AKCİĞER KANSERLİ HASTALARDA TANI TEDAVİ TAKİP ESNASINDA BESLENME DURUMUNUN DEĞERLENDİRMESİ

Yıl 2024, Cilt: 7 Sayı: 2, 102 - 113, 30.06.2024

Esra Şazimet Kars , Timuçin Çil

https://doi.org/10.55517/mrr.1424445

Öz

Amaç: Akciğer kanseri şu anda dünyada en sık görülen kanserdir. Tanı genellikle ileri evrede konulur. Bu nedenle mevcut sınırlı yaşam süresinde yaşam kalitesini artırmak oldukça önemlidir. Ortalama sağkalımı değiştirebilecek faktörlerden biri de kilo kaybıdır. Bu amaçla hastanede akciğer kanseri tedavisi gören popülasyonun Beslenme Risk Taraması (NRS-2002) ile kan biyokimyasal ve antropometrik ölçümleri ile akciğer kanseri malnütrisyon semptomlarının araştırılması ve akciğer kanseri hastalarının sağlık durumlarının araştırılması hedeflendi. Yöntem: Bu çalışma, 2020-2021 yılları arasında Adana Şehir Hastanesi Tıbbi Onkoloji Kliniğine başvuran, akciğer kanseri tanısı alan 18 yaş ve üzeri 216 erkek, 50 kadın olmak üzere toplam 266 gönüllü üzerinde gerçekleştirildi. Bulgular: 266 hasta dahil edildi: 216 erkek, 50 kadın, ortalama yaş 61,7±10,5, ortanca yaş 62 idi. BMI değeri 20'nin altında olan (p<0,001) ve son 3 ayda kilo kaybı olan hastalarda malnütrisyon riski (p<0,045) ikisi arasında pozitif bir ilişki vardı (p<0,005). Hastalarda albumin, antropometrik ölçümler, CRP ve NRS 2002 arasındaki ilişki incelendiğinde anlamlı pozitif ilişki olduğu görüldü. (p<0,005). Hastaların CRP değerleri ile BMI ve antropometrik ölçümleri arasında ters korelasyon mevcuttu (p<0,005). NRS 2002 ile hastanın kilosu ve antropometrik ölçümleri arasında ters korelasyon (p<0,005). Kemoterapi alan hastaların albümin, BMI ve antropometrik ölçümleri ile ters yön arasında, CRP değerleri ile son 3 aydaki kilo kaybı ile NRS 2002 arasında pozitif korelasyon bulundu. (p<0,005). Radyoterapi ile CRP arasında pozitif bir korelasyon. (p<0,005) Hastalarda metastaz ile albumin değerleri, antropometrik ölçümler ve BMI arasında ters ilişki varken; CRP ve NRS 2002 ile pozitif korelasyon bulundu (p<0,005). Yaş, albumin, BMI ve antropometrik ölçümlerle ters ilişki bulunurken, CRP ve NRS 2002 ile pozitif ilişki saptandı (p<0,005). Beslenme tedavisi alan hastalarda kemoterapi alma sıklığı (p=0,06) ve metastaz görülme sıklığı (p< 0,01) yüksek bulundu (p<0,005) Sonuç: Akciğer kanseri tanısı alan hastaların, tanı anından itibaren başka herhangi bir hastalık, yaşam kalitesi, malnütrisyon riski ve beslenme durumu açısından taranması gerektiğini, erken tıbbi tedavi ile birlikte beslenmeye yönelik önlemlerin alınmasıyla hastaların beklenen yaşam süresinin uzatılabileceğine inanıyoruz.

Anahtar Kelimeler

Akciğer kanseri, beslenme, malnütrisyon, NRS 2002

Evaluation of Nutritional Status During Diagnosis, Treatment and Follow-up in Patients with Lung Cancer

Öz

Aim: Lung cancer is currently the most common cancer in the world. Diagnosis is usually made at an advanced stage. For this reason, it is very critical to enhance the standard of life during the current limited lifespan. One of the factors that can change the average survival is weight loss. For this purpose, the Nutritional Risk Screening (NRS-2002) of the population receiving lung cancer treatment in the hospital, blood biochemical and anthropometric measurements, and lung cancer malnutrition symptoms were targeted to explore the health status of lung cancer patients. Methods: This study was conducted on a total of 266 volunteers, 216 men and 50 women, aged 18 and over, who were diagnosed with lung cancer and admitted to Adana City Hospital Medical Oncology Clinic during the years 2020-2021. Results: Of the 266 patients included, 216 were men and 50 were women. The mean age was 61.7±10.5, and the median age was 62. There was a positive relationship between the risk of malnutrition in patients with BMI values below 20 (p<0.001) and weight loss in the last 3 months (p<0.045) (p<0.005). When the relationship between albumin, anthropometric measurements, CRP, and NRS-2002 in patients was examined, there was a significant positive relationship (p<0.005). There was an inverse correlation between the CRP values of the patients and their BMI and anthropometric measurements (p<0.005). An inverse correlation was also found between NRS-2002 and the patient's weight and anthropometric measurements (p<0.005). A positive correlation was found between the patients receiving chemotherapy and albumin, BMI, and anthropometric measurements, and an inverse correlation with CRP values and weight loss in the last 3 months and NRS-2002 (p<0.005).
There was a positive correlation between radiotherapy and CRP (p<0.005). While there was an inverse relationship between metastases and albumin values, anthropometric measurements, and BMI in patients, a positive correlation was found with CRP and NRS-2002 (p<0.005). An inverse relationship was found between age, albumin, BMI, and anthropometric measurements, and a positive relationship with CRP and NRS-2002 (p<0.005). The frequency of receiving chemotherapy (p=0.06) and the incidence of metastasis (p<0.01) were found to be high in cases receiving nutritional therapy (p<0.005)
Conclusion: Cases diagnosed with lung cancer should be screened for any other diseases, quality of life, risk of malnutrition, and nutritional status from the time of diagnosis. We believe that the expected survival of patients can be extended by taking precautions for nutrition together with early medical treatment.

Anahtar Kelimeler

Lung cancer, Nutrition, Malnutrition, NRS 2002

Kaynakça

• Argilés JM, Moore-Carrasco R, Busquets SL, López-Soriano FJ. Catabolic mediators as targets for cancer cachexia. Drug discovery today, 2003; 8(18):838-844.
• Donini LM, Ricciardi LM, Neri B, Lenzi A, Marchesini G. Risk of malnutrition (over and under-nutrition): Validation of the JaNuS screening tool. Clinical nutrition. 2014; 33(6):1087-1094.
• Vinci E, Rampello E, Zanoli L, Oreste G, Pistone G, Malaguarnera M. Serum carnitine levels in patients with tumoral cachexia. European Journal of Internal Medicine. 2005; 16(6):419-23.
• Gavazzi C, Colatruglio S, Sironi A, Mazzaferro V, Miceli R. Importance of early nutritional screening in patients with gastric cancer. British Journal of Nutrition. 2011; 106(12):1773-1778.
• Giannousi Z, Gioulbasanis I, Pallis AG, Xyrafas A, Dalliani D, Kalbakis K. Nutritional status, acute phase response and depression in metastatic lung cancer patients: correlations and association prognosis. Supportive Care in Cancer. 2012; 20(8):1823-1829.
• Shintani Y, Ikeda N, Matsumoto T, Kadota Y, Okumura M, Ohno Y. Nutritional status of patients undergoing chemoradiotherapy for lung cancer. Asian Cardiovascular and Thoracic Annals. 2012; 20(2):172-176.
• Inui A. Cancer anorexia-cachexia syndrome: current issues in research and management. A Cancer Journal for Clinicians. 2002; 52(2):72-91.
• Baracos VE. Cancer-associated cachexia and underlying biological mechanisms. Annual Review of Nutrition. 2006; 26:435-61.
• Barber MD. The pathophysiology and treatment of cancer cachexia. Nutrition in Clinical Practice. 2002; 17(4):203-9.
• Fearon K, Strasser, F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL. Definition and classification of cancer cachexia: an international consensus. The Lancet oncology, 2011; 12(5):489-495.
• Argiles JM, Busquets S, Lopez-Soriano FJ. The pivotal role of cytokines in muscle wasting during cancer. International Journal of Biochemistry and Cell Biology. 2005; 37(8):1609-19.
• Horn L, Lovly CM, Johnson DH. Harrison’s Principles of Internal Medicine 19th ed. New York, NY: McGraw-Hill; 2015:506-22.
• Donini LM, Ricciardi LM, Neri B, Lenzi A, Marchesini G. Risk of malnutrition (over and under-nutrition): Validation of the JaNuS screening tool. Clinical nutrition. 2014; 33(6):1087-1094.
• Stene GB, Helbostad JL, Amundsen T, Sørhaug S, Hjelde H, Kaasa S et al. Changes in skeletal muscle mass during palliative chemotherapy in patients with advanced lung cancer. Acta Oncologica. 2015; 54(3):340-8.
• Jeejeebhoy KN. Nutritional assessment. Nutrition. 2000; 16(7-8):585-90.
• Collins S. Using middle upper arm circumference to assess severe adult malnutrition during famine. Journal of the American Medical Association. 1996; 276(5):391-395.
• Christensen JF, Jones LW, Andersen JL, Daugaard G, Rorth M, Hojman P. Muscle dysfunction in cancer patients. Annals of Oncology. 2014; 25(5):947-58.
• Norman K, Schutz T, Kemps M, Josef LH, Lochs H, Pirlich M. The Subjective Global Assessment reliably identifies malnutrition-related muscle dysfunction. Clinical Nutrition. 2005; 24:143-50.
• Ryu SW, Kim IH. Comparison of different nutritional assessments in detecting malnutrition among gastric cancer patients. World Journal of Gastroenterology. 2010; 16(26):3310.
• Zhang F, Ying L, Jin J. The C-reactive protein/albumin ratio predicts long-term outcomes of patients with operable non-small cell lung cancer. Oncotarget. 2017; 8(5):8835-8842.
• Jin Y, Sun Y, Shi X, Zhao J. Prognostic value of circulating C reactive protein levels in patients with non-small cell lung cancer: a systematic review with meta-analysis. Journal of Cancer Research and Therapatics. 2014; 10:160-6.
• Alan Chung- Hong T, Ming Chen L, Tsui-Lan C. Mid arm and calf circumferences (MAC and CC) are better than body mass index (BMI) in predicting health status and mortality risk in institutionalized elderly Taiwanese. Archives of Gerontology and Geriatrics. 2012; 54:443-447.
• Wu BW, Yin T, Cao WX, Gu ZD, Wang XJ, Yan, M. Clinical application of subjective global assessment in Chinese patients with gastrointestinal cancer. World Journal of Gastroenterology. 2009; 15(28):3542.
• Vergara N, Montoya JE, Luna HE, Amparo JR Cristal G. Quality of life and nutritional status among cancer patients on chemotherapy. Oman Medical Journal. 2013; 28:270-4.
• McMillan DC. An inflammation-based prognostic score and its role in the nutrition-based management of patients with cancer. The Proceedings of the Nutrition Society. 2008; 67(3):257-262.
• Chaves R, Boleo-Tome M, Monteiro-Grillo C, Camilo I, Ravasco MP. The diversity of nutritional status in cancer: new insights. Oncologist. 2010; 15(5):523-530.
• Ravasco P, Monteiro-Grillo I, Vidal PM, Camilo MR. Dietary counseling improves patient outcomes: A prospective, randomized, controlled trial in colorectal cancer patients undergoing radiotherapy. Journal of Clinical Oncology. 2005; 23:1431-38.
• Ravasco P, Monteiro-Grillo I, Vidal PM, Camilo MR. Impact of nutrition on outcome: A prospective randomized controlled trial in patients with head and neck cancer undergoing radiotherapy. Head & Neck. 2005; 27:659-68.
• 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. Journal of Parenteral and Enteral Nutrition. 2014; 38(2):196-204.