Evaluation of Nutritional Status in Cancer Patients Underwent Radiotherapy: The Results of Biochemical, Body Composition with Bioelectrical Impedance Analysis, Anthropometric Measurements, and Patient-Generated Subjective Global Assessment

Year 2023, , 746 - 752, 31.12.2023

Sümerya Duru Birgi , Dilşat Baş , Şeniz Öztürk , Pervin Hürmüz , Erdem Karabulut , Ahmetcan Çağlar , Melis Gültekin , Gözde Yazıcı , Gökhan Özyiğit

https://doi.org/10.54005/geneltip.1320764

Abstract

Aim: This study aims to evaluate the nutritional status and the effect of radiotherapy (RT) on nutrition in all ambulatory cancer patients.
Material and Method: In this prospective observational study 105 cancer patients with various diagnoses treated between 2013 and 2014 were evaluated. All patients were ≥18 years old and had Karnofsky Performance Status ≥70. Anthropometric measurements, body composition with bioelectric impedance, and patient-generated Subjective Global Assessment (PG-SGA) tools were used. The height, weight, body mass index (BMI), triceps skin fold thickness, mid-upper arm circumference, hemoglobin, and serum albumin levels were determined twice before and after RT. Additionally, nutrition-related symptoms and short-term weight loss results were determined by PG-SGA questionnaires.
Results: The patients’ median age was 53 years (range, 18-82 years). At initial evaluation 74 patients were well nourished using the PG-SGA global rating. Malnutrition developed in totally 33 of these 74 patients after RT. The PG-SGA results after RT were significantly worse than before treatment. PG-SGA revealed no significant relationship between nutritional status prior to RT and the parameters including gender, age, mean weight, BMI, disease duration, pre-RT hemoglobin and albumin levels. Post-RT evaluation showed a significant relationship between deterioration (PG-SGA B-C) and mean weight, BMI, serum albumin, hemoglobin levels, and concomitant chemotherapy. Gastrointestinal and head and neck cancer patients had the most deterioration after RT. The patients' weight, BMI, fat-free mass, total body water, and the percentage weight loss at the end of RT were significantly lower than the initial assessment.
Conclusion: It is considerable to use multiple tools for nutritional monitoring. Patients who received RT to the head and neck and upper abdomen region had a high risk of deterioration after treatment. These patients should be monitored carefully during all treatment periods.

Keywords

Nutrition assessment, Cancer, Radiotherapy, Bioelectrical impedance, Anthropometry

Radyoterapi Alan Kanser Hastalarında Beslenme Durumunun Değerlendirilmesi: Biyokimyasal, Biyoelektrik İmpedans Analizi ile Vücut Bileşimi, Antropometrik Ölçümler ve Hasta Tarafından Yapılan Subjektif Global Değerlendirme Sonuçları

Abstract

Amaç: Bu çalışma ayaktan tedavi gören tüm kanser hastalarında beslenme durumunu ve radyoterapinin (RT) beslenme üzerine etkisini değerlendirmeyi amaçlamaktadır.
Gereç ve Yöntem: Bu prospektif gözlemsel çalışmada 2013-2014 yılları arasında çeşitli tanılarla tedavi edilen 105 kanser hastası değerlendirildi. Tüm hastalar ≥18 yaşındaydı ve Karnofsky Performans Durumu ≥70 idi. Antropometrik ölçümler, biyoelektrik impedans ile vücut kompozisyonu ölçümü ve hasta tarafından oluşturulan Subjektif Global Değerlendirme (PG-SGA) araçları kullanıldı. RT öncesi ve sonrası olmak üzere iki kez boy, kilo, vücut kitle indeksi (VKİ), triseps deri kıvrım kalınlığı, orta-üst kol çevresi, hemoglobin ve serum albumin düzeyleri belirlendi. Ayrıca beslenme ile ilgili semptomlar ve kısa süreli kilo kaybı sonuçları PG-SGA anketleri ile değerlendirildi.
Bulgular: Hastaların medyan yaşı 53 yıl (aralık; 18-82 yıl) idi. PG-SGA global değerlendirmesine göre ilk değerlendirmede 74 hasta iyi beslenmiş grupta yer almaktaydı. Bu 74 hastanın 33’ünde RT’den sonra malnütrisyon gelişti. RT sonrası PG-SGA sonuçları, tedavi öncesine göre önemli ölçüde daha kötüydü. PG-SGA, RT öncesi beslenme durumu ile cinsiyet, yaş, ortalama ağırlık, VKİ, hastalık süresi, RT öncesi hemoglobin ve albumin seviyeleri gibi parametreler ile anlamlı bir ilişki göstermedi. RT sonrası değerlendirmede, beslenmede bozulma (PG-SGA B-C) ile ortalama ağırlık, VKİ, serum albumin, hemoglobin düzeyleri ve eş zamanlı kemoterapi arasında anlamlı bir ilişki gösterildi. Gastrointestinal ve baş-boyun tümörleri olan hastalar, RT'den sonra en fazla kötüleşmeye sahipti. Hastaların kilosu, VKİ, yağsız kitlesi, toplam vücut suyu ve RT sonunda kilo kaybı yüzdesi ilk değerlendirmeye göre anlamlı derecede düşüktü.
Sonuç: Beslenme monitörizasyonu için çoklu ölçekler kullanılması oldukça önemlidir. Baş-boyun ve üst karın bölgesine RT uygulanan hastalarda tedavi sonrası beslenmede kötüleşme riski yüksektir. Bu hastalar tüm tedavi dönemlerinde dikkatle izlenmelidir.

Keywords

Beslenme Değerlendirmesi, Kanser, Radyoterapi, Biyoelektriksel impedans analizi, Antropometri

References

• Ravasco P. Nutrition in Cancer Patients. J. Clin. Med. 2019; 8(8):1211
• Cederholm T, Bosaeus I, Barazzoni R, Bauer J, Van Gossum A, Klek S et al. Diagnostic criteria for malnutrition - An ESPEN consensus statement. Clin Nutr. 2015; 34(3):335–340
• Nitenberg G, Raynard B. Nutritional support of the cancer patient: issues and dilemmas. Crit Rev Oncol Hemato 2000; 34:137-168
• Hébuterne X, Lemarié E, Michallet M, de Montreuil CB, Schneider SM, Goldwasser F. Prevalence of malnutrition and current use of nutrition support in patients with cancer. JPEN J Parenter Enteral Nutr. 2014; 38(2):196-204
• Arends J, Baracos V, Bertz H, Bozzetti F, Calder PC, Deutz NEP, et al. ESPEN expert group recommendations for action against cancer-related malnutrition. Clin Nutr. 2017; 36(5):1187-1196
• Seiwert T, Cohen E. State-of-the-art management of locally advanced head and neck cancer. Br J Nurs. 2005; 92:1341-1348
• Bossi P, Delrio P, Mascheroni A, Zanetti M. The Spectrum of Malnutrition/Cachexia/Sarcopenia in Oncology According to Different Cancer Types and Settings: A Narrative Review. Nutrients. 2021; 13(6):1980
• Yin L, Chong F, Huo Z, Li N, Liu J, Xu H. GLIM-defined malnutrition and overall survival in cancer patients: A meta-analysis. JPEN J Parenter Enteral Nutr. 2023; 47(2):207-219
• Patricia Fuhrman M. Nutrition support for oncology patients. In: Marrian M, Roberts S. eds. Clinical nutrition for oncology patients. United States of America: Jones & Bartlett, 2010:32
• Kyle UG, Kossovsky MP, Karsegard VL, Pichard C. Comparison of tools for nutritional assessment and screening at hospital admission: a population study. Clin Nutr. 2006; 25(3):409-417
• Isenring EA, Banks M, Ferguson M, Bauer JD. Beyond malnutrition screening: appropriate methods to guide nutrition care for aged care residents. J Acad Nutr Diet. 2012; 112(3):376-381
• Lewis S. Nutrition screening. In: Shaw C. eds. Nutrition and cancer. Singapore: Wiley Blackwell, 2011:85,88
• Bauer JD, Ash S, Davidson WL, Hill JM, Brown T, Isenring EA et al. Evidence-based practice guidelines for the nutritional management of cancer cachexia. Nutr Diet 2006; 63:3-32
• Bauer J, Capra S, Ferguson M. Use of the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in cancer patients. Eur J Clin Nutr 2002; 56:779-785
• Cederholm T, Jensen GL, Correia M, Gonzalez MC, Fukushima R, Higashiguchi T et al. GLIM criteria for the diagnosis of malnutrition - a consensus report from the global clinical nutrition community. Clin Nutr. 2019; 38(1):1–9
• Jensen GL, Cederholm T, Correia M, Gonzales MC, Fukushima R, Higashiguchi T et al. GLIM criteria for the diagnosis of malnutrition: a consensus report from the global clinical nutrition community. JPEN J Parenter Enteral Nutr. 2019; 43(1):32–40
• Wang Y, Chen X, Wang Y, Liu Z, Fang Y, Peng Z, Liu W. Body Composition Measurement Improved Performance of GLIM Criteria in Diagnosing Malnutrition Compared to PG-SGA in Ambulatory Cancer Patients: A Prospective Cross-Sectional Study. Nutrients. 202; 13(8):2744
• Ottery FD. Patient generated subjective global assessment: In The Clinical Guide to Oncology Nutrition, McCallum P and Polisena C (eds.). Chicago,I L: The American Dietetic Association, 2000, pp. 11–23
• Bannerman E, Miller MD, Daniels LA, Cobiac L, Giles LC, et al. Anthropometricindices predict physical function and mobility in older Australians: The Australian Longitudinal Study of Aging. Public Health Nutr 2002; 5:655–662
• Bishop CW, Elisabeth Isenring, Giordana Cross, Elizabeth Kellett, Bogda Koczwara, Lynne Daniels et al. Nutritional Status and Information Needs of Medical Oncology Patients Receiving Treatment at an Australian Public Hospital Nutrition and Cancer, 2010; 62:2, 220-228
• Iron deficiency anemia: assessement, prevention and control, A guide for programme managers. Genebra: WHO, 2001
• Stratton RJ, Green CJ, Elia M. Disease-related malnutrition: anevidence-based approach. CAB International 2003
• Gupta D, Lammersfeld CA, Vashi PG, Dahlk SL, Lis CG. Can subjective global assessment of nutritional status predict survival in ovarian cancer? J Ovarian Res. 2008; 1(1):5
• Alberici Pastore C, Paiva Orlandi S, González MC. Association between an inflammatory-nutritional index and nutritional status in cancer patients. Nutr Hosp 2013; 28(1):188-193
• Khalid U, Spiro A, Baldwin C, Sharma B, McGough C, Norman AR, et al. Symptoms and weight loss in patients with gastrointestinal and lung cancer at presentation. Support Care Cancer. 2007; 15(1):39-46
• Wu BW, Yin T, Cao WX, Gu ZD, Wang XJ, Yan M, et al. Clinical application of subjective global assessment in Chinese patients with gastrointestinal cancer. World J Gastroenterol. 2009; 15(28):3542-3549
• Fanali G, di Masi A, Trezza V, Marino M, Fasano M, Ascenzi P. Human serum albumin: from bench to bedside. Mol Aspects Med. 2012; 33(3):209-290
• Muscaritoli M, Arends J, Aapro M. From guidelines to clinical practice: a roadmap for oncologists for nutrition therapy for cancer patients. Ther Adv Med Oncol. 2019; 11:1–14
• Pirlich M, Schutz T, Norman K, Gastell S, Lubke HJ, Bischoff SC, et al. The German hospital malnutrition study. Clin Nutr. 2006; 25(4):563-572
• Vidal A, Iglesias MJ, Pertega S, Avúcar A, Vidal O. Prevalence of malnutrition in medical and surgical wards of a university hospital. Nutr Hosp. 2008; 23(3):263-267
• E Isenring, J Bauer, S Capra. The scored Patient-generated Subjective Global Assessment (PG-SGA) and its association with quality of life in ambulatory patients receiving radiotherapy. European Journal of Clinical Nutrition 2003; 57:305–309
• Yin L, Liu J, Lin X, Li N, Guo J, Fan Y, et al. Nutritional features-based clustering analysis as a feasible approach for early identification of malnutrition in patients with cancer. Eur J Clin Nutr. 2021; 75(8):1291-1301
• Ottery F, Bender F & Kasenic S (2002): The design and implementationof a model of nutritional oncology program. Oncol. Iss. 17(2Suppl), 3–8
• Martin L, Watanabe S, Fainsinger R, Lau F, Ghosh S, Quan H, et al. Prognostic factors in patients with advanced cancer: use of the patient-generated subjective global assessment in survival prediction. J Clin Oncol. 2010; 28(28):4376-4383
• Montoya JE, Domingo F Jr, Luna CA, Berroya RM, Catli CA, Ginete JK, et al. Nutritional status of cancer patients admitted for chemotherapy at the National Kidney and Transplant Institute Singapore. Singapore Med J. 2010; 51(11):860-864
• Ramos Chaves M, Boléo-Tomé C, Monteiro-Grillo I, Camilo M, Ravasco P. The diversity of nutritional status in cancer: new insights. Oncologist. 2010; 15(5):523-530
• McRackan TR, Watkins JM, Herrin AE, Garrett-Mayer EM, Sharma AK, Day TA et al. Effect of body mass index on chemoradiation outcomes in head and neck cancer. Laryngoscope. 2008; 118(7):1180–1185
• Silver HJ, Dietrich MS, Murphy BA. Changes in body mass, energy balance, physical function, and inflammatory state in patients with locally advanced head and neck cancer treated with concurrent chemoradiation after low-dose induction chemotherapy. Head Neck.2007; 29:893–900
• Jeffery E, Sherriff J, Langdon C. A clinical audit of the nutritional status and need for nutrition support amongst head and neck cancer patients treated with radiotherapy. Australas Med J. 2012; 5(1):8-13
• Barthelemy N, Streel S, Donneau AF, Coucke P, Albert A, Guillaume M. Screening for malnutrition in lung cancer patients undergoing radiotherapy. Support Care Cancer. 2014; 22(6):1531-1536
• Capra S, Ferguson M, Ried K. Cancer: impact of nutrition intervention outcome - nutrition issues for patients. Nutrition 2001; 17:769-772
• Ravasco P, Monteiro-Grillo I, Marques Vidal P, Camilo ME. Impact of nutrition on outcome: a prospective randomized controlled trial in patients with head and neck cancer undergoing radiotherapy. Head Neck 2005; 27:659-668
• 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. J Am Diet Assoc 2007; 107:404-412