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ABSTRACT Objective To verify whether the presence of related nutritional risk indicators prior to COVID-19 diagnosis is associated with poor survival in patients with cancer. Methods We retrospectively analyzed the data of hospitalized cancer patients who tested positive for COVID-19 between March 2020 and February 2021. Nutritional risk was defined as the presence of one of the following characteristics: body mass index <20kg/m 2 , scored Patient-generated Subjective Global Assessment ≥9 points or classification B, albumin level <3.5g/dL, and C-reactive protein level ≥10mg/L, evaluated between 7 and 60 days prior to the date of patient inclusion. The endpoint measure was all-cause mortality within 30 days of COVID-19 diagnosis. Results A total of 253 patients were included, most of whom were elderly (62.4%) and female (63.6%). Overall, 45.4% of the patients were at nutritional risk. Survival was significantly lower in patients at nutritional risk (8 days; interquartile range [IQR]: 3-29) than in patients not at nutritional risk (16 days; IQR: 6-30) (p<0.001). The presence of prior nutritional risk was associated with increased 30-day mortality (HR: 1.42; 95%CI: 1.03-1.94), regardless of age, gender, tumor site or stage, and other risk factors, and the model had good discrimination accuracy (concordance statistic: 0.744). Conclusion The presence of prior nutritional risk indicators is related to poor prognosis in patients with cancer and COVID-19, emphasizing the importance of nutritional care, notably during this pandemic.
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Introdução: O surgimento de metástase gástrica oriunda de neoplasia da mama é raro. Entretanto, o suporte nutricional nesses casos é imprescindível, já que tumores gástricos estão relacionados a complicações nutricionais, favorecendo desfechos clínicos negativos. Relato do caso: Paciente com diagnóstico de adenocarcinoma de mama, com progressão para ossos, ovário e estômago, internada em razão das complicações clínicas. Apresentou perda de peso grave durante a internação, além de diagnóstico de risco de desnutrição pela avaliação subjetiva global produzida pelo paciente. Em virtude do quadro de odinofagia severa, a alimentação via oral tornou-se impossibilitada, sendo optado pelo uso de sonda nasoentérica após discussão com equipe interdisciplinar. Conclusão: A terapia nutricional em pacientes com câncer avançado ainda é um dilema entre os profissionais e sua execução deve ser discutida e decidida por uma equipe interdisciplinar, com participação indispensável do nutricionista, do paciente e de seus familiares. Para isso, os serviços de saúde devem estar preparados para o correto manejo da conduta nutricional, a fim de promover qualidade de vida para esses pacientes.
Introduction: It is uncommon for breast cancer to metastasize to the stomach. However, when it does occur, nutritional support is indispensable, because gastric tumors are associated with nutritional complications, which worsen clinical outcomes. Case report: We report the case of a female patient diagnosed with breast adenocarcinoma that had metastasized to the bones, ovary, and stomach, who was hospitalized because of clinical complications. During hospitalization, she presented severe weight loss and was classified as being at nutritional risk, as determined by the Patient-Generated Subjective Global Assessment. Due to severe odynophagia, oral intake was not possible. Therefore, after consultation with the multidisciplinary team, the decision was made to insert a nasogastric tube. Conclusion: Nutritional therapy in patients with advanced cancer still constitutes a dilemma facing professionals and needs to be discussed by a multidisciplinary team, the participation of the nutritionist, patient, and family being indispensable. Therefore, health care services must be prepared to manage nutritional therapy correctly, in order to promote better quality of life for such patients.
Introducción: El surgimiento de metástasis gástrica proveniente de neoplasia de mama es raro. Sin embargo, el soporte nutricional en estos casos es imprescindible, ya que los tumores gástricos están relacionados a complicaciones nutricionales, favoreciendo los resultados clínicos negativos. Informe de caso: Paciente con diagnóstico de adenocarcinoma de mama, con progresión para huesos, ovario y estómago, internada debido a complicaciones clínicas. Se presentó una pérdida de peso grave durante la internación, además de diagnóstico de riesgo de desnutrición por la evaluación subjetiva global producida por el paciente. Debido a un cuadro de odinofagia severa, la alimentación oral se volvió imposibilitada, siendo optado por el uso de sonda nasoentérica después de la discusión con el equipo interdisciplinario. Conclusión: La terapia nutricional en pacientes con cáncer avanzado sigue siendo un dilema entre los profesionales y su ejecución debe ser discutida y decidida por un equipo interdisciplinario, con participación indispensable del nutricionista, del paciente y de sus familiares. Para ello, los servicios de salud deben estar preparados para el correcto manejo de la co
Subject(s)
Humans , Female , Middle Aged , Stomach Neoplasms/therapy , Breast Neoplasms/therapy , Adenocarcinoma/therapy , Carcinoma, Lobular/therapy , Nutrition Therapy , Body Mass Index , Nutritional StatusABSTRACT
Despertar o olhar para as vulnerabilidades possíveis, quanto ao contexto histórico e social em que o idoso se encontra, remete-nos aos impactos do diagnóstico e as marcas do intenso sofrimento vivenciado em seus processos, mudanças e estruturas. Envelhecimento e vulnerabilidades são os termos centrais deste estudo, abordando o contexto do HIV/Aids e os impactos e demais fatores que emergem neste processo.
Awakening the look at possible vulnerabilities regarding the historical and social context in which the elderly person finds us refers to the impacts of the diagnosis and the marks of the intense suffering experienced with their processes, changes and structures. Aging and vulnerability are the central terms of this study, addressing the context of HIV/aids and the impacts and other factors that emerge in this process.
Despertar la mirada hacia las vulnerabilidades posibles en cuanto al contexto histórico y social en que el anciano se encuentra nos remite a los impactos del diagnóstico y las marcas del intenso sufrimiento vivido con sus procesos, cambios y estructuras. Envejecimiento y vulnerabilidades son los términos centrales de este estudio, abordando el contexto del VIH / SIDA y los impactos y demás factores que emergen en este proceso.
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Humans , Male , Female , Middle Aged , Aged , Aging , Acquired Immunodeficiency Syndrome/psychology , Health Vulnerability , Acquired Immunodeficiency Syndrome/prevention & control , Sexuality , Qualitative Research , Life Change EventsABSTRACT
A avosidade é tema pouco estudado. A Gerontologia mostra-se como uma área propiciadora para que esta temática sejam mais explorada. A presença dos avôs no processo educativo e formativo dos netos é um fato e nos remete a uma reflexão sobre as novas configurações familiares. Pretende-se apreender como o idoso interpreta a relação avô-neto, o intercâmbio de experiências entre gerações e os sentimentos que se evidenciam no dia-a-dia. Considerando que a avosidade é um fenômeno singular e pessoal, por meio de entrevistas pretendeu-se uma compreensão dos significados, valores e expressões. A avosidade está associada a um forte sentimento de paternidade. Os avôs demonstram uma enorme satisfação na relação com os netos.
Grandparenthood is poorly studied theme. Geronthology presents itself as an instigative area for this thematic to be more explored. However, the presence of grandfathers in the educational and formative process of the grandchildren is a fact and refers us to news configurations of the family. This research is intended to apprehend how the elderly interprets the grandfather-grandchild relationship, the exchange of experiences between generations, and the feelings which become evident on the daily routine. Considering that grandparenthood is a singular and personal phenomenon, by means of interviews this research was intended to gain some comprehension of meanings, values, and expressions. The grandparenthood is associated to a strong feeling of parenthood. Grandfathers demonstrate great satisfaction in the relationship with their grandchildren.