ABSTRACT
Abstract Objective: To evaluate the impact of preoperative body composition in patients with renal cell carcinoma (RCC) undergoing surgical treatment. Materials and Methods: This was a retrospective study of 52 patients with RCC undergoing total or partial nephrectomy. Body composition assessment was performed using the body mass index, together with computed tomography analysis at the level of the third lumbar vertebra to measure the area of visceral adipose tissue, as well as the area and density of skeletal muscle mass. Results: Malnutrition, obesity and inadequate skeletal muscle gauge (SMG) were associated with higher hospital length of stay (p = 0.028, p = 0.02 and p = 0.012, respectively). Although the rates of postoperative symptoms and readmissions were low, survival was better among the patients with an adequate SMG than among those with an inadequate SMG (p = 0.003). Conclusion: Among patients with RCC undergoing surgical treatment, preoperative body composition does not seem to be associated with the rates of perioperative complications, although an inadequate SMG seems to be associated with worse overall survival.
Resumo Objetivo Avaliar o impacto da composição corporal pré-operatória em pacientes portadores de carcinoma de células renais (CCR) submetidos a tratamento cirúrgico. Materiais e Métodos: Foi realizado estudo retrospectivo de 52 pacientes portadores de CCR submetidos a tratamento cirúrgico. A avaliação da composição corporal foi realizada por meio do índice de massa corporal e análise da L3 obtida pela tomografia computadorizada para mensurar a área do tecido adiposo visceral, área e densidade da massa muscular esquelética. Resultados: Os pacientes desnutridos, obesos e que apresentaram produto muscular esquelético (PME) inadequado permaneceram mais tempo internados (p = 0,028, p = 0,02 e p = 0,012, respectivamente). As taxas de sintomas e reinternações no pósoperatório foram baixas em toda a amostra, no entanto, observou-se que pacientes com PME inadequado apresentaram uma pior sobrevida em relação aos pacientes com PME adequado (p = 0,003). Conclusão: A análise da composição corporal pré-operatória não mostrou associação com as taxas de complicações periope-ratórias em pacientes portadores de CCR submetidos a nefrectomia total ou parcial, no entanto, a inadequação do PME está associada a uma pior sobrevida.
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Abstract Objective: To evaluate the preoperative muscle mass of patients with head and neck cancer (HNC) with computed tomography (CT), comparing the results obtained through analysis of cross-sectional areas at the level of the third lumbar vertebra (L3) with those obtained through analysis of cross-sectional areas at the levels of the third cervical and fourth thoracic vertebrae (C3 and T4, respectively). Materials and Methods: A total of 63 patients with HNC were evaluated preoperatively. Using CT, we assessed muscle mass at L3, as well as at C3 and T4. Results: Most (73.0%) of the patients had low muscle mass at L3, whereas 50.8% had a normal body mass index. The cross-sectional area at L3 correlated strongly with those at C3 and T4 (r = 0.831 and r = 0.763, respectively; p < 0.001 for both). In addition, the muscle mass index at L3 correlated strongly with those at C3 and T4 (r = 0.781 and r = 0.715, respectively; p < 0.001 for both). Conclusion: Low muscle mass appears to be highly prevalent in patients with HNC. Measurements at C3 and T4 could represent alternative means of assessing muscle mass in such patients.
Resumo Objetivo: Avaliar e comparar a massa muscular de pacientes com câncer de cabeça e pescoço (CCP) durante o período pré-operatório com tomografia computadorizada (TC), por meio da análise das áreas transversais no nível da terceira vértebra lombar (L3) em comparação com níveis cervical (C3) e torácico (T4). Materiais e Métodos: Sessenta e três pacientes com CCP foram avaliados no pré-operatório. A TC foi utilizada para avaliar a massa muscular de L3, assim como as secções transversais de C3 e T4. Resultados: A maioria dos pacientes (73,0%) tinha baixa massa muscular analisada pela TC de L3, mas índice de massa corpórea normal (50,8%). Também foi observada forte correlação entre as áreas e o índice de massa muscular (IMM) de L3 com C3 (área: r = 0,831, p < 0,001; IMM: r = 0,781, p < 0,001) e T4 (área: r = 0,763, p < 0,001; IMM: r = 0,715, p < 0,001). Conclusão: A baixa massa muscular é altamente prevalente em pacientes com CCP. As análises de TC em C3 e T4 podem representar opção para avaliar a massa muscular em pacientes com CCP.
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OBJECTIVE: Colorectal cancer is the third most diagnosed malignant neoplasm in the world and the fourth leading cause of cancer mortality. The loss of muscle mass in oncological patients is the main aspect of cancer-related malnutrition. Associations between sarcopenia and poor outcomes, such as high postoperative mortality, chemotherapy toxicity, and reduced survival, have been recently described. The aim of this study was to prospectively assess the prevalence of preoperative sarcopenia in patients with colorectal cancer using validated methods to evaluate muscle strength, muscle mass, and physical performance. METHODOLOGY: This study included patients with colorectal cancer undergoing oncological staging at a Cancer Center in Brazil from May 2019 to March 2020 who had images from abdominal computed tomography available for analysis of body composition. The muscle strength test, physical performance, referred fatigue, and clinical and nutritional data were evaluated. RESULTS: A total of 31 patients were included, and most were diagnosed with colon cancer (77.4%) and clinical stage II in 41.9% of cases. The prevalence of probable sarcopenia was 22.6%; of these patients, sarcopenia was confirmed in 19.4%, and ultimately, 9.7% of the sample was classified as severe sarcopenia. We did not find a significant association between the presence of sarcopenia in our sample and age, sex, tumor staging, nutritional characteristics, referred patient fatigue, or postoperative complications. CONCLUSION: Considering the criteria established by the EWGSOP, the prevalence of preoperative sarcopenia in colorectal cancer patients was 19.4%.
Subject(s)
Colonic Neoplasms , Muscle, Skeletal , Sarcopenia , Humans , Colonic Neoplasms/complications , Colonic Neoplasms/epidemiology , Colonic Neoplasms/surgery , Colorectal Neoplasms/complications , Colorectal Neoplasms/epidemiology , Colorectal Neoplasms/surgery , Muscle, Skeletal/diagnostic imaging , Prognosis , Prospective Studies , Risk Factors , Sarcopenia/diagnosis , Sarcopenia/diagnostic imaging , Sarcopenia/epidemiology , Sarcopenia/etiology , Preoperative Care , Prevalence , Brazil/epidemiology , Tomography, X-Ray ComputedABSTRACT
SUMMARY OBJECTIVE: Colorectal cancer is the third most diagnosed malignant neoplasm in the world and the fourth leading cause of cancer mortality. The loss of muscle mass in oncological patients is the main aspect of cancer-related malnutrition. Associations between sarcopenia and poor outcomes, such as high postoperative mortality, chemotherapy toxicity, and reduced survival, have been recently described. The aim of this study was to prospectively assess the prevalence of preoperative sarcopenia in patients with colorectal cancer using validated methods to evaluate muscle strength, muscle mass, and physical performance. METHODOLOGY: This study included patients with colorectal cancer undergoing oncological staging at a Cancer Center in Brazil from May 2019 to March 2020 who had images from abdominal computed tomography available for analysis of body composition. The muscle strength test, physical performance, referred fatigue, and clinical and nutritional data were evaluated. RESULTS: A total of 31 patients were included, and most were diagnosed with colon cancer (77.4%) and clinical stage II in 41.9% of cases. The prevalence of probable sarcopenia was 22.6%; of these patients, sarcopenia was confirmed in 19.4%, and ultimately, 9.7% of the sample was classified as severe sarcopenia. We did not find a significant association between the presence of sarcopenia in our sample and age, sex, tumor staging, nutritional characteristics, referred patient fatigue, or postoperative complications. CONCLUSION: Considering the criteria established by the EWGSOP, the prevalence of preoperative sarcopenia in colorectal cancer patients was 19.4%.
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Lung cancer is a major cause of cancer deaths worldwide. Non-small-cell lung cancer (NSCLC) represents most lung cancer cases, and approximately one-third of patients present with stage III disease at diagnosis. As multiple treatment plans can be adopted for these patients depending on tumor size and nodal staging, stage III NSCLC management is challenging. Over the past decades, multidisciplinary teams (MDTs) have been implemented in healthcare services to coordinate actions among the different health care professionals involved in cancer care. The aim of this review was to discuss real-world evidence of the impact of MDTs on stage III NSCLC management, survival, and quality of life. Here, we performed a literature review to investigate the role of nutrition and navigational nursing in NSCLC care and the influence of MDTs in the choice of treatment plans, including immunotherapy consolidation, and in the management of chemotherapy and radiotherapy-related adverse events. We also performed a mapping review to identify gaps in the implementation of cancer care MDTs in healthcare services around the world.
Subject(s)
Carcinoma, Non-Small-Cell Lung , Lung Neoplasms , Humans , Carcinoma, Non-Small-Cell Lung/therapy , Lung Neoplasms/therapy , Quality of Life , Health Personnel , ImmunotherapyABSTRACT
Objective: To evaluate the preoperative muscle mass of patients with head and neck cancer (HNC) with computed tomography (CT), comparing the results obtained through analysis of cross-sectional areas at the level of the third lumbar vertebra (L3) with those obtained through analysis of cross-sectional areas at the levels of the third cervical and fourth thoracic vertebrae (C3 and T4, respectively). Materials and Methods: A total of 63 patients with HNC were evaluated preoperatively. Using CT, we assessed muscle mass at L3, as well as at C3 and T4. Results: Most (73.0%) of the patients had low muscle mass at L3, whereas 50.8% had a normal body mass index. The cross-sectional area at L3 correlated strongly with those at C3 and T4 (r = 0.831 and r = 0.763, respectively; p < 0.001 for both). In addition, the muscle mass index at L3 correlated strongly with those at C3 and T4 (r = 0.781 and r = 0.715, respectively; p < 0.001 for both). Conclusion: Low muscle mass appears to be highly prevalent in patients with HNC. Measurements at C3 and T4 could represent alternative means of assessing muscle mass in such patients.
Objetivo: Avaliar e comparar a massa muscular de pacientes com câncer de cabeça e pescoço (CCP) durante o período pré-operatório com tomografia computadorizada (TC), por meio da análise das áreas transversais no nível da terceira vértebra lombar (L3) em comparação com níveis cervical (C3) e torácico (T4). Materiais e Métodos: Sessenta e três pacientes com CCP foram avaliados no pré-operatório. A TC foi utilizada para avaliar a massa muscular de L3, assim como as secções transversais de C3 e T4. Resultados: A maioria dos pacientes (73,0%) tinha baixa massa muscular analisada pela TC de L3, mas índice de massa corpórea normal (50,8%). Também foi observada forte correlação entre as áreas e o índice de massa muscular (IMM) de L3 com C3 (área: r = 0,831, p < 0,001; IMM: r = 0,781, p < 0,001) e T4 (área: r = 0,763, p < 0,001; IMM: r = 0,715, p < 0,001). Conclusão: A baixa massa muscular é altamente prevalente em pacientes com CCP. As análises de TC em C3 e T4 podem representar opção para avaliar a massa muscular em pacientes com CCP.
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Objective: To evaluate the impact of preoperative body composition in patients with renal cell carcinoma (RCC) undergoing surgical treatment. Materials and Methods: This was a retrospective study of 52 patients with RCC undergoing total or partial nephrectomy. Body composition assessment was performed using the body mass index, together with computed tomography analysis at the level of the third lumbar vertebra to measure the area of visceral adipose tissue, as well as the area and density of skeletal muscle mass. Results: Malnutrition, obesity and inadequate skeletal muscle gauge (SMG) were associated with higher hospital length of stay (p = 0.028, p = 0.02 and p = 0.012, respectively). Although the rates of postoperative symptoms and readmissions were low, survival was better among the patients with an adequate SMG than among those with an inadequate SMG (p = 0.003). Conclusion: Among patients with RCC undergoing surgical treatment, preoperative body composition does not seem to be associated with the rates of perioperative complications, although an inadequate SMG seems to be associated with worse overall survival.
Objetivo: Avaliar o impacto da composição corporal pré-operatória em pacientes portadores de carcinoma de células renais (CCR) submetidos a tratamento cirúrgico. Materiais e Métodos: Foi realizado estudo retrospectivo de 52 pacientes portadores de CCR submetidos a tratamento cirúrgico. A avaliação da composição corporal foi realizada por meio do índice de massa corporal e análise da L3 obtida pela tomografia computadorizada para mensurar a área do tecido adiposo visceral, área e densidade da massa muscular esquelética. Resultados: Os pacientes desnutridos, obesos e que apresentaram produto muscular esquelético (PME) inadequado permaneceram mais tempo internados (p = 0,028, p = 0,02 e p = 0,012, respectivamente). As taxas de sintomas e reinternações no pósoperatório foram baixas em toda a amostra, no entanto, observou-se que pacientes com PME inadequado apresentaram uma pior sobrevida em relação aos pacientes com PME adequado (p = 0,003). Conclusão: A análise da composição corporal pré-operatória não mostrou associação com as taxas de complicações periope-ratórias em pacientes portadores de CCR submetidos a nefrectomia total ou parcial, no entanto, a inadequação do PME está associada a uma pior sobrevida.
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Objective: To correlate body composition measures, based on computed tomography (CT) analysis of muscle mass and adipose tissue, with disease-free survival in breast cancer patients. Materials and Methods: This single-center retrospective study included 262 female patients with nonmetastatic breast cancer. Body composition was assessed on a pretreatment CT scan (at the L3 level). The analysis included quantification of the areas of subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and skeletal muscle mass, as well as of the mean skeletal muscle density. The VAT/SAT ratio, skeletal mass index (SMI), and skeletal muscle gauge (SMG) were calculated. Results: Of the 262 patients evaluated, 175 (66.8%) were classified as overweight or obese on the basis of their body mass index. We observed low SMI in 35 patients (13.4%) and elevated VAT in 123 (46.9%). Disease-free survival was significantly shorter in the patients who underwent neoadjuvant chemotherapy (p = 0.044), in those with a low SMI (p = 0.006), in those with low SMG (p = 0.013), and in those with a low VAT/SAT ratio (p = 0.050). In a multivariate analysis, only SMG, the VAT/SAT ratio, and having undergone neoadjuvant chemotherapy retained their statistical significance. Conclusion: Our results confirm that low SMG and the VAT/SAT ratio can be used as imaging biomarkers to assess prognosis in patients with nonmetastatic breast cancer.
Objetivo: Correlacionar medidas de composição corporal baseadas na análise por tomografia computadorizada (TC) da massa muscular e tecido adiposo com a sobrevida livre de doença em pacientes com câncer de mama. Materiais e Métodos: Estudo retrospectivo unicêntrico que incluiu 262 mulheres com câncer de mama não metastático. Avaliação da composição corporal foi realizada na TC pré-tratamento (nível de L3), incluindo tecido adiposo subcutâneo (SAT) e tecido adiposo visceral (VAT), massa muscular esquelética e densidade do músculo esquelético. A relação VAT/SAT, o índice de massa esquelética (SMI) e o produto do músculo esquelético (SMG) foram calculados. Resultados: De acordo com o índice de massa corporal, 175 (66,8%) pacientes foram classificadas com sobrepeso ou obesidade. Baixo SMI foi observado em 35 (13,4%) pacientes e VAT elevado, em 123 (46,9%). Houve uma redução significativa na sobrevida livre de doença nas pacientes que realizaram quimioterapia neoadjuvante (p = 0,044), nas com baixo SMI (p = 0,006), baixo SMG (p = 0,013) e baixa relação VAT/SAT (p = 0,050). Na análise multivariada, apenas SMG, relação VAT/SAT e quimioterapia neoadjuvante confirmaram significância estatística. Conclusão: Nossos resultados confirmaram que SMG e relação VAT/SAT baixos podem ser usados como importantes biomarcadores de imagem para avaliar o prognóstico em pacientes com câncer de mama não metastático.
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Abstract Objective: To correlate body composition measures, based on computed tomography (CT) analysis of muscle mass and adipose tissue, with disease-free survival in breast cancer patients. Materials and Methods: This single-center retrospective study included 262 female patients with nonmetastatic breast cancer. Body composition was assessed on a pretreatment CT scan (at the L3 level). The analysis included quantification of the areas of subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and skeletal muscle mass, as well as of the mean skeletal muscle density. The VAT/SAT ratio, skeletal mass index (SMI), and skeletal muscle gauge (SMG) were calculated. Results: Of the 262 patients evaluated, 175 (66.8%) were classified as overweight or obese on the basis of their body mass index. We observed low SMI in 35 patients (13.4%) and elevated VAT in 123 (46.9%). Disease-free survival was significantly shorter in the patients who underwent neoadjuvant chemotherapy (p = 0.044), in those with a low SMI (p = 0.006), in those with low SMG (p = 0.013), and in those with a low VAT/SAT ratio (p = 0.050). In a multivariate analysis, only SMG, the VAT/SAT ratio, and having undergone neoadjuvant chemotherapy retained their statistical significance. Conclusion: Our results confirm that low SMG and the VAT/SAT ratio can be used as imaging biomarkers to assess prognosis in patients with nonmetastatic breast cancer.
Resumo Objetivo: Correlacionar medidas de composição corporal baseadas na análise por tomografia computadorizada (TC) da massa muscular e tecido adiposo com a sobrevida livre de doença em pacientes com câncer de mama. Materiais e Métodos: Estudo retrospectivo unicêntrico que incluiu 262 mulheres com câncer de mama não metastático. Avaliação da composição corporal foi realizada na TC pré-tratamento (nível de L3), incluindo tecido adiposo subcutâneo (SAT) e tecido adiposo visceral (VAT), massa muscular esquelética e densidade do músculo esquelético. A relação VAT/SAT, o índice de massa esquelética (SMI) e o produto do músculo esquelético (SMG) foram calculados. Resultados: De acordo com o índice de massa corporal, 175 (66,8%) pacientes foram classificadas com sobrepeso ou obesidade. Baixo SMI foi observado em 35 (13,4%) pacientes e VAT elevado, em 123 (46,9%). Houve uma redução significativa na sobrevida livre de doença nas pacientes que realizaram quimioterapia neoadjuvante (p = 0,044), nas com baixo SMI (p = 0,006), baixo SMG (p = 0,013) e baixa relação VAT/SAT (p = 0,050). Na análise multivariada, apenas SMG, relação VAT/SAT e quimioterapia neoadjuvante confirmaram significância estatística. Conclusão: Nossos resultados confirmaram que SMG e relação VAT/SAT baixos podem ser usados como importantes biomarcadores de imagem para avaliar o prognóstico em pacientes com câncer de mama não metastático.
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Objetivo Traçar e comparar o perfil nutricional de pacientes provenientes de planos de saúde/particular e do Sistema Único de Saúde (SUS), atendidos pela primeira vez no ambulatório de nutrição. Indivíduos com câncer apresentam alterações fisiológicas provocadas pelo tumor ou pelo tipo de tratamento proposto, causando efeitos colaterais que diminuem a ingestão alimentar causando desnutrição. A desnutrição em pacientes oncológicos pode chegar a 80%, dependendo da localização do tumor e estágio da doença. Traçar o perfil nutricional permite uma adequada intervenção a fim de prevenir ou reverter o declínio do estado nutricional, e assim amenizar a progressão da doença. Métodos Estudo do tipo descritivo, quantitativo e retrospectivo, onde os pacientes atendidos no ambulatório de nutrição foram avaliados quanto ao seu estado nutricional por meio de coleta de informações de prontuário em ficha de dados desenvolvida especialmente para o estudo. Resultados 2704 pacientes foram avaliados, com maior prevalência do sexo feminino (66,4%) e maior prevalência de tumores colorretais (20,6%). Entre os pacientes, 27,1% estavam em tratamento de quimioterapia e/ou radioterapia e a maior parte dos classificados como desnutridos foram atendidos pelo SUS (36,9%), enquanto que a obesidade estava presente em 28% dos pacientes convênio/particulares. A perda de peso intensa foi semelhante nos dois grupos, porém, perda de peso leve ocorreu em sua maioria nos pacientes convênio/particulares. A classificação pelo IMC apresentou menor desnutrição (18%) quando comparada com a associação de perda de peso (25,1%). Conclusão A prevalência de desnutrição em pacientes oncológicos, evidencia a importância do acompanhamento ambulatorial
Objective The goal of this study was to compare the nutritional profiles of patients covered by the Universal Health System versus private health care systems in Brazil prior to their treatment at a nutrition clinic. Individuals with cancer present physiological changes depending on their type of tumor and treatment. Adverse reactions to either can reduce food intake. As a result, up to 80% of cancer patients develop malnutrition, depending on tumor location and stage of disease. Thus, monitoring the nutritional profile of cancer patients during treatment is important, especially to identify and reverse adverse nutritional patterns which can facilitate disease progression if they are left untreate. Methods In this descriptive, quantitative, and retrospective study, nutritional information for each participant was collected from their medical records and entered in a data sheet specifically designed for this study. Results A total of 2704 patients were included in this study, with a higher prevalence of females (66.4%) and patients with colorectal tumors (20.6%) included. Among this cohort, 27.1% of the patients were receiving chemotherapy and/or radiotherapy for cancer treatment. The majority of the patients classified as malnourished were covered by the Universal Health System (36.9%). However weight loss was similar between the two patient groups. Body mass index classification was the lowest for those presenting malnutrition (18%), followed by those presenting weight loss (25.1%). Conclusion The present findings demonstrate that malnutrition is prevalent among cancer patients and outpatient follow-up is important
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Objetivo Avaliar os benefícios da abreviação de jejum pré-operatória em pacientes cirúrgicos oncológicos, analisando os sintomas apresentados no período pré-operatório, as complicações existentes no pós-operatório e o tempo de internação. Métodos O estudo é do tipo prospectivo, de coorte e observacional. Apresentou uma amostra de 208 pacientes que foram divididos entre grupo intervenção e grupo controle (que fizeram a abreviação de jejum pré-operatório, e que não fizeram, respectivamente) e teve como método de avaliação do estado nutricional o Índice de Massa Corpórea. Também foi analisado a incidência de fome e sede e foi utilizado uma escala analógica visual (EVA) para determinar náuseas e vômitos. Resultados O grupo que recebeu suplemento específico apresentou menor sensação de sede e fome com diferença muito significativa (p<0,000), porém, apresentou mais complicações pós-cirúrgicas (p = 0,002), maior tempo de internação (p < 0,000) e maior frequência de náuseas e vômitos, mas sem diferença significante (valor de p igual a 0,0666 e 0,365, respectivamente). Conclusão A ingesta de suplemento específico de rápida absorção em até duas horas no pré-operatório apresentou efeitos benéficos no conforto do paciente, diminuindo a sensação de fome e sede. No entanto, nesse estudo não houve melhora nas náuseas, complicações no pós-operatório e no tempo de internação
Objective To evaluate the benefits of the abbreviation for preoperative fasting in surgical oncology patients, analyzing the symptoms presented in the preoperative period, the existing complications in the postoperative period and the length of hospital stay. Methods The study is a prospective, cohort and observational study. It presented a sample of 208 patients who were divided into an intervention group and a control group (who abbreviated preoperative fasting and who did not, respectively) and had the Body Mass Index as a method of assessing nutritional status. The incidence of hunger and thirst was also analyzed and a visual analog scale (VAS) was used to determine nausea and vomiting. Results The group that received a specific supplement had less sensation of thirst and hunger with a very significant difference (p <0.000), however, it presented more post-surgical complications (p = 0.002), longer hospital stay (p <0.000) and greater frequency of nausea and vomiting, but with no significant difference (p-value equal to 0.066 and 0.365, respectively). Conclusion The intake of specific supplement with rapid absorption in up to two hours in the preoperative period had beneficial effects on the patient's comfort, reducing the sensation of hunger and thirst. However, in this study there was no improvement in nausea, complications in the postoperative period and length of stay
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Introdução: a desnutrição é comum nos pacientes com câncer de cabeça e pescoço e traz como conseqüência o aumento de complicações pós-operatório e no tempo hospitalização, diminuição da qualidade de vida e aumento da mortalidade. A avaliação nutricional é importante para pacientes que apresentam risco nutricional e imprescindível para determinar uma terapia nutricional mais adequada. O uso da tomografia computadorizada (TC) para avaliação do status nutricional tem sido recomendada para os pacientes oncológicos, pois permite uma quantificação da massa muscular, além de ser um exame amplamente utilizado no estadiamento oncológico. Objetivos: avaliar a massa muscular de pacientes portadores de câncer de cabeça e pescoço no pré-operatório através da TC, comparando avaliação em L3 com C3 e T4, e avaliar o estado nutricional por diferentes métodos de avaliação nutricional, correlacionando-os com as complicações pós-operatórias e tempo de hospitalização. Materiais e Métodos: foram avaliados 63 pacientes com câncer de cabeça e pescoço no pré-operatório. A avaliação da massa muscular foi através da TC de L3 e a avaliação nutricional foi pela Avaliação Subjetiva Global Produzida pelo Paciente (ASG-PPP), força de preensão manual e antropometria (Índice da Massa Corpórea [IMC] e circunferência muscular do braço [CMB]). Foram analisados cortes da TC de C3 e T4 e a área e morfologia do músculo psoas e foram comparados com os resultados de L3. Resultados: a maior parte dos pacientes (73%) apresentou massa muscular inadequada pela TC de L3, IMC de eutrofia (50,8%), ASG-PPP com risco de desnutrição ou desnutrição já presente (82,5%) e CMB de eutrofia (55,6%). Houve associação significativa da massa muscular pela TC de L3 apenas com o IMC (p=0,038). O tempo de internação apresentou diferença significativa para IMC (p=0,018), CMB (p=0,023) e ASG-PPP (p=0,002). As complicações foram associadas significativamente ao resultado da ASG-PPP (p=0,018). Forte correlação foi observada entre as áreas e índice de massa muscular de L3 com C3 e T4. Conclusão: a desnutrição e a baixa massa muscular têm alta prevalência em pacientes com câncer de cabeça e pescoço, desfavorecendo os resultados clínicos. A análise de C3 e T4 podem ser alternativas para avaliação da massa muscular nestes pacientes
Introduction: malnutrition is common in patients with head and neck cancer and results in increased postoperative complications and length of hospital stay, decreased quality of life and increased mortality. Nutritional assessment is important for patients who are at nutritional risk and essential to determine a more appropriate nutritional therapy. The use of computed tomography (CT) to assess body composition has been recommended for cancer patients, as it allows the quantification of muscle mass, and this exam is already used in cancer staging. Aim: to assess the muscle mass of patients with head and neck cancer in the preoperative period through CT, comparing L3 evaluation with C3 and T4, and to assess nutritional status using different methods, correlating nutritional assessment with postoperative complications and length of hospital stay. Materials and Methods: 63 patients with head and neck cancer in the preoperative period were evaluated. Muscle mass was assessed through the L3-level on CT and the nutritional assessment included the Patient-Generated Subjective Global Assessment (PG-SGA), handgrip strength and anthropometry (body mass index [BMI] and mid-arm muscle circumference [MAMC]). CT assessments on C3 and T4-levels, as well as the morphology of the psoas muscle were also analyzed and compared with the results of L3-level. Results: most patients (73%) had inadequate muscle mass by L3 CT, normal BMI (50.8%), PG-SGA with risk of malnutrition or malnutrition already present (82, 5%) and eutrophic anthropometry (55.6%). There was a significant association of muscle mass by L3 CT only with BMI (p = 0.038). The length of hospital stay showed a significant difference for BMI (p = 0.018), mid-arm muscle circumference (p = 0.023) and PG-SGA (p = 0.002). The complications were significantly associated with the result of the PG-SGA (p = 0.018). There was a strong correlation of muscle mass obtained on L3-level with C3 and T4-levels. Conclusion: malnutrition and low muscle mass have a high prevalence in patients with head and neck cancer, disfavoring clinical results. The analysis of C3 and T4 may be alternatives for assessing muscle mass in these patients
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Preoperative Care/methods , Tomography, X-Ray Computed , Nutrition Assessment , Anthropometry , Head and Neck NeoplasmsABSTRACT
The nutritional status of patients submitted to hematopoietic stem cell transplant is considered an independent risk factor, which may influence on quality of life and tolerance to the proposed treatment. The impairment of nutritional status during hematopoietic stem cell transplant occurs mainly due to the adverse effects resulting from conditioning to which the patient is subjected. Therefore, adequate nutritional evaluation and follow-up during hematopoietic stem cell transplant are essential. To emphasize the importance of nutritional status and body composition during treatment, as well as the main characteristics related to the nutritional assessment of the patient, the Brazilian Consensus on Nutrition in Hematopoietic Stem Cell Transplant: Adults was prepared, aiming to standardize and update Nutritional Therapy in this area. Dietitians, nutrition physicians and hematologists from 15 Brazilian centers thar are references in hematopoietic stem cell transplant took part.
Subject(s)
Hematopoietic Stem Cell Transplantation/standards , Nutrition Therapy/standards , Nutritional Status , Adult , Anthropometry , Brazil , Hematopoietic Stem Cell Transplantation/adverse effects , Humans , Nutrition Assessment , Nutrition Therapy/methods , Parenteral Nutrition/methods , Parenteral Nutrition/standards , Transplantation ConditioningABSTRACT
ABSTRACT The nutritional status of patients submitted to hematopoietic stem cell transplant is considered an independent risk factor, which may influence on quality of life and tolerance to the proposed treatment. The impairment of nutritional status during hematopoietic stem cell transplant occurs mainly due to the adverse effects resulting from conditioning to which the patient is subjected. Therefore, adequate nutritional evaluation and follow-up during hematopoietic stem cell transplant are essential. To emphasize the importance of nutritional status and body composition during treatment, as well as the main characteristics related to the nutritional assessment of the patient, the Brazilian Consensus on Nutrition in Hematopoietic Stem Cell Transplant: Adults was prepared, aiming to standardize and update Nutritional Therapy in this area. Dietitians, nutrition physicians and hematologists from 15 Brazilian centers thar are references in hematopoietic stem cell transplant took part.
RESUMO O estado nutricional do paciente submetido ao transplante de células-tronco hematopoéticas é considerado fator de risco independente, podendo influenciar na qualidade de vida e na tolerância ao tratamento proposto. O comprometimento do estado nutricional durante o transplante de células-tronco hematopoéticas ocorre principalmente devido aos efeitos adversos decorrentes do condicionamento ao qual o paciente é submetido. Desta forma, a adequada avaliação nutricional e o acompanhamento durante o transplante de células-tronco hematopoéticas tornam-se imprescindíveis. Com o objetivo de salientar a importância do estado nutricional e da composição corporal durante o tratamento, bem como as principais características relacionadas à avaliação nutricional do paciente, o Consenso Brasileiro de Nutrição em Transplante de Células-Tronco Hematopoiéticas: Adulto foi elaborado visando uniformizar e atualizar a Terapia Nutricional nesta área. Com a participação de nutricionistas, nutrólogos e hematologistas de 15 centros brasileiros referências em transplante de células-tronco hematopoéticas
Subject(s)
Humans , Adult , Nutritional Status , Hematopoietic Stem Cell Transplantation/standards , Nutrition Therapy/standards , Brazil , Nutrition Assessment , Anthropometry , Parenteral Nutrition/methods , Parenteral Nutrition/standards , Hematopoietic Stem Cell Transplantation/adverse effects , Transplantation Conditioning , Nutrition Therapy/methodsABSTRACT
Abstract Objective: To determine whether preoperative anthropometric and computed tomography (CT) measurements of body composition can predict postoperative morbidity and mortality in patients with gastric or esophageal cancer. Materials and Methods: This was a retrospective study in which we reviewed the medical records and abdominal CT scans of patients with gastric or esophageal cancer who underwent surgery in 2015 at a cancer center. CT scans performed during routine preoperative evaluation were retrospectively assessed to measure the area of lean body mass at the level of the third lumbar vertebra, as well as the area of visceral and subcutaneous fat. Results: Seventy patients were included in the study. The mean age was 59.9 years (range, 33-82 years), and 47 patients (67.1%) were men. The mean postoperative follow-up period was 14.9 months. Neither postoperative morbidity nor postoperative mortality correlated significantly with gender, age, the type of primary tumor, the presence of comorbidities, smoking status, body mass index, nutritional status, or visceral fat area. The survival rate was higher for patients with normal lean body mass than for those with low lean body mass (hazard ratio = 0.116; 95% confidence interval: 0.015-0.906; p = 0.040). Conclusion: Our data suggest that lean body mass can be a relevant prognostic factor in patients with gastric or esophageal cancer, and that CT measurements should be included in the routine preoperative evaluation, because it may provide information that aids nutritional and clinical care for these patients.
Resumo Objetivo: Investigar se medidas antropométricas e tomografia computadorizada (TC) da composição corporal podem predizer morbimortalidade pós-operatória em pacientes com câncer gástrico e/ou esofágico. Materiais e Métodos: Estudo retrospectivo que revisou prontuários médicos e TCs abdominais de pacientes com câncer gástrico e/ou esofágico que foram operados em 2015 em um centro de referência oncológico. As TCs realizadas durante a avaliação pré- operatória de rotina foram avaliadas retrospectivamente para medir a área de massa magra ao nível de L3 e gordura visceral e subcutânea. Resultados: Setenta pacientes foram incluídos no estudo. A média de idade foi 59,9 anos (faixa de 33-82 anos), e 47 desses pacientes (67,1%) eram homens. O seguimento pós-operatório médio foi 14,9 meses. Não houve associação significativa entre morbidade ou mortalidade pós-operatória e sexo, idade, tumor primário, comorbidades, tabagismo, índice de massa corpórea, diagnóstico nutricional ou área de gordura visceral. A taxa de sobrevida foi maior para pacientes com área de massa magra normal, em comparação com pacientes com baixa área de massa magra (hazard ratio = 0,116; intervalo de confiança 95% = 0,015-0,906; p = 0,040). Conclusão: Nossos dados sugerem que a área de massa magra pode ser um importante fator prognóstico em pacientes com câncer gástrico e/ou esofágico, e sua medida na TC deve ser incluída na avaliação pré-operatória de rotina, podendo fornecer informações que auxiliem no manejo clínico e nutricional desses pacientes.
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Objetivo Analisar e comparar a qualidade microbiológica de frutas e hortaliças cruas e cozidas servidas em uma instituição oncológica. Métodos Para isso foram analisadas amostras de 10 alimentos na forma crua e cozida. As análises microbiológicas dos alimentos não apresentaram alterações que indicassem risco sanitário ao paciente. Resultados Houve alteração no valor de mesófilos totais do abacaxi cru, mostrando que é possível a contaminação pelos microrganismos indicadores higiênicos após a higienização do alimento, podendo ser pela manipulação inadequada após este procedimento ou superfícies de contato. Conclusão As análises microbiológicas revelaram que os alimentos crus podem ser consumidos por pacientes oncológicos e neutropênicos, pois não houve presença de micro-organismos indicadores sanitários que representassem alto risco à saúde e não apresentaram diferenças microbiológicas destes com os alimentos cozidos. As contagens de micro-organismos higiênicos se mantiveram dentro dos limites aceitáveis tanto para os alimentos crus quanto os cozidos
Objective To analyze and compare the microbiological quality of raw and cooked fruits and vegetables served at an oncological institution. Methods For this, 10 food samples were analyzed in raw and cooked form. The microbiological analyzes of the food did not present alterations that indicated health risk to the patient. Results There was a change in the total mesophyll value of raw pineapple, showing that it is possible to contaminate the hygienic indicator microorganisms after food hygiene, and may be due to improper handling after this procedure or contact surfaces. Conclusion Microbiological analysis revealed that raw foods can be consumed by oncology and neutropenic patients, as there were no micro-organisms that were health indicators that presented a high health risk and did not present microbiological differences with cooked food. The counts of hygienic microorganisms have remained within acceptable limits for both raw and cooked foods
ABSTRACT
OBJECTIVE: To determine whether preoperative anthropometric and computed tomography (CT) measurements of body composition can predict postoperative morbidity and mortality in patients with gastric or esophageal cancer. MATERIALS AND METHODS: This was a retrospective study in which we reviewed the medical records and abdominal CT scans of patients with gastric or esophageal cancer who underwent surgery in 2015 at a cancer center. CT scans performed during routine preoperative evaluation were retrospectively assessed to measure the area of lean body mass at the level of the third lumbar vertebra, as well as the area of visceral and subcutaneous fat. RESULTS: Seventy patients were included in the study. The mean age was 59.9 years (range, 33-82 years), and 47 patients (67.1%) were men. The mean postoperative follow-up period was 14.9 months. Neither postoperative morbidity nor postoperative mortality correlated significantly with gender, age, the type of primary tumor, the presence of comorbidities, smoking status, body mass index, nutritional status, or visceral fat area. The survival rate was higher for patients with normal lean body mass than for those with low lean body mass (hazard ratio = 0.116; 95% confidence interval: 0.015-0.906; p = 0.040). CONCLUSION: Our data suggest that lean body mass can be a relevant prognostic factor in patients with gastric or esophageal cancer, and that CT measurements should be included in the routine preoperative evaluation, because it may provide information that aids nutritional and clinical care for these patients.
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Introduction: Tumor resection, chemotherapy and / or radiotherapy are used in the treatment of head and neck neoplasms, and these therapies trigger side effects that interfere with the patient's nutritional status. Nutritional intervention makes it possible to recover nutritional status and contributes to reduce treatment morbidity. Objective: To verify the evolution of the nutritional status of patients with head and neck cancer who followed the treatment and attended the nutrition clinic. Methods: Nutritional status was evaluated based on data collection and weight, height, percentage of weight loss, body mass index, arm circumference, triceps skinfold, nutritional muscular area and nutritional intervention. Results: When comparing the nutritional status of the patients at the beginning and at the final moment of follow-up, we did not observe a statistically significant difference (p=0.261); however, moderate / intense weight loss was observed in 23.6% (n=17) at the end of treatment. When assessing adherence to targeted nutritional therapy and weight loss, it was observed that of the 48 (66.7%) patients who adhered fully to the guidelines, 39 (81.3%) had no significant weight loss (p=0.091). Conclusion: Although the study did not indicate a statistically significant difference in relation to the nutritional status of the patients, 81.3% of those who adhered to the nutritional guidelines did not have significant weight loss corroborating with the results presented in the studies that suggest that individualized nutritional monitoring during radiotherapy and / or radiotherapy concomitant with chemotherapy helps maintain nutritional status.
Introdução: A ressecção tumoral, a quimioterapia e/ou radioterapia são utilizadas no tratamento de neoplasias de cabeça e pescoço, e essas terapias desencadeiam efeitos colaterais que interferem no estado nutricional do paciente. A intervenção nutricional possibilita a recuperação do estado nutricional e contribui para reduzir a morbidade do tratamento. Objetivo: Verificar a evolução do estado nutricional de pacientes com câncer de cabeça e pescoço que acompanharam o tratamento e compareceram à clínica de nutrição. Método: O estado nutricional foi avaliado com base na coleta de dados e peso, altura, percentual de perda de peso, índice de massa corporal, circunferência do braço, prega cutânea tricipital, área muscular nutricional e intervenção nutricional. Resultados: Ao comparar o estado nutricional dos pacientes no início e no momento final do acompanhamento, não observamos diferença estatisticamente significante (p=0,261); no entanto, perda de peso moderada/intensa foi observada em 23,6% (n=17) no final do tratamento. Ao avaliar a adesão à terapia nutricional direcionada e à perda de peso, observou-se que, dos 48 (66,7%) pacientes que aderiram plenamente às orientações, 39 (81,3%) não apresentaram perda de peso significativa (p=0,091). Conclusão: Apesar de o estudo não indicar diferença estatisticamente significante em relação ao estado nutricional dos pacientes, 81,3% daqueles que aderiram às diretrizes nutricionais não apresentaram perda de peso significativa, corroborando com os resultados apresentados em estudos, que sugerem que a monitorização nutricional individualizada durante a radioterapia e/ou radioterapia concomitante à quimioterapia ajuda a manter o estado nutricional.