A Albumina Sérica é Preditor Independente de Mortalidade Hospitalar em Pacientes com Câncer

Introdução: O câncer e uma das principais causas de morbidade e mortalidade em todo o mundo. Existem poucos estudos mostrando modelos ajustados com outros preditores de mortalidade por uma perspectiva de modelo conceitual. Objetivo: Verificar a predição de albumina e do Índice Nutricional Prognostico (IPN) com mortalidade intra-hospitalar em pacientes com câncer. Método: Estudo retrospectivo realizado de 2014 a 2016 com 262 pacientes com câncer (trato gastrointestinal, órgãos genitais masculinos, mama, metástases, trato urinário, cabeça e pescoço e outros). Foram coletados dados demográficos, hemograma, proteína C reativa, albumina e índices hematológicos (índice de prognostico nutricional - IPN; relação neutrófilo por linfócitos - RNL; relação monócitos por linfócitos - RML; relação plaquetas por linfócitos - RPL; e relação plaquetas por albumina – RPA), diagnósticos nutricionais e desfechos hospitalares (alta ou óbito). A probabilidade cumulativa de morte foi calculada pelas curvas de Kaplan-Meier e as análises de sobrevivência realizadas usando o modelo de risco proporcional de Cox. Resultados: A frequência de óbito entre os pacientes do estudo foi de 10,7% (28). Entre os pacientes que morreram, 99,2% (26) apresentavam algum grau de desnutrição (p=0,004). Na análise multivariada, a albumina sérica (<3 g/dL) associou-se de forma independente a mortalidade hospitalar (HR=3,43, IC95% 1,11-10,63). Por outro lado, o IPN não foi associado com mortalidade intra-hospitalar. Conclusão: Os níveis de albumina sérica durante a internação foram preditores de mortalidade intra-hospitalar na população avaliada. Esses resultados sugerem que os níveis séricos dessa proteína podem ser utilizados na prática clínica, agregando informações prognosticas em pacientes com câncer.

Health-related quality of life became worse in short-term during treatment in head and neck cancer patients: a prospective study

BACKGROUND

Quality of life (QoL) is influenced in head and neck cancer (HNC) patients by a set of factors related to diagnosis, treatment and tumor impacts. The aim of this study was to evaluate the Quality of Life (QoL) changes in Head and Neck cancer (HNC) patients during treatment (radiotherapy and/or chemoradiotherapy).

METHODS

QoL was evaluated prospectively in 63 HNC patients during radiotherapy and/or chemoradiotherapy at three moments: before or at beginning (T0), in the middle (T1 ~ four weeks) and immediately at the end (T2 ~ eight weeks) of treatment. The differences between the scores at different time points was verified using Friedman's non-parametric test. Negative changes between time points were evaluated, with differences (delta) of ±10 points being considered to be clinically significant.

RESULTS

The total mean age was 59.1 ± 9.5y, and 82.5% were male. The oral cavity and larynx were more frequent tumors. The functional score for 'role' was decreased at time points T1 and T2 as compared to T0, while an improvement in scores was observed for cognitive function. Several physical symptoms also worsened over time, such as: fatigue, nausea and vomiting, dry mouth and sticky saliva, swallowing and skin symptoms, senses and teeth problems. A high frequency of altered and clinically meaningful values were observed for most of domains, ranging from 6 to 74%.

CONCLUSIONS

The QoL became worse at approximately one month after treatment beginning in HNC patients, and this remained until the end of therapy. Protocols directing to early nutritional counseling and management of symptoms of nutritional impact are important to improve clinical outcomes. This is part of preventive actions aiming to make the exhausting treatment process less traumatic and easier to complete.

Oral Nutritional Supplementation Affects the Dietary Intake and Body Weight of Head and Neck Cancer Patients during (Chemo) Radiotherapy

Considering the symptoms of (chemo) radiotherapy and the reduction in food intake in head and neck cancer (HNC) patients, this study aimed to investigate the association between treatment time points and oral nutritional supplementation (ONS) on dietary intake to estimate the frequency of energy and nutrient inadequacy, and also to evaluate body weight changes (BWC). Dietary intake data of 65 patients were obtained from 24-h dietary recalls and prevalence of inadequacy was calculated before or at the beginning (T0), in the middle (T1), and at the end of treatment (T2). BWC were calculated as the weight difference considering the previous weight reported and/or measured. Energy and macronutrient intake decreased in T1 and then improved in T2 (p < 0.001 for both). Micronutrient intake increased during treatment due to ONS use, but still presented a high probability of inadequate intake. In particular, calcium, magnesium, and vitamin B6 showed almost 100% of probability of inadequacy for those who did not use ONS. Finally, overweight patients suffered a higher weight accumulated deficit with a delta of −15 kg compared to other BMI (body mass index) categories. Therefore, we strongly recommend initiating nutritional counseling in conjunction with prophylactic ONS prescription from diagnosis to adjust nutrient intake and minimize weight loss.

Combination of red blood cell distribution width and body mass index (COR-BMI) predicts in-hospital mortality in patients with different diagnoses?

Background

The combination of red blood cell distribution width and body mass index (COR-BMI) is indicated as a new prognostic index of survival in patients with laryngeal cancer. However, the ability of this prediction in other types of cancer or whether its use can be expanded to non-oncological patients is unknown. The aim of this study was to investigate the prediction of prognosis of in-hospital mortality of the COR-BMI in oncological and non-oncological patients.

Methods

A retrospective study was performed with all hospitalized patients between 2014 and 2016, totaling 2930 patients, 262 oncological and 2668 non-oncological. The COR-BMI was divided into three classes: 0, RDW ≤ 13.1% and BMI ≥ 25 kg/m²; 1, RDW ≤ 13.1% and BMI < 18.5 or ≥ 18.5 but < 25 kg/m² and RDW > 13.1% and BMI ≥ 18.5 but < 25 or BMI ≥ 25 kg/m²; and 2, RDW > 13.1% and BMI < 18.5 kg/m². In order to analyze the relationship between COR-BMI and in-hospital mortality in the studied population, the Cox Proportional Hazards Model was used in a multivariate analysis based on a conceptual model.

Results

The COR-BMI was an independent predictor of in-hospital mortality in non-oncological patients (1 versus 0: HR = 3.34; CI = 1.60–6.96, p = 0.001; 2 versus 0: HR = 3.38; CI = 1.22–9.39, p = 0.019). The survival rate of these patients was lower among those with the highest scores on the COR-BMI. This prediction was not found in oncological patients.

Conclusion

The present study suggests that the COR-BMI may have its practical use expanded to non-oncological patients as an independent predictor of in-hospital mortality.