PROPER-PRehabilitatiOn Plus Enhanced Recovery after surgery versus enhanced recovery after surgery in gynecologic oncology: a randomized clinical trial.

BACKGROUND: Prehabilitation is a process that occurs before surgery and aims to improve patient functional capacity and enhance surgical recovery. This process includes medical, nutritional, physical, and psychological interventions that may reduce the duration of hospital stay and provide postoperative physical benefits. PRIMARY OBJECTIVE: To evaluate the impact of a prehabilitation program on postoperative recovery time for patients who will undergo gynecological surgery following the Enhanced Recovery After Surgery (ERAS) guidelines. STUDY HYPOTHESIS: A multidisciplinary, preoperative prehabilitation program for patients who will undergo gynecological surgery leads to a reduction in the length of hospital stay and improves patient functional capacity. TRIAL DESIGN: Prospective, interventionist, and randomized controlled trial in a 1:1 ratio, open to multidisciplinary team and patients, blinded to surgeons and anesthesiologists. The control group will undergo ERAS standard preoperative care while the intervention group will have ERAS standard preoperative care plus prehabilitation. MAJOR INCLUSION CRITERIA: Patients scheduled to undergo gynecologic surgery performed by laparotomy with a preoperative schedule that allows prehabilitation intervention for 2 to 3 weeks. PRIMARY ENDPOINT: To compare time between surgery and the day the patient is ready for discharge in patients who underwent the prehabilitation process versus those who did not. Readiness for discharge is defined as the ability to take care of one's-self, to walk alone, and to ingest at least 75% of daily recommended calorie intake. SAMPLE SIZE: 194 participants ESTIMATED DATES FOR COMPLETING ACCRUAL AND PRESENTING RESULTS: At present, 30 patients have been recruited. Accrual should be completed by 2023-24. TRIAL REGISTRATION: The study is approved by the IBCC - São Camilo Oncologia ethics committee (reference number 4.256.553) and is registered at clinicaltrials.gov (NCT04596800).

Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: Adults.

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.

Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: Adults / Consenso Brasileiro de Nutrição em Transplante de Células-Tronco Hematopoiéticas: Adultos

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

Appetite Assessment of Hospitalized Cancer Patients in Brazil - A Validation Study.

OBJECTIVES: Appetite loss, a common symptom in cancer patients, contributes to worsened nutritional status. A validated specific tool to assess appetite is clinically useful for diagnosing and identifying symptoms and signs that could be reversed with nutritional and pharmacological therapies. The aim of this study is to produce a Brazilian Portuguese version of the Hill and Blundell visual analog scale (VAS) for appetite and investigate its validity among hospitalized cancer patients. METHODS: The original English VAS version was translated into Brazilian Portuguese in full accordance with the guidelines in the literature and adapted to the Brazilian context by conducting interviews and meetings with an expert committee until the final version was reached. Afterwards, the version was validated in hospitalized cancer patients in a cross-sectional study at São Paulo Cancer Institute (ICESP), where the relationships between breakfast intake (rest-ingestion index) and VAS were compared. The Spearman test was used to verify the correlation between the rest-ingestion index and the VAS ratings. RESULTS: Sixty-four patients with a mean age of 56.1 (±12.3) years answered the Portuguese VAS version, and their breakfast intake was evaluated. The mean rest-ingestion index was 18.8%. The correlations between the rest-ingestion index (food acceptance) and three questions of the Portuguese visual analog scale version were inverse and significant: first question (ρ -0.3028 p=0.0046), second question (ρ -0.2317 p=0.0319) and third question (ρ -0.3049 p=0.0043). CONCLUSION: The "Appetite Assessment Scale of Brazilian Oncology Patients" is a valid instrument to assess appetite in hospitalized cancer patients in Brazil.

Appetite Assessment of Hospitalized Cancer Patients in Brazil - A Validation Study

OBJECTIVES: Appetite loss, a common symptom in cancer patients, contributes to worsened nutritional status. A validated specific tool to assess appetite is clinically useful for diagnosing and identifying symptoms and signs that could be reversed with nutritional and pharmacological therapies. The aim of this study is to produce a Brazilian Portuguese version of the Hill and Blundell visual analog scale (VAS) for appetite and investigate its validity among hospitalized cancer patients. METHODS: The original English VAS version was translated into Brazilian Portuguese in full accordance with the guidelines in the literature and adapted to the Brazilian context by conducting interviews and meetings with an expert committee until the final version was reached. Afterwards, the version was validated in hospitalized cancer patients in a cross-sectional study at São Paulo Cancer Institute (ICESP), where the relationships between breakfast intake (rest-ingestion index) and VAS were compared. The Spearman test was used to verify the correlation between the rest-ingestion index and the VAS ratings. RESULTS: Sixty-four patients with a mean age of 56.1 (±12.3) years answered the Portuguese VAS version, and their breakfast intake was evaluated. The mean rest-ingestion index was 18.8%. The correlations between the rest-ingestion index (food acceptance) and three questions of the Portuguese visual analog scale version were inverse and significant: first question (ρ -0.3028 p=0.0046), second question (ρ -0.2317 p=0.0319) and third question (ρ -0.3049 p=0.0043). CONCLUSION: The "Appetite Assessment Scale of Brazilian Oncology Patients" is a valid instrument to assess appetite in hospitalized cancer patients in Brazil.

Quality control of enteral nutrition therapy in cancer patients at nutritional risk.

INTRODUCTION: Quality indicators in nutritional therapy (QINTs) allow for the practical assessment of quality in the management of enteral nutrition therapy (ENT) among hospitalized patients. OBJECTIVE: To control ENT quality in cancer patients at nutritional risk. METHODS: A prospective, observational study was performed with cancer patients over 19 years of age who had undergone exclusive ENT for at least 72 h. Nutritional Risk Screening was used to assess nutritional risk; in the presence of nutritional risk, the Subjective Global Assessment (SGA) was used. Six QINTs were applied. RESULTS: Our study included 211 patients (mean age: 59 ± 10 years, 67.3% men). Most common cancer diagnoses were head and neck (68.2%) and gastrointestinal (18%). Nutritional risk was identified in 93.3% (n = 197) of patients; SGA identified malnutrition in 84.2% of patients (n = 166). ENT was used for 9.7 ± 7 days, presenting a daily deficit of -243.1 ± 141 ml of dietary volume, -363.3 ± 214.1 kcal, and -14.2 ± 8.41 g of protein. Three of the six QINTs were in accordance with the proposed goal: frequency of SGA application, calculations of nutritional needs, and frequency of diarrhea. Three of the six QINTs were in disagreement with the proposed goal: ENT infused volume exceeding 70% of prescribed volume, frequency of digestive fasting exceeding 24 h, and frequency of constipation. Prescriptions for anticholinergic drugs (p = 0.023) and diuretics (p = 0.007) were associated with diarrhea. CONCLUSION: Nutritional risk and malnutrition are frequent among ENT cancer patients. Quality control in ENT was moderately impaired by episodes of fasting and intestinal motility disorders.

Quality control of enteral nutrition therapy in cancer patients at nutritional risk / Control de calidad en terapia nutricional enteral en el paciente oncológico con riesgo nutricional

Introduction: Quality indicators in nutritional therapy (QINTs) allow for the practical assessment of quality in the management of enteral nutrition therapy (ENT) among hospitalized patients. Objective: To control ENT quality in cancer patients at nutritional risk. Methods: A prospective, observational study was performed with cancer patients over 19 years of age who had undergone exclusive ENT for at least 72 h. Nutritional Risk Screening was used to assess nutritional risk; in the presence of nutritional risk, the Subjective Global Assessment (SGA) was used. Six QINTs were applied. Results: Our study included 211 patients (mean age: 59 ± 10 years, 67.3% men). Most common cancer diagnoses were head and neck (68.2%) and gastrointestinal (18%). Nutritional risk was identified in 93.3% (n = 197) of patients; SGA identified malnutrition in 84.2% of patients (n = 166). ENT was used for 9.7 ± 7 days, presenting a daily deficit of -243.1 ± 141 ml of dietary volume, -363.3 ± 214.1 kcal, and -14.2 ± 8.41 g of protein. Three of the six QINTs were in accordance with the proposed goal: frequency of SGA application, calculations of nutritional needs, and frequency of diarrhea. Three of the six QINTs were in disagreement with the proposed goal: ENT infused volume exceeding 70% of prescribed volume, frequency of digestive fasting exceeding 24 h, and frequency of constipation. Prescriptions for anticholinergic drugs (p = 0.023) and diuretics (p = 0.007) were associated with diarrhea. Conclusion: Nutritional risk and malnutrition are frequent among ENT cancer patients. Quality control in ENT was moderately impaired by episodes of fasting and intestinal motility disorders (AU)

Objetivos: controlar la calidad de la TNE en pacientes con cáncer en riesgo nutricional. Metodología: estudio prospectivo, observacional, con pacientes oncológicos > 19 años y sobre TNE exclusiva > 72 h. Para la evaluación del riesgo nutricional fue utilizada la Nutritional Risk Screening y en presencia de riesgo nutricional fue aplicada la Subjective Global Assessment (SGA). Fueron aplicados 6 ICTN. Resultados: nuestro estudio incluyó 211 pacientes (edad promedio de 59 ± 10 años; 67,3% de sexo masculino). Los diagnósticos oncológicos más predominantes fueron: cáncer de cabeza y cuello (68,2%) y gastrointestinal (18%). El riesgo nutricional estaba presente en el 93,3% (n = 197) de los pacientes; la SGA identificó desnutrición en 84,2% (n = 166). La TNE fue aplicada por 9,7 ± 7 días y presentó un déficit diario de -243,1 ± 141 ml de volumen de dieta administrada, -363,3 ± 214,1 kcal y -14,2 ± 8,41 g de proteínas. Tres de los seis ICTN aplicados estuvieron de acuerdo con la meta: frecuencia de aplicación de la SGA; cálculo de las necesidades nutricionales y frecuencia de diarrea. En desacuerdo con la meta: volumen de la TNE administrada > 70% de lo prescrito; frecuencia de ayuno digestivo > 24 h y frecuencia de estreñimiento. La prescripción de medicamentos anticolinérgicos (p = 0,023) y diuréticos (p = 0,007) se asoció con la aparición de diarrea. Conclusión: el riesgo nutricional y la desnutrición son frecuentes entre pacientes con cáncer que reciben TNE. El control de calidad en la TNE se afectó de una forma negativa por los episodios de ayuno y disturbios en el tránsito intestinal (AU)