Inadequate Nutritional Status of Hospitalized Cancer Patients

Abstract

Objective: In oncology practice, nutrition and also metabolic activity are essential to support the nutritional status and prevent malignant cachexia. It is important to evaluate the patients and plan the maneuvers at the start of the therapy. The primary objective of the study is to define the nutritional status of hospitalized patients and the factors affecting it in order to define the most susceptible patients and maneuvers for better nutritional support. Methods: Patients hospitalized in oncology clinic for therapy were evaluated for food intake and nutritional status through structured interviews. The clinical properties, medical therapies, elements of nutritional support were noted and predictors of inadequate nutritional status (INS) were analyzed. Results: Four hundred twenty three patients, between 16-82 years old (median: 52) were evaluated. Nearly half of the patients (185, 43%) reported a better appetite at home than in hospital and declared that hospitalization is an important cause of loss of appetite (140/185, 75.6%). Presence of nausea/vomiting (N/V), depression, age less than 65 and use of non-steroidal anti-inflammatory drugs (NSAIDs) were associated with increased risk of INS in hospitalized cancer patients. On the contrary, steroid medication showed a positive impact on nutritional status of cancer patients. Conclusion: N/V, younger age, presence of depression and NSAIDs medication were associated with INS in hospitalized cancer patients. Clinicians should pay more attention to this group of patients. In addition, unnecessary hospitalizations and medications that may disturb oral intake must be avoided. Corticosteroids are important tools for managing anorexia and INS.

Keywords

• Inadequate nutritional status,malnutrition,cancer cachexia

Kaynakça

1. 1. Zhang L, Lu Y, Fang Y. Nutritional status and related factors of patients with advanced gastrointestinal cancer. Br J Nutr. 2014;111(7):1239-44.
2. 2. Laky B, Janda M, Kondalsamy-Chennakesavan S, Cleghorn G, Obermair A. Pretreatment malnutrition and quality of life - association with prolonged length of hospital stay among patients with gynecological cancer: A cohort study. BMC Cancer. 2010;10:232.
3. 3. Gupta D, Vashi PG, Lammersfeld CA, Braun DP. Role of nutritional status in predicting the length of stay in cancer: a systematic review of the epidemiological literature. Ann Nutr Metab. 2011;59(2-4):96-106.
4. 4. Larsson M, Hedelin B, Johansson I, Athlin E. Eating problems and weight loss for patients with head and neck cancer: a chart review from diagnosis until one year after treatment. Cancer Nurs. 2005;28(6):425-35.
5. 5. Leistra E, Eerenstein SE, van Aken LH, et al. Effect of early individualized dietary counseling on weight loss, complications and length of hospital stay in patients with head and neck cancer: A comparative study. Nutr Cancer. 2015:1-11.
6. 6. Baracos VE. Cancer-associated cachexia and underlying biological mechanisms. Annu Rev Nutr. 2006;26:435-61.
7. 7. Strasser F. Eating-related disorders in patients with advanced cancer. Support Care Cancer. 2003;11(1):11-20.
8. 8. Holden CM. Anorexia in the terminally ill cancer patient: the emotional impact on the patient and the family. Hosp J. 1991;7(3):73-84.

9. 9. Hopkinson JB. Psychosocial impact of cancer cachexia. J Cachexia Sarcopenia Musc. 2014;5(2):89-94.
10. 10. Topkan E, Yavuz AA, Ozyilkan O. Cancer cachexia: pathophysiologic aspects and treatment options. Asian Pac J Cancer Prev. 2007;8(3):445- 51.
11. 11. Akbulut G. New perspective for nutritional support of cancer patients: Enteral/parenteral nutrition. Exp Ther Med. 2011;2(4):675-84.
12. 12. Kanat O, Cubukcu E, Avci N, et al. Comparison of three different treatment modalities in the management of cancer cachexia. Tumori. 2013;99(2):229-33.
13. 13. Argiles JM, Busquets S, Lopez-Soriano FJ. The pivotal role of cytokines in muscle wasting during cancer. Int J Biochem Cell Biol. 2005;37(10):2036- 46.
14. 14. von Haehling S, Anker SD. Cachexia as major underestimated unmet medical need: facts and numbers. Int J Cardiol. 2012;161(3):121-3.
15. 15. von Meyenfeldt M. Cancer-associated malnutrition: an introduction. Eur J Oncol Nurs. 2005;9 Suppl 2:S35-8.
16. 16. Cuvelier GD, Baker TJ, Peddie EF, et al. A randomized, double-blind, placebo-controlled clinical trial of megestrol acetate as an appetite stimulant in children with weight loss due to cancer and/or cancer therapy. Pediatr Blood Cancer. 2014;61(4):672-9.
17. 17. Tsoli M, Robertson G. Cancer cachexia: malignant inflammation, tumorkines and metabolic mayhem. Trends Endocrinol Metab. 2013;24(4):174-83.
18. 18. von Haehling S, Anker SD. Cachexia as a major underestimated and unmet medical need: facts and numbers. J Cachexia Sarcopenia Muscle. 2010;1(1):1-5.
19. 19. Barritta de Defranchi RL, Bordalejo A, Canueto I, Villar A, Navarro E. Evolution of nutritional status in patients with autologous and allogeneic hematopoietic stem cell transplant. Support Care Cancer. 2015;23(5):1341-7.
20. 20. Dias do Prado C, Alvares Duarte Bonini Campos J. Nutritional status of patients with gastrointestinal cancer receiving care in a public hospital; 2010-2011. Nutr Hosp. 2013;28(2):405- 11.
21. 21. Duffy SA, Ronis DL, Valenstein M, et al. Depressive symptoms, smoking, drinking, and quality of life among head and neck cancer patients. Psychosomatics. 2007;48(2):142-8.
22. 22. Nho JH, Kim SR, Kwon YS. Depression and appetite: predictors of malnutrition in gynecologic cancer. Support Care Cancer. 2014;22(11):3081- 8.
23. 23. Santarpia L, Contaldo F, Pasanisi F. Nutritional screening and early treatment of malnutrition in cancer patients. J Cachexia Sarcopenia Muscle. 2011;2(1):27-35.
24. 24. Britton B, Clover K, Bateman L, et al. Baseline depression predicts malnutrition in head and neck cancer patients undergoing radiotherapy. Support Care Cancer. 2012;20(2):335-42.
25. 25. Daudt HM, Cosby C, Dennis DL, Payeur N, Nurullah R. Nutritional and psychosocial status of colorectal cancer patients referred to an outpatient oncology clinic. Support Care Cancer. 2012;20(7):1417-23.
26. 26. Gomez Valiente da Silva H, Fonseca de Andrade C, Bello Moreira AS. Dietary intake and nutritional status in cancer patients; comparing adults and older adults. Nutr Hosp. 2014;29(4):907-12.
27. 27. Fernandez Lopez MT, Saenz Fernandez CA, de Sas Prada MT, et al. [Malnutrition in patients with cancer; four years experience]. Nutr Hosp. 2013;28(2):372-81.
28. 28. Lundholm K, Gelin J, Hyltander A, et al. Antiinflammatory treatment may prolong survival in undernourished patients with metastatic solid tumors. Cancer Res. 1994;54(21):5602-6.
29. 29. Gelin J, Andersson C, Lundholm K. Effects of indomethacin, cytokines and cyclosporin A on tumor growth and the subsequent development of cancer cachexia. Cancer Res. 1991;51(3):880-5.
30. 30. Fazal S, Saif MW. Supportive and palliative care of pancreatic cancer. JOP. 2007;8(2):240-53.
31. 31. Varadhan KK, Neal KR, Dejong CH, Fearon KC, Ljungqvist O, Lobo DN. The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr. 2010;29(4):434-40.
32. 32. Gullett N, Rossi P, Kucuk O, Johnstone PA. Cancer-induced cachexia: a guide for the oncologist. J Soc Integr Oncol. 2009;7(4):155-69.
33. 33. Paulsen O, Klepstad P, Rosland JH, et al. Efficacy of methylprednisolone on pain, fatigue and appetite loss in patients with advanced cancer using opioids: a randomized, placebo-controlled, double-blind trial. J Clin Oncol. 2014;32(29): 3221- 8.
34. 34. Aoyagi T, Terracina KP, Raza A, Matsubara H, Takabe K. Cancer cachexia, mechanism and treatment. World J Gastrointest Oncol. 2015;7(4):17-29.