The effect of individual nutritional support and nurse follow-up on weight loss during radiotherapy in cancer patients
Öz
Purpose:The aim of this study was to evaluate the nutritional status of patients receiving definitive or adjuvant radiotherapy with head and neck, pelvic, thorax and intraabdominal tumors and to determine their weight loss.
Patients and Methods:40 patients admitted to the radiation oncology outpatient clinic since 01.11.2015 and planned head, thoracic, abdominal and pelvic radiotherapy were included in the study. The patients were evaluated before the treatment and in addition to the daily nutrition of the patients, special nutritional support was provided as 35 kcal/kg energy, 2gr/kg protein and 15 mg glutamine daily. The weight loss of the patients evaluated by radiation oncologist and nurse was recorded.
Results:The mean age was 61 years (range, 39-86 years). 9 patients with lung cancer were over 70 years old and had definitive radiotherapy. All patients underwent radiotherapy treatment without interrupting treatment, except for a 86-year-old patient scheduled for adjuvant therapy with gastric cancer and two patients with lung cancer receiving chemoradiotherapy. 72% of the patients continued their nutritional support during the entire treatment. When weight loss was evaluated, only 8% of patients had more than 10% weight loss. According to the nutritional support, weight loss rates were found to be significantly lower in patients who fully applied nutritional support (p: 0.003).
Conclusion:Early and intense nutritional support of cancer patients with risk of malnutrition may lead to less weight loss during radiotherapy.
Anahtar Kelimeler
Kaynakça
- 1. Laviano A, Meguid MM., Nutritional issues in cancer management. Nutrition. 1996; 12(5): 358-71.
- 2. Bozzetti F. Nutrition support in patients with cancer. In: Payne-James J, Grimble G, Silk D, editors. Artificial Nutrition Support in Clinical Practice. 2nd ed. London; 2001, 639-80.
- 3. Bozzetti F, Mariani L, Lo Vullo S, Group SW, Amerio ML, Biffi R, et al: The nutritional risk in oncology: a study of 1,453 cancer outpatients. Support Care Cancer 2012, 20(8):1919-1928. doi: 10.1007/s00520-012-1387-x
- 4. Dewey A, Baughan C, Dean TP, Higgins B, Johnson I. Eicosapentaenoicacid (EPA, an omega-3 fatty acid from fish oils) for the treatment of cancer cachexia. Cochrane Database Syst Rev. 2007; CD004597.
- 5. Correia MI, Waitzberg DL. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr. 2003; 22: 235-9.
- 6. Naber THJ, Schermer T, Bree A, Nusteling K, Eggink L, Kruimel JW, et al. Prevalence of malnutrition in nonsurgical hospitalized patients and its association with disease complications. Am J Clin Nutr. 1997; 66: 1232-9.
- 7. Schattner M, Shike M. Nutrition support of the patient with cancer. In: Shils ME, et al., editors. Modern nutrition in health and disease. 10th ed. Philadelphia: Lippincott Williams & Wilkins; 2005. p. 1290-313.
- 8. Fearon K, et al. Definition and classification of cancer cachexia: an international consensus. Lancet Oncol. 2011;12: 489–95.
- 9. Baracos VE, et al. Cancer-associated cachexia. Nat Rev Dis Prim. 2018;4: 17105.
- 10. De Van Der Schueren MAE, et al. Systematic review and meta- analysis of the evidence for oral nutritional intervention on nutritional and clinical outcomes during chemo(radio)therapy: current evidence and guidance for design of future trials. Ann Oncol. 2018; 29: 1141–53.
- 11. Isenring EA, Capra S. Nutrition intervention is beneficial in oncology outpatients receiving radiotherapy to the gastrointestinal or head and neck area. Br J Cancer. 2004; 91: 447-52.
- 12. Ravasco P, Monteiro-Grillo I, Marques Vidal P, Camilo ME. Dietary counseling improves patient outcomes: a prospective, randomised, controlled trial in colorectal cancer patients undergoing radiotherapy. J Clin Oncol. 2005; 23: 1431-8.
- 13. Paccagnella A, Morello M, Da Mosto MC, Baruffi C, Marcon ML, Gava A, et al. Early nutritional intervention improves treatment tolerance and outcomes in head and neck cancer patients undergoing concurrent chemoradiotherapy. Support Care Cancer; 2010: 18: 837-45.
- 14. Isenring E, Capra S, Bauer J. Patient satisfaction is rated higher by radiation oncology outpatients receiving nutrition intervention compared with usual care. J Hum Nutr Diet. 2004; 17:145–52.
- 15. Langius JA, Bakker S, Rietveld DH, Kruizenga HM, Langendijk JA, Weijs PJ, et al. Critical weight loss is a major prognostic indicator for disease-specific survival in patients with head and neck cancer receiving radiotherapy. Br J Cancer. 2013; 109: 1093–9.
- 16. Stratton R, Elia M. A critical, systematic analysis of the use of oral nutrition supplements in the community. Clin Nutr. 1999; 18: 29–84.
- 17. Evans WK, Nixon DW, Daly JM, Ellenberg SS, Gardner L, Wolfe E, et al. A randomized study of oral nutritional support versus ad lib nutritional intake during chemotherapy for advanced colorectal and non-small-cell lung cancer. J Clin Oncol. 1987; 5: 113-24.
- 18. Ovesen L, Allingstrup L, Hannibal J, Mortensen EL, Hansen OP. Effect of dietary counseling on food intake, body weight, response rate, survival, and quality of life in cancer patients undergoing chemotherapy: a prospective, randomized study. J Clin Oncol. 1993; 11: 2043-49.
- 19. Baldwin C, Parsons T, Logan S. Dietary advice for illness-related malnutrition in adults. In: The Cochrane Library issue 2. Oxford; 2004. Update Software.
- 20. Capra S, Bauer J, Davidson W, Ash S. Nutritional therapy for cancer- induced weight loss. Nutr Clin Pract. 2002; 17: 210-13.
- 21. The American Dietetic Association and Morrison Health Care. Medical Nutrition Therapy Across the Continuum of Care. 2nd ed. Chicago, IL: American Dietetic Association; 1998.
- 22. Isenring EA, Bauer JD, Capra S. Nutrition Support Using the American Dietetic Association Medical Nutrition Therapy Protocol for Radiation Oncology Patients Improves Dietary Intake Compared with Standard Practice. Journal of the American Dietetic Association. 2007; 107(3), 404–12.
Kanserli hastalarda radyoterapi sırasında hastaya özel beslenme desteği ve hemşire takibi yapılmasının kilo kaybı üzerine etkisi
Öz
Amaç:Çalışmanın amacı baş ve boyun kanserli, toraks, üst batın ve pelvis yerleşimli tümör tanısı ile definitif veya adjuvan radyoterapi almakta olan hastaların beslenme durumlarını değerlendirmek ve tedavi sırasında yapılan beslenme desteği ile kilo takiplerini tespit etmektir.
Hastalar ve Yööntem:Çalışmaya Radyasyon Onkolojisi polikliniğine 01.11.2015 tarihinden itibaren başvuran ve baş boyun, torakal, batın ve pelvik radyoterapi planlanan rastgele 40 hasta dahil edilmiştir. Hastalar tedavi öncesi değerlendirilmiş ve hastaların gündelik beslenmelerine ek olarak günlük 35 kcal/kg enerji, 2gr/kg protein ve 15 mg glutamin olarak özel beslenme destekleri sağlanmıştır. Poliklinik kontrollerinde radyasyon onkoloğu ve hemşiresi tarafından beraber değerlendirilen hastaların kilo kayıpları kaydedilmiştir.
Bulgular:Hastalarda ortalama yaş 61 (39-86 yaş) idi. 5’i akciğer kanseri olan 9 hasta 70 yaş üzerindedir ve definitif radyoterapi uygulanmıştır. Mide kanseri ile adjuvan tedavi planlanan 86 yaşındaki bir hasta ve akciğer kanseri ile kemoradyoterapi alan iki hasta dışında tüm hastalar tedaviye ara vermeden radyoterapi tedavisini almışlardır. Hastaların %72’i tüm tedavi boyunca beslenme desteklerine devam etmişlerdir. Kilo kaybı değerlendirildiğinde ise sadece %8 hastada %10’dan fazla kilo kaybı görülmüştür. Beslenme desteğine göre kilo kayıp oranları beslenme desteğini tam uygulayanlarda kilo kaybının anlamlı olarak daha az olduğu görülmüştür (p:0.003).
Sonuç:Erken ve yoğun beslenme desteği uygulanarak malnütrisyon riski olan kanser hastalarında radyoterapi sırasında daha az kilo kaybı görülebilir.
Anahtar Kelimeler
Kaynakça
- 1. Laviano A, Meguid MM., Nutritional issues in cancer management. Nutrition. 1996; 12(5): 358-71.
- 2. Bozzetti F. Nutrition support in patients with cancer. In: Payne-James J, Grimble G, Silk D, editors. Artificial Nutrition Support in Clinical Practice. 2nd ed. London; 2001, 639-80.
- 3. Bozzetti F, Mariani L, Lo Vullo S, Group SW, Amerio ML, Biffi R, et al: The nutritional risk in oncology: a study of 1,453 cancer outpatients. Support Care Cancer 2012, 20(8):1919-1928. doi: 10.1007/s00520-012-1387-x
- 4. Dewey A, Baughan C, Dean TP, Higgins B, Johnson I. Eicosapentaenoicacid (EPA, an omega-3 fatty acid from fish oils) for the treatment of cancer cachexia. Cochrane Database Syst Rev. 2007; CD004597.
- 5. Correia MI, Waitzberg DL. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr. 2003; 22: 235-9.
- 6. Naber THJ, Schermer T, Bree A, Nusteling K, Eggink L, Kruimel JW, et al. Prevalence of malnutrition in nonsurgical hospitalized patients and its association with disease complications. Am J Clin Nutr. 1997; 66: 1232-9.
- 7. Schattner M, Shike M. Nutrition support of the patient with cancer. In: Shils ME, et al., editors. Modern nutrition in health and disease. 10th ed. Philadelphia: Lippincott Williams & Wilkins; 2005. p. 1290-313.
- 8. Fearon K, et al. Definition and classification of cancer cachexia: an international consensus. Lancet Oncol. 2011;12: 489–95.
- 9. Baracos VE, et al. Cancer-associated cachexia. Nat Rev Dis Prim. 2018;4: 17105.
- 10. De Van Der Schueren MAE, et al. Systematic review and meta- analysis of the evidence for oral nutritional intervention on nutritional and clinical outcomes during chemo(radio)therapy: current evidence and guidance for design of future trials. Ann Oncol. 2018; 29: 1141–53.
- 11. Isenring EA, Capra S. Nutrition intervention is beneficial in oncology outpatients receiving radiotherapy to the gastrointestinal or head and neck area. Br J Cancer. 2004; 91: 447-52.
- 12. Ravasco P, Monteiro-Grillo I, Marques Vidal P, Camilo ME. Dietary counseling improves patient outcomes: a prospective, randomised, controlled trial in colorectal cancer patients undergoing radiotherapy. J Clin Oncol. 2005; 23: 1431-8.
- 13. Paccagnella A, Morello M, Da Mosto MC, Baruffi C, Marcon ML, Gava A, et al. Early nutritional intervention improves treatment tolerance and outcomes in head and neck cancer patients undergoing concurrent chemoradiotherapy. Support Care Cancer; 2010: 18: 837-45.
- 14. Isenring E, Capra S, Bauer J. Patient satisfaction is rated higher by radiation oncology outpatients receiving nutrition intervention compared with usual care. J Hum Nutr Diet. 2004; 17:145–52.
- 15. Langius JA, Bakker S, Rietveld DH, Kruizenga HM, Langendijk JA, Weijs PJ, et al. Critical weight loss is a major prognostic indicator for disease-specific survival in patients with head and neck cancer receiving radiotherapy. Br J Cancer. 2013; 109: 1093–9.
- 16. Stratton R, Elia M. A critical, systematic analysis of the use of oral nutrition supplements in the community. Clin Nutr. 1999; 18: 29–84.
- 17. Evans WK, Nixon DW, Daly JM, Ellenberg SS, Gardner L, Wolfe E, et al. A randomized study of oral nutritional support versus ad lib nutritional intake during chemotherapy for advanced colorectal and non-small-cell lung cancer. J Clin Oncol. 1987; 5: 113-24.
- 18. Ovesen L, Allingstrup L, Hannibal J, Mortensen EL, Hansen OP. Effect of dietary counseling on food intake, body weight, response rate, survival, and quality of life in cancer patients undergoing chemotherapy: a prospective, randomized study. J Clin Oncol. 1993; 11: 2043-49.
- 19. Baldwin C, Parsons T, Logan S. Dietary advice for illness-related malnutrition in adults. In: The Cochrane Library issue 2. Oxford; 2004. Update Software.
- 20. Capra S, Bauer J, Davidson W, Ash S. Nutritional therapy for cancer- induced weight loss. Nutr Clin Pract. 2002; 17: 210-13.
- 21. The American Dietetic Association and Morrison Health Care. Medical Nutrition Therapy Across the Continuum of Care. 2nd ed. Chicago, IL: American Dietetic Association; 1998.
- 22. Isenring EA, Bauer JD, Capra S. Nutrition Support Using the American Dietetic Association Medical Nutrition Therapy Protocol for Radiation Oncology Patients Improves Dietary Intake Compared with Standard Practice. Journal of the American Dietetic Association. 2007; 107(3), 404–12.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Klinik Tıp Bilimleri |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 16 Aralık 2020 |
| Gönderilme Tarihi | 17 Haziran 2019 |
| Yayımlandığı Sayı | Yıl 2021Cilt: 12 Sayı: 1 |
