Associação entre Sarcopenia, Estado Nutricional e Qualidade de Vida em Pacientes com Câncer Avançado em Cuidados Paliativos / Sarcopenia: Association with Nutritional Status and Quality of Life in Patients with Advanced-Stage Cancer in Palliative Care / Asociación entre Sarcopenia, Estado Nutricional y Calidad de Vida en Pacientes con Cáncer Avanzado en Cuidados Paliativos

RESUMO

Introdução: A sarcopenia pode comprometer a qualidade de vida de indivíduos com câncer. Objetivo: Avaliar a prevalência de sarcopenia e sua associação com estado nutricional e qualidade de vida em pacientes com câncer avançado em cuidados paliativos. Método: Estudo transversal com indivíduos com câncer em fase avançada, ambos os sexos, idade >20 anos, em seu primeiro atendimento na unidade de Cuidados Paliativos do Instituto Nacional de Câncer José Alencar Gomes da Silva. Variáveis analisadas antropometria, força de preensão manual (FPM), Karnofsky performance status, qualidade de vida (QLQ-C15-PAL), avaliação subjetiva global produzida pelo paciente e exames laboratoriais. Para a classificação da sarcopenia, foram consideradas baixa massa muscular [circunferência muscular do braço (CMB) adequação

ABSTRACT

Abstract Introduction: Sarcopenia can compromise the quality of life of individuals with cancer. Objective: To evaluate the prevalence of sarcopenia, as well as its association with nutritional status and quality of life, among patients with advanced-stage cancer in palliative care. Method: This was a cross-sectional study involving patients with advanced-stage cancer who were ≥20 years of age and were receiving treatment for the first time in the Palliative Care Unit of the José Alencar Gomes da Silva National Cancer Institute. The following variables were analyzed anthropometric parameters; handgrip strength (HGS); Karnofsky performance status; quality of life (QLQ-C15- PAL score); Patient-Generated Subjective Global Assessment score; and laboratory tests. Sarcopenia was diagnosed on the basis of low muscle mass (mid-arm circumference [MAC] adequacy <90%) and low muscle strength (HGS <10th percentile). Patients with low HGS were classified as having dynapenia, and those with low MAC adequacy were classified as having muscle atrophy. The level of statistical significance adopted was 5%. Results: A total of 210 patients were studied. The mean age was 60.6 (± 13.4) years. There was a predominance of females and of patients with low functional capacity. Among the patients in the sample, we identified dynapenia in 21.9%, muscular atrophy in 17.1%, and sarcopenia in 32.4%. The patients with sarcopenia had worse nutritional status, higher leukocyte counts, higher C-reactive protein levels, lower lymphocyte proportions, and lower albumin levels than did those without sarcopenia. We observed a significant difference between those two groups in terms of physical impairment affecting quality of life. Conclusion: Sarcopenia is associated with poor nutritional status and can potentiate functional impairment, reducing the quality of life of patients with advanced-stage cancer in palliative care.

RESUMEN

Resumen Introducción: La sarcopenia puede comprometer la calidad de vida de los individuos con cáncer. Objetivo: Evaluar la prevalencia de sarcopenia y su asociación con el estado nutricional y la calidad de vida en pacientes con cáncer avanzado en cuidados paliativos. Método: Estudio transversal con individuos con cáncer avanzado, ambos sexos, edad >20 años, en su primera atención en la unidad de Cuidados Paliativos del Instituto Nacional de Cáncer José Alencar Gomes da Silva. Las variables analizadas fueron antropometría, fuerza por dinamometría (FPD), Karnofsky performance status, calidad de vida (QLQC15-PAL), Valoración Subjetiva Global generada por el paciente y exámenes de laboratorio. Para una composición de sarcopenia se consideró como baja masa muscular [circunferencia muscular del brazo (CMB) adecuación <90%] y baja fuerza muscular [FPD < percentil 10]. Pacientes con Baja FPD se agruparon como dinapénicos y con baja adecuación de CMB como atrofia muscular. El nivel de significancia estadística adoptado fue del 5%. Resultados:Estudió 210 individuos, media de edad 60,6 (± 13,4) años, predominio del sexo femenino y baja capacidad funcional. La dinapenia estaba presente en el 21,9%, la atrofia muscular en el 17,1% y la sarcopenia en el 32,4% de la muestra. Los pacientes sarcopénicos presentaron peor estado nutricional, mayores valores de leucocitos y proteína C reactiva y menores de linfocitos y albúmina cuando comparados a los en el sarcopénico. Para la calidad de vida, fue observada diferencia en la función física entre los grupos. Conclusión: La sarcopenia está asociada a un peor estado nutricional y potencial compromiso funcional, y reduce la calidad de vida de los pacientes con cáncer avanzado en cuidados paliativos.