Dietary supplement use in ambulatory cancer patients: a survey on prevalence, motivation and attitudes.

PURPOSE: Patients with cancer often believe dietary supplements (DS) such as micronutrients and botanical products to be health supporting and non-toxic despite growing concerns regarding potential pharmacological interactions. Studies on the prevalence of DS use among patients with cancer are heterogeneous and mainly conducted at university-based cancer centers. This survey focused on a particular cancer patient group treated in an ambulatory setting without regular access to professional nutritional counselling. METHODS: Patients with a history of cancer or hematological malignancy were included in this survey. A self-reported questionnaire was used to evaluate the different aspects of DS use, changes in dietary habits and patients' demographic characteristics. RESULTS: Almost every second patient reported using DS (47.2%). Women (56.3%), patients with an academic degree (56.0%) and non-smokers (84.8%) were more inclined to use DS. Along with magnesium (16.6%), calcium (14.3%), multivitamins (12.0%) and vitamin C (9.4%), use of herbal supplements (12.6%) was common. Women (84.8% vs. 74.9% of men, p = < 0.001) and patients younger than 65 years (84.4% vs. 77.2% of patients > 65 y, p = 0.002) sought dietary advice more often. Support of the immune system was the main reason for DS use (26.4%) and a relevant number of patients (49.6%) reported to have changed their dietary habits following cancer diagnosis. CONCLUSION: DS use is common among patients with cancer treated in an ambulatory setting. This finding should encourage oncologists to implement detailed questioning about DS use and dietary habits to prevent potential interactions and offer substantial advice.

Targeting extracellular nutrient dependencies of cancer cells.

BACKGROUND: Cancer cells rewire their metabolism to meet the energetic and biosynthetic demands of their high proliferation rates and environment. Metabolic reprogramming of cancer cells may result in strong dependencies on nutrients that could be exploited for therapy. While these dependencies may be in part due to the nutrient environment of tumors, mutations or expression changes in metabolic genes also reprogram metabolic pathways and create addictions to extracellular nutrients. SCOPE OF REVIEW: This review summarizes the major nutrient dependencies of cancer cells focusing on their discovery and potential mechanisms by which metabolites become limiting for tumor growth. We further detail available therapeutic interventions based on these metabolic features and highlight opportunities for restricting nutrient availability as an anti-cancer strategy. MAJOR CONCLUSIONS: Strategies to limit nutrients required for tumor growth using dietary interventions or nutrient degrading enzymes have previously been suggested for cancer therapy. The best clinical example of exploiting cancer nutrient dependencies is the treatment of leukemia with l-asparaginase, a first-line chemotherapeutic that depletes serum asparagine. Despite the success of nutrient starvation in blood cancers, it remains unclear whether this approach could be extended to other solid tumors. Systematic studies to identify nutrient dependencies unique to individual tumor types have the potential to discover targets for therapy.

Hypertension and incident cardiovascular events following ibrutinib initiation.

Ibrutinib is associated with dramatic efficacy against B-cell malignancies. Yet, it has been linked with potentially limiting cardiotoxicity, including emerging reports of profound hypertension (HTN). The long-term incidence, severity, and impact of HTN development with ibrutinib are unknown. Therefore, in 562 consecutive patients treated with ibrutinib for B-cell malignancies from 2009 through 2016, we assessed the new/incident or worsened HTN (systolic blood pressure [BP] cutoff, 130 mm Hg). Observed incident HTN rates were compared with Framingham-heart-predicted incident HTN rates. We also evaluated the relationship of HTN to the development of other major adverse cardiovascular events (MACEs), including arrhythmia, myocardial infarction, stroke, heart failure, and cardiovascular death. Further, we assessed the effects of different antihypertensive classes on ibrutinib-related HTN. Overall, 78.3% of ibrutinib users developed new or worsened HTN over a median of 30 months. New HTN developed in 71.6% of ibrutinib users, with a time to 50% cumulative incidence of 4.2 months. Among those without preceding HTN, 17.7% developed high-grade HTN (BP >160/100 mm Hg). In multivariate regression, new or worsened HTN was associated with increased MACEs (hazard ratio [HR], 2.17; 95% confidence interval [CI], 1.08-4.38). No single antihypertensive class was associated with prevention or control of ibrutinib-related HTN. However, antihypertensive initiation was associated with a lower risk of a MACE (HR, 0.40; 95% CI, 0.24-0.66). Collectively, these data suggest that ibrutinib is associated with a substantial increase in the incidence and severity of HTN, and that HTN development carries a higher risk of subsequent cardiotoxic events.

Avaliação do Risco Nutricional em Pacientes Onco-Hematológicos Hospitalizados / Evaluation of Nutritional Risk in Hospitalized Oncohematologic Patients / Evaluación del Riesgo Nutricional en Pacientes Onco-Hematológicos Hospitalizados

Introdução: O diagnóstico precoce do risco nutricional pode melhorar o prognóstico dos pacientes onco-hematológicos. Objetivo:Descrever o estado nutricional nos pacientes onco-hematológicos e avaliar os fatores associados ao risco nutricional nos pacientes onco-hematológicos de um hospital universitário terciário de Fortaleza - Ceará. Método: Estudo transversal que incluiu 127 pacientes adultos internados. Os dados de diagnóstico clínico e demográficos foram coletados por meio da análise de prontuários. O estado nutricional foi avaliado pelo índice de massa corporal (IMC), circunferência braquial (CB) e pela aplicação da ferramenta de triagem de risco nutricional - NRS-2002. Resultados: Pelos diferentes parâmetros, houve divergências no estado nutricional. A maioria da amostra apresentava risco nutricional de acordo com a avaliação da NRS-2002 (70,1%; n=89), seguida pela CB (33,9%; n=43) e pelo IMC (8,7%; n=11). Houve correlação positiva significativa entre IMC e idade [r=0,313, p<0,001] e CB [r=0,846, p<0,001], e associação significativa entre NRS-2002≥3 e IMC<18,5 kg/m² (p=0,023); NRS-2002 ≥3 e CB classificada como desnutrição (p=0,001); IMC<18,5kg/m² e CB classificada como desnutrição; e residir em zona urbana e apresentar CB adequada (p=0,023). Conclusão: Este estudo revelou alta prevalência de risco nutricional, bem como uma associação significativa entre risco nutricional e baixos valores de IMC e CB, e residir em zona rural. Assim, há a necessidade de utilizar uma combinação de indicadores, a fim de diagnosticar, de forma mais precisa e precoce, o estado nutricional desses pacientes.

Introduction: Early diagnosis of nutritional risk may improve the prognosis of oncohaematological patients. Objective: To describe the nutritional status and to evaluate the nutritional risk factors in oncohaematological patients of a tertiary university hospital in Fortaleza, Ceará. Method: This cross-sectional study included 127 patients hospitalized. Clinical and demographic diagnostic data were selected through chart analysis. The nutritional status was elaborated by body mass index (BMI), arm circumference (AC) and by the application of the nutritional risk screening (NRS-2002). Results:Due to the different parameters, there were differences in nutritional status. The majority of the presentation criteria were NRS-2002 70.1% (n=89), followed by the AC 33.9% (n=43) and the BMI 8.7% (n=11). There was a significant positive correlation between BMI and age [r=0.313, p<0.001] and AC [r=0.846, p<0.001]. There was a significant association between NRS-2002≥3 and BMI<18.5 kg/m² (p=0.023); NRS-2002≥3 and AC classified as malnutrition (p=0.001); BMI<18.5 kg/m² and AC classified as malnutrition; and reside in urban areas and present adequate AC (p=0.023). Conclusion: This study revealed a high prevalence of nutritional risk, as well as a significant association between nutritional risk and low BMI, AC and to reside in rural areas. Thus, there is a need to use a combination of indicators to diagnose the nutritional status of these patients in a more precise and early manner.

Introducción: El diagnóstico precoz del riesgo nutricional puede mejorar el pronóstico de los pacientes onco-hematológicos. Objetivo: Describir el estado nutricional en los pacientes onco-hematológicos y evaluar los factores asociados al riesgo nutricional en los pacientes onco-hematológicos de un Hospital Universitario Terciario de Fortaleza - Ceará. Método: Estudio transversal que incluyó a 127 pacientes adultos internados. Los datos de diagnóstico clínico y demográfico fueron recolectados a través de análisis de prontuarios. El estado nutricional fue evaluado por el índice de masa corporal (IMC), circunferencia braquial (CB) y por la aplicación de la herramienta de clasificación de riesgo nutricional - NRS-2002. Resultados: Diferentes parámetros, hubo divergencias en el estado nutricional. La mayoría de la muestra presentaba riesgo nutricional de acuerdo con la evaluación de la NRS-2002 70,1% (n=89), seguida por la CB 33,9% (n=43) y por IMC 8,7% (n=11). Se observó una correlación positiva significativa entre el IMC y la edad [r=0,313, p<0,001] y CB [r=0,846, p<0,001]. Se observó una asociación significativa NRS-2002≥3, e IMC<18,5 kg/m² (p=0,023) y CB desnutrida (p=0,001). Hubo asociación significativa entre IMC<18,5kg/m² y CB desnutrida (p=0,001), y entre residir en zona urbana y presentar CB adecuado (p=0,023). Conclusión: Alta prevalencia de riesgo nutricional, así como una asociación significativa entre riesgo nutricional y bajos valores de IMC y CB, y residir en zonas rurales. Hay la necesidad de utilizar una combinación de indicadores para diagnosticar de forma más precisa y precoz el estado nutricional de estos pacientes.

The Effect of Special Diets on Weight and Nutritional Intake in Hematological Cancer Patients: A Randomized Study.

Major weight loss and taste changes are well documented in patients with hematological cancer during chemotherapy. We have previously documented, that such patients have preferences for much umami, a little sweet, sour and salt, and no bitter. We wanted to convert these results into real diets. Patients participated in two sensory pilot studies (n = 10), where dishes were tested for preferences before and after chemotherapy. From these results, four dishes were selected and tested on 32 patients in 30 days in a cross-over design. The diets resulted in a beneficial and statistically significant difference in weight development (p = 0.0008), with 1.2 ± 1.9 kg (+2%) in the intervention period and -2.8 ± 5.2 kg (-4%) in the control period. This difference persisted after sensitivity analysis (±10%) P = 0.005. However, the nutritional intake was still low in both periods, and the treatment with cytarabine turned out to be a major confounder as dosage was significantly higher in the control period.

Response to aspirin therapy in patients with myeloproliferative neoplasms depends on the platelet count.

Patients with myeloproliferative neoplasms (MPN) are at an increased risk of thrombotic events even during antiplatelet therapy with aspirin. In the current study, we sought to investigate the association of the platelet count with the inhibitory potential of antiplatelet therapy in MPN. We determined arachidonic acid (AA)- and adenosine diphosphate (ADP)-inducible platelet reactivity by multiple electrode aggregometry in 93 patients with essential thrombocythemia, polycythemia vera or primary myelofibrosis. In patients without aspirin therapy (n = 44), the platelet count did not correlate with platelet aggregation. In aspirin-treated patients (n = 49), we observed a moderate correlation of residual AA-inducible platelet aggregation with the platelet count (r = 0.49; P < 0.001). Further, patients with high on-treatment residual platelet reactivity to AA (HRPR AA) had a significantly higher platelet count than patients without HRPR AA (547 × 109/L [340 - 644 × 109/L] vs 358 × 109/L [242 - 501 × 109/L], P = 0.01). Receiver-operating characteristic curve analysis revealed a platelet count of ≥317 × 109/L as best threshold to distinguish between patients without and with HRPR AA (area under the curve: 0.73). After adding the direct ADP P2Y12 inhibitor cangrelor to blood samples from all 93 patients in vitro, residual ADP-inducible platelet reactivity correlated weakly with the platelet count (r = 0.26, P = 0.01), but the platelet count did not differ significantly between patients with and without HRPR ADP (396 × 109/L [316 - 644 × 109/L] vs 340 × 109/L [241 - 489 × 109/L]; P = 0.2). In conclusion, our findings suggest that the extent of platelet inhibition by aspirin in patients with MPN at least in part depends on their individual platelet count.

Espessura do músculo adutor do polegar: um método sensível na detecção de risco nutricional em pacientes onco-hematológicos / Adductor Pollicis Muscle Thickness: a sensitive method in the detection of nutritional risk in onco-hematological patients

Introdução: A desnutrição é comum em pacientes com neoplasias hematológicas. A avaliação do estado nutricional de pacientes oncológicos hospitalizados pode ser realizada através do cálculo do Índice de Massa Corporal (IMC), da aferição da Circunferência do Braço (CB), da Dobra Cutânea Tricipital (DCT) e o cálculo da Circunferência Muscular do Braço (CMB). A Espessura do Músculo Adutor do Polegar (EMAP) é uma ferramenta simples, não invasiva e de baixo custo para avaliação do conteúdo muscular corporal, porém não há muitos estudos quanto ao uso desta técnica de avaliação nutricional em pacientes onco-hematológicos. Objetivo: Determinar a sensibilidade da EMAP para avaliação nutricional de pacientes onco-hematológicos. Metodologia: Trata-se de um estudo transversal analítico, com avaliação de 133 pacientes onco-hematológicos atendidos em um Hospital Universitário no Nordeste do Brasil. Foram submetidos à avaliação nutricional através da aferição do peso, altura, IMC, CB, DCT, CMB e EMAP da mão dominante. Resultados: A média da espessura do músculo adutor do polegar foi de 11,9 ± 3,2 mm. Para desnutrição, a sensibilidade da EMAP foi de 87% para os pontos de cortes encontrados com a curva Receiver Operating Characteristic (12,8mm), e a especificidade foi de 56,3%. Encontrou-se correlação significativa (p <0,001) da EMAP com CB, CMB e IMC. Discussão: A EMAP apresentou alta sensibilidade no diagnóstico de desnutrição e especificidade de 56,3% proporcionando, assim, menor inadimplência no manejo nutricional, por detectar melhor os pacientes em risco nutricional do que aqueles saudáveis. Conclusão: A EMAP mostrou ser um método sensível na detecção de desnutrição em pacientes onco-hematológicos, podendo ser usada na prática clínica

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Introduction: Malnutrition is common in patients with haematological malignancies. The assessment of the nutritional status of hospitalized oncology patients can be performed by calculating body mass index (BMI), measuring the circumference of the arm (CB), tricipital skinfold (DCT) and calculating arm circumference (CMB). The thickness of the Adductor Muscle of the Thumb (EMAP) is a simple, noninvasive and inexpensive tool for assessing body muscle contents, but there are not many studies about the use of this nutritional assessment technique in onco-hematological patients. Objective: To determine the sensitivity of EMAP for nutritional evaluation of onco-hematological patients. Methodology: This is a cross-sectional, analytical study with 133 onco-hematological patients attended at a University Hospital from Northeastern Brazil. They were submitted to nutritional assessment through the measurement of weight, height, BMI, CB, TDC, CMB and EMAP of the dominant hand. Results: The average thickness of the adductor muscle of the thumb was 11.9 ± 3.2 mm. For malnutrition, the EMAP sensitivity was 87% for the cut points found with the Receiver Operating Characteristic (12.8mm) curve, and the specificity was 56.3%. There was a significant correlation (p <0.001) of EMAP with CB, CMB and BMI. Discussion: EMAP presented a high sensitivity in the diagnosis of malnutrition and specificity of 56.3%, thus providing less delinquency in nutritional management, since it better detects patients at nutritional risk than healthy ones. Conclusion: EMAP has been shown to be a sensitive method for the detection of malnutrition in onco-hematological patients, and it can be used in clinical practice

A short nutritional intervention in a cohort of hematological inpatients improves energy and protein intake and stabilizes nutritional status.

INTRODUCTION: Oncohematological diseases are associated with an important prevalence of malnutrition. AIM: Our aim is to determine if early recognition and treatment of malnourished hematological inpatients can improve their oral intake, nutritional status and reduce the length of hospital stay. METHODS: Prospective 2-year study conducted in a cohort of hematology inpatients. Malnutrition Screening Tool (MST) was carried out on the first day of admission. Patients with a positive screening were recruited to have a complete nutritional evaluation and intervention, following usual clinical practice. Nutritional evaluation was repeated after one week. RESULTS: Six hundred and seventeen hematological patients were screened (37.8% with positive screening). After one week, median diet intake increased from 80% to 90% (p < 0.001), and an increase of 407.36 Kcal (SD 679.37) and 17.58 g of protein (SD 31.97) was also achieved. More patients reached their energy and protein requirements (41.6 vs.% 63.3%, p = 0.009) and nutritional parameters remained stable. A trend to a lower stay (3.5 to 4.5 days less) was detected in the groups of patients who covered their needs. CONCLUSIONS: The implementation of early malnutrition screening and short nutritional interventions improved energy and protein intake, increasing the percentage of patients who meet their requirements and avoiding deterioration of nutritional status.

A short nutritional intervention in a cohort of hematological inpatients improves energy and protein intake and stabilizes nutritional status / Una intervención nutricional en una cohorte de pacientes hospitalizados hematológicos mejora la ingesta calórico-proteica y estabiliza el estado nutricional

Introduction: Oncohematological diseases are associated with an important prevalence of malnutrition. Aim: Our aim is to determine if early recognition and treatment of malnourished hematological inpatients can improve their oral intake, nutritional status and reduce the length of hospital stay. Methods: Prospective 2-year study conducted in a cohort of hematology inpatients. Malnutrition Screening Tool (MST) was carried out on the first day of admission. Patients with a positive screening were recruited to have a complete nutritional evaluation and intervention, following usual clinical practice. Nutritional evaluation was repeated after one week. Results: Six hundred and seventeen hematological patients were screened (37.8% with positive screening). After one week, median diet intake increased from 80% to 90% (p < 0.001), and an increase of 407.36 Kcal (SD 679.37) and 17.58 g of protein (SD 31.97) was also achieved. More patients reached their energy and protein requirements (41.6 vs.% 63.3%, p = 0.009) and nutritional parameters remained stable. A trend to a lower stay (3.5 to 4.5 days less) was detected in the groups of patients who covered their needs. Conclusions: The implementation of early malnutrition screening and short nutritional interventions improved energy and protein intake, increasing the percentage of patients who meet their requirements and avoiding deterioration of nutritional status (AU)

Introducción: las enfermedades oncohematológicas se asocian con una elevada prevalencia de malnutrición. Objetivo: nuestro objetivo es determinar si la detección y el tratamiento precoz de la malnutrición en los pacientes hematológicos hospitalizados pueden mejorar su ingesta, su estado nutricional y reducir la estancia hospitalaria. Métodos: estudio prospectivo de 2 años de duración realizado en una cohorte de pacientes hematológicos hospitalizados. El Malnutrition Screening Tool (MST) fue el método de cribado efectuado el primer día del ingreso. En los pacientes con un resultado positivo en el cribado se realizó una valoración nutricional completa y una intervención terapéutica cuando fue preciso, siguiendo la práctica clínica habitual. La valoración nutricional se repitió una semana después de la inicial. Resultados: se evaluaron 617 pacientes hematológicos (de los cuales el 37,8% tuvo un resultado positivo en el cribado). Tras una semana de ingreso, la mediana de ingesta aumentó del 80% al 90% de la dieta (p < 0,001), y se logró un incremento en el consumo de 407,36 (DE 679,37) Kcal y 17,58 (DE 31,97) g de proteínas. El número de pacientes que alcanzaron sus requerimientos calórico-proteicos aumentó (41,6% vs. 63,3%, p = 0,009) y los parámetros nutricionales permanecieron estables. La estancia hospitalaria tendió a ser menor en los pacientes que cubrían sus necesidades nutricionales (3,5 a 4,5 días menos). Conclusiones: la implantación de un método de cribado nutricional precoz y la realización de intervenciones nutricionales cortas consiguió mejorar la ingesta calórico-proteica, aumentando el porcentaje de pacientes que cubrían sus necesidades y evitando el deterioro del estado nutricional (AU)

Abordaje nutricional del enfermo oncohematológico. Best-practice en España / Nutritional approach in oncohematological patients. Best-practice in Spain

Los datos del estudio PREDYCES® nos revelaron que en España la desnutrición relacionada con la enfermedad (DRE) afecta a uno de cada cuatro pacientes hospitalizados. Esta cifra aumenta hasta el 36,8% en los pacientes hematológicos. Se calcula que un 20% de los pacientes oncológicos muere por complicaciones relacionadas con la DRE. Nuestro grupo se planteó en 2011 comenzar la implantación de un cribado nutricional en los servicios con mayor riesgo de DRE. La presente revisión trata de describir todo el proceso que hemos seguido para mejorar la situación nutricional en los pacientes ingresados en el Servicio de Hematología del Complejo Asistencial Universitario de León (CAULE), mayoritariamente con diagnóstico de neoplasias hematológicas. En un primer estudio piloto, detectamos una alta prevalencia de desnutrición, que tendió a aumentar durante la hospitalización. Además, solo el 8,3% los enfermos valorados recibieron algún tipo de soporte nutricional y no se estaban cubriendo sus necesidades ni calóricas ni proteicas, lo que se asociaba a un peor pronóstico. Por este motivo, nos decidimos a implantar de manera sistemática un cribado y una intervención nutricional adecuada, que comenzó en 2011 y que ha recibido el reconocimiento como Buena Práctica del Sistema Nacional de Salud (AU)

The PREDYCESR study showed that disease related malnutrition (DRM) affects 1 in 4 admitted patients, increasing to 36.8% in oncohematological patients. About 20% of oncological patients die for complications related to DRM. Our group planned in 2011 starting the implantation of nutritional screening in those departments with a higher risk of DRM. The present review aims to describe the whole process followed to improve the nutritional status in patients admitted in the Haematology ward of the Complejo Asistencial Universitario de León (CAULE), mostly diagnosed of haematological neoplasia. In an initial study, a high prevalence of undernutrition was detected, which tended to increase during admission. Besides, only 8.3% of patients received any nutritional support, and their energy and protein requirements were not covered, associated to a worse outcome. This reason made us to develop a nutritional screening and intervention, starting in 2011 and which has been recognized as Best Practice in our National Health Service (AU)

Food caregivers influence on nutritional intake among admitted haematological cancer patients - a prospective study.

PURPOSE: Haematological cancer patients have an increased risk of undernourishment due to their malignancy, treatment toxicity and severe infections. This study examines whether kitchen assistants working as food caregivers increase nutritional intake and knowledge among haematological cancer patients. METHODS: Comparison of two cross-sectional studies with dietary assessment of patients with haematological malignancies before (N = 42) and after (N = 45) implementation of food caregivers. Secondly, a questionnaire concerning dietary counselling performed before (N = 74) and after (N = 78) the implementation. RESULTS: The energy requirements were fulfilled with 76.2% (CI 95% 64.6-87.9) and 93.3% (CI 95% 82.3-104.3) of the calculated need in the before-group and the after-group, respectively (p = 0.03). The improvement was mainly due to increased energy intake through between meal snacks served by the food caregivers. There was no difference in protein intake between the two groups. The study showed that more than two-thirds of the patients in both groups had side effects like fatigue, loss of appetite, vomiting, xerostomia or taste disorder to a degree that affected nutritional intake. When adjusted for side effects, patients in the after-group increased energy intake by 22% (CI 95% 6.1-38.0) (p = 0.007). After implementation of food caregivers significantly more patients stated that they were informed about their nutritional needs, 41% in the before-group and 67% in the after-group (p = 0.001). CONCLUSIONS: Educated and trained food caregivers working at the wards increase nutritional intake and knowledge among haematological cancer patients and play an important role in the multi professional nutritional management.

Nutritional status and adequacy of enteral nutrition in pediatric cancer patients at a reference center in northeastern Brazil / El estado nutricional y la adecuación de la nutrición enteral en pacientes de oncología pediátrica en un centro de referencia del noreste de Brasil

Introduction: Individualized nutritional support is important to pediatric cancer patients and should be integrated to the overall treatment of these patients. Objective: Analyze the nutritional status of cancer patients submitted to enteral nutrition (EN) and assess the adequacy of this form of nutrition. Methods: A case series study was carried out at the Pediatric Oncology Unit of the Institute of Integrative Medicine Professor Fernando Figueira (IMIP, Brazil, Recife-PE) between January and December 2009. Clinical and anthropometric data were obtained from medical charts and nutritional follow-up charts. Z scores for height for age, weight for age and body mass index for age indicators (H/A, W/A and BMI/A, respectively) were calculated using the AnthroPlus® program. Caloric and protein requirements were calculated based on the recommendations of the Brazilian National Council of Oncologic Nutrition. Results: At the beginning of EN, 32.4% of the sample had short stature and 23.9% were underweight based on the BMI/A indicator. The assessment of EN adequacy demonstrated that 49.3% reached the caloric requirements and 76.1% reached the protein requirements, with maximal intakes of 65.6 Kcal/Kg/day and 1.95 g of protein/kg/day. Malnourished patients had greater mean Z scores for W/A and BMI/A at the end of EN, whereas no significant changes were found among patients with adequate nutritional status and significant reductions in these indicators were found among those with overweight or obesity. Conclusion: The patients either maintained or achieved a significant improvement in nutritional status, which demonstrates the importance of nutritional support and follow up during hospitalization (AU)

Introducción: El soporte nutricional individualizado se considera una terapia importante en oncología pediátrica y, como tal, debe integrarse en el tratamiento global de estos pacientes. Objetivo: Evaluar el estado nutricional de los pacientes sometidos a terapia de la nutrición enteral y la adecuación de la nutrición enteral (NE). Métodos: Una serie de casos realizado en la Oncología Pediátrica del Instituto de Medicina Integrativa Profesor Fernando Figueira (IMIP, Brasil, Recife-PE), entre los meses de enero a diciembre de 2009. Se obtuvieron los datos antropométricos y clínicos de los registros médicos y formularios para recibir asesoramiento nutricional. Los valores de puntuación Z de los indicadores de A/E, P/E y el IMC/E se calcularon utilizando el software AnthroPlus®. Las necesidades calóricas y proteínas se calcularon de acuerdo con el Consenso Nacional de Nutrición Oncológica. Resultados: Al inicio de la terapia se obtuvo 32,4% de retraso del crecimiento y 23,9% de bajo peso según el IMC/E. La evaluación de la adecuación de NE mostró que el 49,3% llegó a las necesidades calóricas y 76,1% las necesidades de proteínas, cuya contribución máxima fue de 65,6 kcal/kg/día y 1,95 g/kg/día de proteína. Los pacientes desnutridos tienen mayor media de las puntuaciones para Z de P /E y IMC/E al final de la NE. Los pacientes eutróficos tuvieron ningún cambio significativo, mientras aquellos con el sobrepeso o obesos tuvieron una reducción significativa. El grupo de desnutridos tuvieron una mayor ingesta media de calorías y proteínas durante el NE. Conclusión: Los pacientes tuvieron mantenimiento o una mejoría significativa del estado nutricional, poniendo de relieve la necesidad de asesoramiento nutricional durante la hospitalización (AU)

Intervención nutricional en el paciente oncohematológico / Nutritional intervention in oncohematological patient

Objetivos: Las enfermedades oncohematológicas como el Linfoma o la Leucemia afectan a un número importante y creciente de personas en España. Tanto la enfermedad como las distintas modalidades de tratamiento que puede llegar a precisar el paciente a lo largo del curso de la misma impactan negativamente en el estado nutricional del paciente, no siendo infrecuente el desarrollo de desnutrición, situación que compromete la evolución, la respuesta al tratamiento y la calidad de vida del paciente. Método: La implementación de una estrategia multidisciplinar, sistematizada y protocolizada de valoración nutricional puede resultar de utilidad a la hora de abordar a los pacientes con enfermedades oncohematológicas. Resultados: Se presenta una propuesta de protocolo de evaluación y soporte nutricional en el paciente oncohematológico elaborada a partir del análisis de la literatura publicada al respecto, así como de la práctica clínica habitual de un equipo sanitario multidisciplinar especialmente implicado en el manejo de los pacientes con enfermedades oncohematológicas (AU)

Background: Oncohematological diseases such as lymphoma or leukaemia affect an increasing number of newly diagnosed patients in Spain and other countries. Both disease and treatment may have a negatively impact in the nutritional status of the patient. Malnutrition is not uncommon among oncohematological patients. This situation can compromised the course of the disease, the clinical response of the treatment and the patient's quality of life. Method: The implementation of a multidisciplinary approach and a systematic and protocolled nutritional assessment would be useful when dealing with haematological malignancies. Results: We present a proposal of protocol for nutritional intervention in oncohematological patients. This proposal is been developed from the analysis of the published literature as well as clinical practice of a multi-disciplinary team specialized in the management of patients with haematological malignancies (AU)

Panobinostat (LBH589)-induced acetylation of tubulin impairs megakaryocyte maturation and platelet formation.

Drug-induced thrombocytopenia often results from dysregulation of normal megakaryocytopoiesis. In this study, we investigated the mechanisms responsible for thrombocytopenia associated with the use of Panobinostat (LBH589), a histone deacetylase inhibitor with promising anti-cancer activities. The effects of LBH589 were tested on the cellular and molecular aspects of megakaryocytopoiesis by utilizing an ex vivo system in which mature megakaryocytes (MK) and platelets were generated from human primary CD34(+) cells. We demonstrated that LBH589 did not affect MK proliferation or lineage commitment but inhibited MK maturation and platelet formation. Although LBH589 treatment of primary MK resulted in hyperacetylation of histones, it did not interfere with the expression of genes that play important roles during megakaryocytopoiesis. Instead, we found that LBH589 induced post-translational modifications of tubulin, a nonhistone protein that is the major component of the microtubule cytoskeleton. We then demonstrated that LBH589 treatment induced hyperacetylation of tubulin and alteration of microtubule dynamics and organization required for proper MK maturation and platelet formation. This study provides new insights into the mechanisms underlying LBH589-induced thrombocytopenia and provides a rationale for using tubulin as a target for selective histone deacetylase inhibitor therapies to treat thrombocytosis in patients with myeloproliferative neoplasms.

Supplements for immune enhancement in hematologic malignancies.

This brief review aims to discuss the various cellular immunological aspects and related mechanisms of the use of specific components from traditional herbal medicines. We begin with lessons learned from thalidomide as an effective single drug with multiple mechanisms of action to treat multiple myeloma. Examples of "supplements" or integrative therapy will be drawn from arsenic trioxide, medicinal mushrooms including Coriolus vesicular and Ganoderma lucidum, followed by the discussion of beta-glucans affecting various immunological important cellular subsets. Different classes of compounds may enhance distinct immune cell populations that might contribute to a multi-targeted holistic effects on anti-cancer treatment. Finally, we conclude by highlighting an herbal formulation PHY906 as a potential adjunct to chemotherapy that might become one of the first US Food and Drug Administration (FDA) approved oral herbal medicines for anti-cancer adjunct treatment.

Examining low bacterial dietary practice: a survey on low bacterial food.

Patients with haematological malignancies have periods of neutropenia caused by the disease process and subsequent treatments, during which time they are at an increased risk of developing life threatening infections. Historically, many measures have been initiated to protect patients during this time. One such measure has been to provide a low bacterial diet to minimise the number of pathogens ingested from food. However, scientific literature lacks any substantial evidence confirming whether this is beneficial in the management of these patients while guidelines are often unclear and give conflicting advice. A detailed survey was carried out to examine the use of low bacterial diets considering criteria, conditions and specific dietary products. One hundred and eight questionnaires were completed, mainly European. Ninety-five (88%) centres used guidelines to advise practice for inpatients. Although 88% of the hospitals have guidelines, when these were examined there were enormous differences in both the guidelines themselves and the way in which they are implemented. The restrictions seen are varied and sometimes even contradict each other. Forty-eight (44%) of the respondents imposed restrictions on all products mentioned. Conditions for starting or stopping dietary restrictions were also diverse. This survey highlights the need to attempt to standardise dietary restrictions in a patient group for whom good nutrition is paramount.

Obstacles to effective Toll-like receptor agonist therapy for hematologic malignancies.

It has long been noted that products of microorganisms have clinical activity against hematologic malignancies. Recent advances suggest that Toll-like receptors (TLRs) activated by ligands in the microbial preparations might account for some of this activity, and that defined TLR agonists might improve the clinical efficacy of this approach. A potentially important mechanism of action of TLR agonists is their ability to cause tumor cells to differentiate into a 'tolerized' state in which they become highly sensitive to cytotoxic effector cells and chemotherapeutic drugs. TLR agonists as single agents have strong activity against cutaneous leukemias and lymphomas but are not as effective against systemic disease. A possible reason for this discrepancy is the hypoxic internal tumor microenvironment, which promotes glycolytic metabolism, and the presence of suppressive cytokines, prostaglandins and nucleosides that prevent strong TLR signaling in cancer cells. Accordingly, concomitant use of agents to counter this intrinsic microenvironmental inhibition, together with TLR agonists, may prove to be an effective treatment strategy for the hematologic malignancies.

[Comparison of short term acceptability of three oral nutritional supplements]. / Comparación de la aceptabilidad de tres suplementos nutricionales.

BACKGROUND: Although liquid supplements are formulated to provide extra energy, minerals, vitamins and proteins, much of the success of supplementation depends upon the acceptability of the product and the ability of the patients to take large volumes over a period of time. OBJECTIVE: This study was set up to evaluate the acceptability by haematological cancer patients of 3 commercially available nutritional supplements. DESIGN: A population of 32 haematological cancer patients with reduced food intakes (less than 50% of calorie requirements by Harrist Benedict formula) was enrolled. Supplements were randomly assigned to each patient. Patients could try the drinks over 2 days period. They were asked to rate the acceptability of supplement, rating the product with a visual scale from 1 to 5 points with five parameters (color, taste, smell, texture, and temperature). RESULTS: Ten patients received first ONS (oral nutritional supplements), 12 second ONS, and 10 third ONS. No epidemiological differences were detected among three groups. Total calorie and macronutrient consumption improved with all supplements. Average values of color, taste, smell, temperature and texture were similar on three oral nutritional supplements (ONS). Analogic scale was analyze in a categoric way with frequencies, too. Frequencies of 1 and 2 points (very good and good responses) with taste were better with second ONS (85%; p < 0.05) than first ONS (50%) and third ONS (55.5%). Frequencies with smell were better with second ONS (83.3%; p < 0.05) than first (55.5%) and third ONS (62.5%). Frequencies with texture were higher in first ONS (90%; p < 0.05) and second ONS (100%; p < 0.05) than third ONS (66.7%). Temperature and color frequencies were similar in all ONS. CONCLUSIONS: Oral nutritional supplements had different acceptability in haematological cancer patients. Taste, smell and texture could be better in some ONS in these patients.

Comparación de la aceptabilidad de tres suplementos nutricionales / Comparation of short term acceptability of three oral nutritional supplements

Introducción: Aunque los suplementos nutricionales son fórmulas que aportan energía, minerales, vitaminas y proteínas, el consumo de estos productos en la mayor parte de las ocasiones depende de la aceptabilidad del paciente y de la habilidad para mantener consumos de volúmenes grandes a lo largo del tiempo. Objetivos: Este estudio presenta como objetivo evaluar la aceptabilidad por parte de pacientes con tumores hematológicos de 3 suplementos nutricionales. Diseño: Se estudiaron un total de 32 pacientes con tumores hematológicos y disminución de la ingesta (menos de un 50% de los requerimientos calóricos determinados por la fórmula de Harrist Benedict). Los suplementos fueron asignados aleatoriamente a los pacientes, recibiendo el preparado durante dos semanas. Mediante una escala visual del 1 al 5 se evaluaron los siguientes parámetros (color, sabor, olor, textura, y temperatura). Resultados: Un total de 10 pacientes recibieron el primer suplemento nuricional oral (SNO), 12 pacientes el segundo SON y 10 el tercero. No existieron diferencias epidemiológicas significativas entre los tres grupos. EL total de ingesta de calorías y macronutrientes mejoró con todos los suplementos. Los valores medios de color, sabor, olor, temperatura y textura fueron similares en los tres SON. Analizando mediante frecuencias relativas los resultados de la escala analógica, la frecuencia de las respuestas 1 y 2 (muy bueno y bueno, respectivamente) con respecto al sabor fue superior en el SON 2º (85%; p < 0,05) que en el SON 1º (50%) y que en SON 3º (55,5%). Las frecuencias de las respuestas favorables (1 y 2) con respecto al olor fueron superiores en el SON 2º (83,3%; p < 0,05) que en el primero (55,5%) y en el tercero (62,5%). Las frecuencias de las respuestas (bueno y muy bueno) fueron superiores en el primer SON (90%; p < 0,05) y en el segundo (100%; p < 0,05) que en el tercero (66,7%). La valoración con respecto a la temperatura y color fueron similares en los tres suplementos. Conclusiones: La aceptación de los diferentes suplementos orales nutricionales en los pacientes con tumores hematológicos es variable. Sabor, olor y textura fueron significativamente superior en algunos preparados

Background: Although liquid supplements are formulated to provide extra energy, minerals, vitamins and proteins, much of the success of supplementation depends upon the acceptability of the product and the ability of the patients to take large volumes over a period of time. Objective: This study was set up to evaluate the acceptability by haematological cancer patients of 3 commercially available nutritional supplements. Design: A population of 32 haematological cancer patients with reduced food intakes (minor than 50% of calory requirements by Harrist Benedict formula) was enrolled. Supplements were radomnly assigned to each patient. Patients could try the drinks over 2 days period. They were asked to rate the acceptability of supplement, rating the product with a visual scale from 1 to 5 points with five parameters (color, taste, smell, texture, and temperature). Results: Ten patients received first ONS (oral nutritional supplements), 12 second ONS, and 10 third ONS. No epidemiological differences were detected among three groups. Total calorie and macronutrient consumption improved with all supplements. Average values of color, taste, smell, temperature and texture were similar on three oral nutritional supplements (ONS). Analogic scale was analyze in a categoric way with frequencies, too. Frequencies of 1 and 2 points (very good and good responses) with taste were better with second ONS (85%; p < 0.05) than first ONS (50%) and third ONS (55.5%). Frequencies with smell were better with second ONS (83.3%; p < 0.05) than first (55.5%) and third ONS (62.5%). Frequencies with texture were higher in first ONS (90%; p < 0.05) and second ONS (100%; p < 0.05) than third ONS (66.7%). Temperature and color frequencies were similar in all ONS. Conclusions: Oral nutritional supplements had different acceptability in haematological cancer patients. Taste, smell and texture could be better in some ONS in these patients