional screening tool with both high sensitivity and specificity should be selected or developed.
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Affiliation(s)
- Qianqian Zhang
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Shihui Yu
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Qingfeng Li
- Department of Nursing, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Meng Zhang
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Lei Meng
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Shaohua Hu
- Department of Nursing, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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16
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Uslu A, Canbolat O. Relationship Between Frailty and Fatigue in Older Cancer Patients. Semin Oncol Nurs 2021; 37:151179. [PMID: 34275706 DOI: 10.1016/j.soncn.2021.151179] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 06/11/2021] [Accepted: 06/16/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Older patients with cancer present many symptoms during treatment. One of those symptoms is fatigue, which may be caused by factors unrelated to cancer. One of those factors is frailty increased with age. Frailty and fatigue affect older patients with cancer physically, psychosocially, emotionally, and spiritually. This study investigated the relationship between frailty and fatigue in older patients with cancer. DATA SOURCES This descriptive study was conducted between July 15, 2019, and February 15, 2020, in the medical oncology polyclinic and the medical oncology outpatient treatment unit of a university hospital. The sample consisted of voluntary 288 patients who met inclusion criteria. Data were collected using a demographic questionnaire and the Edmonton Frail Scale (EFS), and the Cancer Fatigue Scale (CFS). CONCLUSION The mean age of participants was 71.71 ± 5.29 years. Participants had a mean EFS score of 6 ± 3.21. Of participants, 36.1% were not frail, while 20.1% were vulnerable, 19.1% moderately frail, 17.7% mildly frail, and 6.9% severely frail. Participants had a mean CFS score of 21.41 ± 12.25. There was a positive correlation between EFS and CFS scores (P = .000, r = 0.734). Of participants, 63.8% were frail with physical and cognitive fatigue. The higher the frailty, the higher the fatigue. IMPLICATIONS FOR NURSING PRACTICE Elderly patients with cancer appear to be fragile, with frailty causing fatigue and many other conditions. It is important to determine the frailty and fatigue of elderly patients with cancer. It is essential understand the relationship between the frailty and fatigue for effective and correct management of nursing care.
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Affiliation(s)
- Arzu Uslu
- Faculty of Nursing, Department of Internal Medicine Nursing, Necmettin Erbakan University, Konya, Turkey.
| | - Ozlem Canbolat
- Faculty of Health Science, Department of Internal Medicine Nursing, Gazi University, Ankara, Turkey
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17
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Zhang X, Tang M, Zhang Q, Zhang KP, Guo ZQ, Xu HX, Yuan KT, Yu M, Braga M, Cederholm T, Li W, Barazzoni R, Shi HP. The GLIM criteria as an effective tool for nutrition assessment and survival prediction in older adult cancer patients. Clin Nutr 2021; 40:1224-1232. [DOI: 10.1016/j.clnu.2020.08.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 01/04/2023]
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18
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Sonneborn-Papakostopoulos M, Dubois C, Mathies V, Heß M, Erickson N, Ernst T, Huebner J. Quality of life, symptoms and dietary habits in oncology outpatients with malnutrition: A cross-sectional study. Med Oncol 2021; 38:20. [PMID: 33543336 PMCID: PMC7862192 DOI: 10.1007/s12032-021-01460-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/01/2021] [Indexed: 01/06/2023]
Abstract
Cancer-related malnutrition has a high prevalence, reduces survival and increases side effects. The aim of this study was to assess oncology outpatients and risk of malnutrition. Reported symptoms and quality of life (QoL) in patients found to be at risk of malnutrition or malnourished were compared to patients without malnutrition. Using a standardized questionnaire, the European Organization for Research and Treatment of Cancer Questionnaire for Quality of Life and the Mini Nutritional Assessment (MNA), patients in an outpatient cancer clinic undergoing chemotherapy treatment at a German University Hospital were assessed for nutrition, risk of malnutrition and quality of life. Based on the MNA, 39 (45.9%) patients were categorized as malnourished or at risk for malnutrition. Loss of appetite (n = 37.6%, p < 0.001) and altered taste sensation (n = 30,3%, p < 0.001) were the symptoms most frequently associated with reduced food intake. Patients with risk of malnutrition scored lower on the global health status (n = 48.15%, p = 0.001). Side effects of cancer treatments lead to a higher risk of malnutrition and as a consequence lower QoL. These side effects should be addressed more efficiently in cancer care.
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Affiliation(s)
| | - Clara Dubois
- Klinik für Innere Medizin II, University Hospital Jena, Jena, Germany
| | - Viktoria Mathies
- UniversitätsTumorCentrum Jena, University Hospital Jena, Bachstraße 18, 07743, Jena, Germany.
| | - Mara Heß
- Klinik für Innere Medizin II, University Hospital Jena, Jena, Germany
| | - Nicole Erickson
- Comprehensive Cancer Center CCCLMU, Ludwig-Maximilian University Clinic, Munich, Germany
| | - Thomas Ernst
- Klinik für Innere Medizin II, University Hospital Jena, Jena, Germany
| | - Jutta Huebner
- Klinik für Innere Medizin II, University Hospital Jena, Jena, Germany
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19
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Associations between the quality of life in sarcopenia measured with the SarQoL® and nutritional status. Health Qual Life Outcomes 2021; 19:28. [PMID: 33482832 PMCID: PMC7821480 DOI: 10.1186/s12955-020-01619-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 11/04/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the relationship between nutritional status and health-related quality of life after adjusting for essential factors of muscle mass, calf circumference, grip strength, and the timed up and go (TUG) test for diagnosis of sarcopenia. METHODS The subjects of this study were those who visited a health care center or a senior welfare center among the aged 65 years or older living in a community in two counties (Jinju, Sacheon), and the survey was conducted from April to August 2019. Among them, those with cardiovascular disease, cognitive disorder, or malignancy were excluded. To determine the nutritional status of the elderly subjects, a questionnaire-based screening tool called DETERMINE was used. Developed as a health-related quality of life tool for sarcopenia, the Sarcopenia-specific Quality of Life (SarQoL) questionnaire was used. For screening of sarcopenia, a rapid questionnaire based on self-reported information about falls, mobility, and strength known as the SARC-F questionnaire was used. Assessment of sarcopenia included skeletal muscle mass, calf circumference, grip strength, and the TUG test. RESULTS A total of 324 elderly people living in rural villages who were able to move to senior and welfare centers was surveyed. As a result of evaluating the association between SarQoL and nutritional risk in elderly subjects, the association was statistically significant in the moderate-risk group (B = - 5.542, p = 0.001) and in the high-risk group (B = - 8.136, p < 0.001) in comparison to the low-risk group. Significant correlations were found in all seven domains of SarQoL, except the fear domain. CONCLUSIONS This study confirms an association between quality of life dimensions surveyed by the SarQoL questionnaire and nutritional status in elderly subjects. Therefore, appropriate interventions are needed following brief evaluation of sarcopenia and nutritional deficiency among elderly people in communities.
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Lorenzon L, Brandl A, Guiral DC, Hoogwater F, Lundon D, Marano L, Montagna G, Polom K, Primavesi F, Schrage Y, Gonzalez-Moreno S, Kovacs T, D'Ugo D, Sandrucci S. Nutritional assessment in surgical oncology: An ESSO-EYSAC global survey. Eur J Surg Oncol 2020; 46:2074-2082. [PMID: 32938568 DOI: 10.1016/j.ejso.2020.08.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/21/2020] [Accepted: 08/28/2020] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION The majority of cancer patients report malnutrition, with a significant impact on patient's outcome. This study aimed to compare how nutritional assessment is conducted across different surgical oncology sub-specialties. METHODS Survey modules were designed for breast, hepato-pancreato-biliary (HPB), upper-gastrointestinal (UGI), sarcoma, peritoneal and surface malignancies (PSM) and colorectal cancer (CRC) surgeries to describe 4 domains: participants' setting, evaluation of clinical factors, use of screening tools and clinical practice. Results were compared among sub-specialties and according to human development index (HDI) in the largest cohorts. RESULTS Out of 457 answers from 377 global participants (62% European), 35.0% were from breast and 28.9% were from CRC surgeons. Although MDTs management is consistently reported (64-88%), the presence of a nutritionist/dietician ranges from 14.1% to 44.2%. Breast surgeons seldom evaluate albumin (25.6%) and weight loss (30.6%), opposite to HPB, PSM and UGI groups (>70%, p 0.044). Overall, responders declared that the use of screening tools is largely neglected, that nutritional status is often assessed by the surgeons and that nutrition is not consistently modified according to risk factors (range among groups respectively: 1.9%-25.6%, 33.1%-51.4%, 33.1%-60.5%). Less than 20% of breast surgeons assess patients before/after surgery, comparing to >60% of PSM surgeons. However, no statistical differences were documented comparing groups for the majority of the items of the 4 domains. Nutritional evaluation is more often conducted by breast surgeons in medium/low HDI countries comparing very high/high HDI (p 0.04). CONCLUSIONS Nutritional assessment is largely neglected. These results identify target-issues for the implementation of clinical practice.
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Affiliation(s)
- Laura Lorenzon
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy.
| | - Andreas Brandl
- Champalimaud Centre for the Unknown, Digestive Unit, Lisbon, Portugal
| | - Delia Cortes Guiral
- Universitary Hospital Principe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Frederik Hoogwater
- University Medical Center, Department of Surgery, Groningen, Netherlands
| | - Dara Lundon
- The Conway Institute, University College Dublin, Dublin, Ireland
| | - Luigi Marano
- University of Siena, Department of Medicine, Surgery, and Neurosciences, Siena, Italy
| | - Giacomo Montagna
- Universitätsspital Basel Switzerland, Department of Surgery, Basel, Switzerland
| | - Karol Polom
- Medical University of Gdansk, Department of Surgical Oncology, Gdansk, Poland
| | - Florian Primavesi
- Medical University of Innsbruck, Department of Visceral, Transplant and Thoracic Surgery, Innsbruck, Austria
| | - Yvonne Schrage
- Leiden University Medical Center, Department of Surgery, Leiden, Netherlands
| | | | - Tibor Kovacs
- Breast Surgery Unit, Guy's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Domenico D'Ugo
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy
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21
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Saragiotto L, Leandro-Merhi VA, Aquino JLBD, MendonÇa JA. GASTROINTESTINAL CHANGES DURING NUTRITIONAL FOLLOW-UP OF CANCER PATIENTS UNDERGOING OUTPATIENT CHEMOTHERAPY. ARQUIVOS DE GASTROENTEROLOGIA 2020; 57:354-360. [PMID: 33237213 DOI: 10.1590/s0004-2803.202000000-68] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 08/07/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Cancer patients may have gastrointestinal changes that influence nutritional status. OBJECTIVE To investigate the occurrence of gastrointestinal changes resulting from outpatient chemotherapy treatment in cancer patients. METHODS In a retrospective longitudinal study, the nutritional status and chemotherapy gastrointestinal changes (nausea, vomit, diarrhea, constipation, mucositis, dysphagia, xerostomia, inappetence, dysgeusia and heartburn) in cancer patients (n=187) were investigated in an outpatient follow-up. For the study of the parameters over time, the generalized estimating equation (GEE) method was used. Kruskal-Wallis, Mann-Whitney tests and Spearman coefficient, at a significance level of 5% were also used. RESULTS The majority of the patients were female (63.64%) and the mean age was 57.5±12.1 years. The most frequent symptoms were nausea (18.54%); inappetence (18.31%); intestinal constipation (11.58%); diarrhea (7.98%); xerostomia (7.59%) and vomiting (7.43%). The nutritional status did not exhibit any relevant changes (P=0.7594). However, a higher prevalence of eutrophy was observed, followed by overweight; vomiting exhibited a significant difference (P=0.0211). The nausea symptom exhibited a significant difference with a higher prevalence of colorectal neoplasia when compared to breast neoplasia (P=0.0062); as well as vomiting in lung and colorectal neoplasias (P=0.0022), and dysphagia, in head and neck neoplasia, when compared to other neoplasms (P<0.001). There was a statistically significant difference between the number of medical appointments and gender (P=0.0102) and between dysphagia and gender (P<0.0001). CONCLUSION The study findings enhance the need for signs and symptoms follow up, as well as nutritional status follow up of patients undergoing outpatient chemotherapy.
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Affiliation(s)
- Laiz Saragiotto
- Programa de Pós-Graduação em Ciências da Saúde, PUC-Campinas, SP, Brasil
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22
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Abd Allah ES, Gad HMM, Abdel-Aziz HR. Nutritional Status and Its Contributing Factors among Older Adults with Cancer Receiving Chemotherapy. Clin Nurs Res 2020; 29:650-658. [PMID: 32755230 DOI: 10.1177/1054773820947953] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The study aimed to assess nutritional status and its contributing factors among older adults with cancer receiving chemotherapy so, a descriptive study design was used. The study was conducted at Zagazig University Hospitals, Egypt. The study's sample was selected purposively which composed of 194 older adults. Nutritional status was measured by the Arabic version of the Mini-Nutritional Assessment (MNA). Contributing factors were identified by examining the relationship of nutritional status with demographic and clinical variables. Study results revealed that 33% of the older patients were malnourished and 51.5% were at risk for malnutrition. Statistically significant relations were found between nutritional status and advanced age, illiteracy, insufficient monthly income, comorbidities, cancer stage four at diagnosis, and receiving ≥4 chemotherapy cycles. High prevalence of malnutrition and many contributing factors were identified among older patients with cancer receiving chemotherapy. So, continuous malnutrition screening along chemotherapy courses with special concern for contributing factors assessed in this study is recommended.
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Affiliation(s)
- Eman Shokry Abd Allah
- Professor of Community Health Nursing and Gerontological Nursing, Gerontological Nursing Department, Faculty of Nursing, Zagazig University, Egypt
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23
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Abstract
Cancer occurs most frequently in patients aged 65 and older. With the increasing age of the world's population, there will be a significant increase in cancer diagnoses in older adults. Aging imposes a wide variety of physiological responses, comorbidities, and ailments, but older patients are less represented in clinical studies. Specific needs of older patients with cancer often go under-recognized and consequently unmet. In this review, common diagnoses that can affect the outcomes of this population, including frailty, malnutrition, and delirium, are discussed. Areas that need further research to improve the care of geriatric cancer patients, particularly in the hospital settings, are also identified.
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Affiliation(s)
- Anne M Meehan
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Lena Kassab
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Haixia Qin
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
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24
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Schneider SM, Correia MITD. Epidemiology of weight loss, malnutrition and sarcopenia: A transatlantic view. Nutrition 2019; 69:110581. [PMID: 31622908 DOI: 10.1016/j.nut.2019.110581] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Malnutrition is a common comorbidity in patients with cancer, with determinants linked to the patients, the tumor, and the treatment. Cancer malnutrition, also called cachexia, represents the chronic form of disease-related malnutrition with chronic inflammation, and strongly impairs the prognosis. Reduced muscle mass, otherwise called sarcopenia in these patients, is a feature of malnutrition and thus of cancer cachexia that may appear before weight loss, and has a strong negative effect on prognosis, as well. The reported global prevalence of loss of muscle mass is 39%, whereas the prevalence of malnutrition in important cohorts varies from 25% to 70%. This is mostly due to the very different screening and diagnostic tools used throughout the world. The recent Global Leadership Initiative on Malnutrition has become a consensus alternative to standardize how malnutrition may be diagnosed based on etiologic and phenotypic criteria available everywhere, from rich to poor countries. This will lead to an easier diagnosis of cancer malnutrition that itself will help us speak the same language worldwide.
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Affiliation(s)
- Stéphane M Schneider
- Centre Hospitalier Universitaire de Nice, and Université Côte d'Azur, Nice, France.
| | - M Isabel T D Correia
- Medical School, Universidade Federal de Minas Gerais, and Eterna - Nutrition Therapy Team, Rede Mater Dei, Belo Horizonte, MG, Brazil
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25
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Volkert D, Beck AM, Cederholm T, Cereda E, Cruz-Jentoft A, Goisser S, de Groot L, Großhauser F, Kiesswetter E, Norman K, Pourhassan M, Reinders I, Roberts HC, Rolland Y, Schneider SM, Sieber CC, Thiem U, Visser M, Wijnhoven HAH, Wirth R. Management of Malnutrition in Older Patients-Current Approaches, Evidence and Open Questions. J Clin Med 2019; 8:E974. [PMID: 31277488 PMCID: PMC6678789 DOI: 10.3390/jcm8070974] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 06/27/2019] [Accepted: 07/01/2019] [Indexed: 01/07/2023] Open
Abstract
Malnutrition is widespread in older people and represents a major geriatric syndrome with multifactorial etiology and severe consequences for health outcomes and quality of life. The aim of the present paper is to describe current approaches and evidence regarding malnutrition treatment and to highlight relevant knowledge gaps that need to be addressed. Recently published guidelines of the European Society for Clinical Nutrition and Metabolism (ESPEN) provide a summary of the available evidence and highlight the wide range of different measures that can be taken-from the identification and elimination of potential causes to enteral and parenteral nutrition-depending on the patient's abilities and needs. However, more than half of the recommendations therein are based on expert consensus because of a lack of evidence, and only three are concern patient-centred outcomes. Future research should further clarify the etiology of malnutrition and identify the most relevant causes in order to prevent malnutrition. Based on limited and partly conflicting evidence and the limitations of existing studies, it remains unclear which interventions are most effective in which patient groups, and if specific situations, diseases or etiologies of malnutrition require specific approaches. Patient-relevant outcomes such as functionality and quality of life need more attention, and research methodology should be harmonised to allow for the comparability of studies.
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Affiliation(s)
- Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, 90408 Nuremberg, Germany.
| | - Anne Marie Beck
- Department Nutrition and Health, University College Copenhagen, 2200 Copenhagen, Denmark
- Herlev and Gentofte University Hospital, 2703 Herlev, Denmark
| | - Tommy Cederholm
- Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, 701 05 Uppsala, Sweden
- Theme Ageing, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Emanuele Cereda
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Alfonso Cruz-Jentoft
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), 28034 Madrid, Spain
| | - Sabine Goisser
- Heidelberg University Centre for Geriatric Medicine and Network Aging Research (NAR), University of Heidelberg, 69126 Heidelberg, Germany
| | - Lisette de Groot
- Division of Human Nutrition, Wageningen University, 6708 WE Wageningen, The Netherlands
| | - Franz Großhauser
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, 90408 Nuremberg, Germany
| | - Eva Kiesswetter
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, 90408 Nuremberg, Germany
| | - Kristina Norman
- German Institute for Human Nutrition Potsdam-Rehbrücke, Department of Nutrition and Gerontology, 14558 Nuthetal, Germany
- Research Group on Geriatrics, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
- Institute of Nutritional Science, University of Potsdam, 14558 Nuthetal, Germany
| | - Maryam Pourhassan
- Department for Geriatric Medicine, Marien Hospital Herne-University Hospital, Ruhr-Universität Bochum, 44625 Herne, Germany
| | - Ilse Reinders
- Department of Health Sciences, Faculty of Science, and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Helen C Roberts
- Southampton NIHR Biomedical Research Centre, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK
| | - Yves Rolland
- Gérontopôle, Centre Hospitalo-Universitaire de Toulouse, 31059 Toulouse, France
| | - Stéphane M Schneider
- Nutritional Support Unit, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, 06200 Nice, France
| | - Cornel C Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, 90408 Nuremberg, Germany
- Department of Medicine, Kantonsspital Winterthur, 8401 Winterthur, Switzerland
| | - Ulrich Thiem
- Centre of Geriatrics and Gerontology, Albertinen-Haus, Hamburg, and Chair of Geriatrics and Gerontology, University Medical Centre Eppendorf, 20246 Hamburg, Germany
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science, and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Hanneke A H Wijnhoven
- Department of Health Sciences, Faculty of Science, and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Rainer Wirth
- Department for Geriatric Medicine, Marien Hospital Herne-University Hospital, Ruhr-Universität Bochum, 44625 Herne, Germany
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26
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Bozzetti F. Nutritional interventions in elderly gastrointestinal cancer patients: the evidence from randomized controlled trials. Support Care Cancer 2018; 27:721-727. [PMID: 30413927 DOI: 10.1007/s00520-018-4532-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 10/25/2018] [Indexed: 01/05/2023]
Abstract
Literature concerning nutritional interventions in elderly patients with gastrointestinal cancer, with special reference to randomized clinical trials, has been critically reviewed. This segment of oncologic population was found to be penalized by a high prevalence of malnutrition and sarcopenia which translated in an increased rate of toxicity from chemotherapy, poor compliance with oncologic treatments, and, finally, with a poor prognosis. Attempts to reverse this condition included a potentiation of nutrients intake which should sequentially proceed through the use of dietary counseling and administration of standard or ω-3 fatty acid-enriched oral supplements to finally come to enteral or parenteral nutrition. Randomized clinical trials investigating the effects of simple dietary advice and use of standard oral supplements were disappointing as regards long-term compliance and results. Nutritional and clinical benefits were reported with the use of ω-3 fatty acid-enriched oral supplements and especially with long-term supplemental parenteral nutrition. Despite the general recommendation of the scientific community that emphasizes the use of the enteral route, whenever possible, for delivering the nutritional support, it appears from the literature that more consistent benefits can be achieved, especially in the long-term nutritional support, when an insufficient oral nutrition is partnered with intravenous nutrition.
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Affiliation(s)
- Federico Bozzetti
- Faculty of Medicine, University of Milan, Via Festa del Perdono 11, 20100, Milan, Italy.
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27
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Mikkelsen MK, Lund CM, Vinther A, Tolver A, Ragle AM, Johansen JS, Chen I, Engell-Noerregaard L, Larsen FO, Zerahn B, Nielsen DL, Jarden M. Engaging the older cancer patient; Patient Activation through Counseling, Exercise and Mobilization - Pancreatic, Biliary tract and Lung cancer (PACE-Mobil-PBL) - study protocol of a randomized controlled trial. BMC Cancer 2018; 18:934. [PMID: 30261853 PMCID: PMC6161425 DOI: 10.1186/s12885-018-4835-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 09/18/2018] [Indexed: 01/06/2023] Open
Abstract
Background Several intervention studies have demonstrated that exercise training has beneficial effects among cancer patients. However, older cancer patients are underrepresented in clinical trials, and only few exercise-based studies have focused specifically on older patients with cancer. In particular, research investigating the effects of exercise training among older patients with advanced cancer is lacking. The purpose of the current study is to investigate the effect of a 12-week multimodal and exercise-based intervention among older patients (≥65 years) with advanced pancreatic, biliary tract or lung cancer, who are treated with first-line palliative chemotherapy, immunotherapy or targeted therapy. Methods PACE-Mobil-PBL is a two-armed randomized controlled trial. Participants will be randomized 1:1 to an intervention group (N = 50) or a control group (N = 50). Participants in the intervention group will receive standard oncological treatment and a 12-week multimodal intervention, comprised of: (I) supervised exercise training, twice weekly in the hospital setting, (II) home-based walking with step counts and goal-setting, (III) supportive and motivational nurse-led counseling, and (IV) protein supplement after each supervised training session. Participants in the control group will receive standard oncological treatment. The primary outcome is physical function measured by the 30-s chair stand test. Secondary outcomes include measures of feasibility, activity level, physical capacity and strength, symptom burden, quality of life, toxicity to treatment, dose reductions, inflammatory biomarkers, body weight and composition, hospitalizations and survival. Assessments will be conducted at baseline, and after 6, 12 and 16 weeks. Discussion The current study is one of the first to investigate the effect of an exercise-based intervention specifically targeting older patients with advanced cancer. PACE-Mobil-PBL supports the development of health promoting guidelines for older patients with cancer, and the study results will provide new and valuable knowledge in this understudied field. Trial registration The study was prospectively registered at ClinicalTrials.gov on January 26, 2018 (ID: NCT03411200). Electronic supplementary material The online version of this article (10.1186/s12885-018-4835-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marta Kramer Mikkelsen
- Department of Oncology and Hematology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark. .,Department of Oncology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev Ringvej 75, 2730, Herlev, Denmark.
| | - Cecilia Margareta Lund
- Department of Oncology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev Ringvej 75, 2730, Herlev, Denmark.,Department of Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev Ringvej 75, Herlev, 2730, Denmark
| | - Anders Vinther
- Department of Rehabilitation, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev Ringvej 75, 2730, Herlev, Denmark.,QD-Research Unit, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev Ringvej 75, 2730, Herlev, Denmark
| | - Anders Tolver
- Data Science Laboratory, Department of Mathematical Sciences, University of Copenhagen, 2100 Copenhagen Ø, Denmark
| | - Anne-Mette Ragle
- Department of Rehabilitation, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev Ringvej 75, 2730, Herlev, Denmark
| | - Julia Sidenius Johansen
- Department of Oncology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev Ringvej 75, 2730, Herlev, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen N, Denmark.,Department of Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev Ringvej 75, Herlev, 2730, Denmark
| | - Inna Chen
- Department of Oncology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev Ringvej 75, 2730, Herlev, Denmark
| | - Lotte Engell-Noerregaard
- Department of Oncology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev Ringvej 75, 2730, Herlev, Denmark
| | - Finn Ole Larsen
- Department of Oncology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev Ringvej 75, 2730, Herlev, Denmark
| | - Bo Zerahn
- Department of Clinical Physiology and Nuclear Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev Ringvej 75, 2730, Herlev, Denmark
| | - Dorte Lisbet Nielsen
- Department of Oncology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev Ringvej 75, 2730, Herlev, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen N, Denmark
| | - Mary Jarden
- Department of Oncology and Hematology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.,Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, 1014 Copenhagen K, Denmark
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28
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Mislang AR, Di Donato S, Hubbard J, Krishna L, Mottino G, Bozzetti F, Biganzoli L. Nutritional management of older adults with gastrointestinal cancers: An International Society of Geriatric Oncology (SIOG) review paper. J Geriatr Oncol 2018; 9:382-392. [PMID: 29396234 DOI: 10.1016/j.jgo.2018.01.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 11/28/2017] [Accepted: 01/08/2018] [Indexed: 12/15/2022]
Abstract
Malnutrition is one of the most common physical manifestations of gastrointestinal (GI) cancers and is often under-diagnosed and under-treated. Like cancers, malnutrition occurs more commonly in older adults, with potential negative consequences to quality of life, functional status, tolerance to treatment, and prognosis. Nutritional assessment and management require a proactive and systematic, multi-disciplinary approach. Early assessment, detection, and prompt intervention of cancer-associated malnutrition and cachexia are equally essential to achieve better quality nutritional care for older oncology patients. This article aims to provide an overview of the evidence associated with poor nutrition and outcomes in older adults with GI cancers, and recommends a management approach from a geriatric oncologist's perspective.
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Affiliation(s)
- Anna Rachelle Mislang
- Medical Oncology Department, Nuovo Ospedale-Santo Stefano, Instituto Toscano Tumori, 59100 Prato, Italy; Cancer Clinical Trials Unit, Department of Medical Oncology, Royal Adelaide Hospital, 1 Port Road, Thebarton, South Australia 5000, Australia
| | - Samantha Di Donato
- Medical Oncology Department, Nuovo Ospedale-Santo Stefano, Instituto Toscano Tumori, 59100 Prato, Italy
| | - Joleen Hubbard
- Mayo Clinic Medical Oncology, 200 First St. SW, Rochester, MN 55905, United States
| | - Lalit Krishna
- Duke-NUS Graduate Medical School, Singapore; National Cancer Centre Singapore, Singapore; Centre of Biomedical Ethics at National University Singapore, Singapore
| | - Giuseppe Mottino
- Geriatric Medicine, Nuovo Ospedale-Santo Stefano, 59100 Prato, Italy
| | - Federico Bozzetti
- Faculty of Medicine, University of Milan, Via Festa del Perdono, 7, 20122 Milan, Italy
| | - Laura Biganzoli
- Medical Oncology Department, Nuovo Ospedale-Santo Stefano, Instituto Toscano Tumori, 59100 Prato, Italy.
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