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Abstract Introduction Supracricoid laryngectomy (SCL CHEP) removes ~ 70% of the larynx, resulting in structural rearrangement and modification of the swallowing mechanism, promoting chronic dysphagia. One of the consequences of this new physiology is the formation of pharyngeal residues that can increase the possibility of aspiration. The formation of residues after SCL CHEP, its functional consequences, and its influence on quality of life (QOL) is still poorly described in the literature. Objective To investigate and compare the association between self-reported QoL and objective assessments of swallowing function in patients undergoing SCL CHEP. Methods A cross-sectional study was performed from 2018 to 2020 in a reference service for head and neck surgery in Brazil. A total of 860 swallowing videofluoroscopy images were evaluated using the Penetration and Aspiration Scale (PAS) and Dynamic Imaging Grade of Swallowing Toxicity (DIGEST). Results In a group of 86 patients, there was a significant relationship between oncological staging and the global (p<0.001) and total (p = 0.002) QoL domains. There was a negative correlation between the DIGEST scale and the emotional domain of the QoL protocol (p = 0.045). The swallowing function proved to be relevant for QoL. Conclusion The PAS scale did not show any correlation with QoL. The functional performance of swallowing according to the DIGEST scale was coherent with the QOL scores. It is suggested that the residue may be a more relevant aspect for QoL than the aspiration, making DIGEST a promising tool in the assessment of dysphagic patients.
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Introdução: O estado nutricional em fase pré-tratamento pode estar relacionado a desfechos clínicos desfavoráveis em pacientes com câncer. Objetivo: Avaliar o estado nutricional de pacientes adultos e idosos com leucemia em fase de pré-tratamento oncológico. Método: Trata-se de um estudo transversal, retrospectivo, envolvendo pacientes com leucemia em fase pré-tratamento oncológico. Os critérios de inclusão foram ≥20 anos de idade; ambos os sexos; e matrícula no Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA). Os critérios de exclusão foram não ter diagnóstico confirmado de leucemia; registro de avaliação do estado nutricional por meio da avaliação subjetiva global produzida pelo paciente; e não ter recebido tratamento oncológico prévio. Os testes qui-quadrado e t deStudent foram utilizados. Resultados: Foram avaliados 69 pacientes com leucemia em fase pré-tratamento oncológico, sendo em sua maioria homens (52,2%) com menos de 60 anos de idade (52,2%). A prevalência de desnutrição foi de 65,2%, sendo mais expressiva nos idosos (78,8%, p=0,023). A prevalência de risco nutricional apresentou a mesma frequência (65,2%), no entanto, foi maior em pacientes com comorbidades (80,8%, p=0,017) e história de tabagismo (90,9%, p=0,056). Conclusão: A maior parte dos pacientes com leucemia iniciou seu tratamento oncológico com o estado nutricional debilitado, o que se exacerbou entre aqueles com leucemia crônica, idosos, com comorbidades e história de tabagismo.
Introduction: The nutritional status in the pretreatment phase may be related to unfavorable clinical outcomes in cancer patients. Objective: To assess the nutritional status of adult and older adults patients with leukemia in the pretreatment cancer phase. Method: Cross-sectional, retrospective study, involving patients with leukemia in the pretreatment cancer phase. The inclusion criteria were: ≥20 years of age, both genders and enrollment at the National Cancer Institute José Alencar Gomes da Silva (INCA). The exclusion criteria were not having confirmed diagnosis of leukemia, registration of the Patient-Generated Subjective Global Assessment and not having submitted to previous cancer treatment. Chi-square and Student's t tests were used. Results: 69 patients were evaluated with leukemia in the pretreatment cancer phase, mostly men (52.2%) under 60 years of age (52.2%). The prevalence of malnutrition was 65.2%, being more expressive in the older adults (78.8%, p=0.023). The prevalence of nutritional risk had the same frequency (65.2%), however it was higher in patients with comorbidities (80.8%, p=0.017) and smoking history (90.9%, p=0.056). Conclusion: Most patients with leukemia started their cancer treatment with impaired nutritional status, which was exacerbated for those with chronic leukemia, older adults, with comorbidities and history of smoking.
Introducción: El estado nutricional en la fase de pretratamiento puede estar relacionado con resultados clínicos desfavorables en pacientes con cáncer. Objetivo: Evaluar el estado nutricional de pacientes adultos y ancianos con leucemia en fase de pretratamiento de cáncer. Método: Este es un estudio transversal, retrospectivo, que involucra a pacientes con leucemia en la fase de pretratamiento de cáncer. Los criterios de inclusión fueron ≥20 años de edad; ambos os sexos; e inscripción en el Instituto Nacional del Cáncer José Alencar Gomes da Silva (INCA). Los criterios de exclusión fueron no tener un diagnóstico confirmado de leucemia; registro de la evaluación del estado nutricional a través de la Valoración Subjetiva Global-Generada por el Paciente; y no haber recibido tratamiento previo contra el cáncer. Se utilizaron las pruebas de Chi-cuadrado y t de Student. Resultados: Se evaluaron 69 pacientes con leucemia en la fase de pretratamiento de cáncer, en su mayoría hombres (52,2%) menores de 60 años (52,2%). La prevalencia de desnutrición fue del 65,2%, siendo más expresiva en los ancianos (78,8%, p=0,023). La prevalencia del riesgo nutricional tuvo la misma frecuencia (65,2%), sin embargo, fue mayor en pacientes con comorbilidades (80,8%, p=0,017) y antecedentes de tabaquismo (90,9%, p=0,056). Conclusión: La mayoría de los pacientes con leucemia comenzaron su tratamiento con un estado nutricional deteriorado, que se exacerbó entre aquellos con leucemia crónica, ancianos, con comorbilidades y antecedentes de tabaquismo.