Serum Albumin is Independent Predictor of Hospital Mortality in Patients with Cancer / A Albumina Sérica é Preditor Independente de Mortalidade Hospitalar em Pacientes com Câncer / La Albúmina Sérica es un Predictor Independiente de Mortalidad Hospitalaria en Pacientes con Cáncer

Introduction: Cancer is one of the leading causes of morbidity and mortality worldwide. There are few studies showing adjusted models with other predictors of mortality by a conceptual model perspective. Objective: The objective of this study was to verify the prediction of albumin and Prognostic Nutritional Index (PNI) with in-hospital mortality in cancer patients. Method: Retrospective study was performed from 2014 to 2016 with 262 cancer patients (gastrointestinal tract, male genital organs, breast, metastasis, urinary tract, head and neck and others). Demographic data, blood counts, C-reactive protein, albumin, and haematological indexes (Prognosis nutritional index - PNI, Neutrophils to lymphocytes ratio - NLR, Monocytes lymphocytes ratio - MLR, Platelets to lymphocytes ratio - PLR and Platelets to albumin ratio - PAR), nutritional diagnoses and hospital outcomes (discharge or death) were collected. The cumulative probability of death was calculated by Kaplan-Meier curves, and survival analyses were performed using the Cox proportional hazards model. Results: The frequency of death among the study patients was 10.7% (28). Among the patients who died, 99.2% (26) presented some degree of malnutrition (p=0.004). In the multivariate analysis, serum albumin (<3 g/dL) was independently associated with in-hospital mortality (HR=3.43, 95% CI 1.11-10.63). On the other hand, the PNI was not associated with in-hospital mortality. Conclusion: Serum albumin levels during hospitalization were predictors of in-hospital mortality in the population evaluated. These results suggest that the serum levels of this protein can be used in clinical practice, adding prognostic information in patients with cancer

Introducción: El cáncer es una de las principales causas de morbilidad y mortalidad en todo el mundo. Hay pocos estudios que muestren modelos ajustados con otros predictores de mortalidad desde una perspectiva de modelo conceptual. Objetivo: El objetivo de este estudio fue verificar la predicción de la albúmina y el Índice Nutricional Pronóstico (IPN) con la mortalidad hospitalaria en pacientes con cáncer (tracto gastrointestinal, órganos genitales masculinos, mama, metástasis, tracto urinario, cabeza y cuello y otros). Método: Se realizó un estudio retrospectivo de 2014 a 2016 con 262 pacientes con cáncer. Se recogieron datos demográficos, hemogramas, proteína C reactiva, albúmina y índices hematológicos (Índice de Pronóstico Nutricional - IPN, proporción neutrófilos/linfocitos - NLR, proporción monocitos/linfocitos - MLR, proporción plaquetas/linfocitos - PLR y proporción plaquetas/albúmina - PAR), diagnósticos nutricionales y resultados hospitalarios (alta o muerte). La probabilidad acumulada de muerte se calculó mediante curvas de Kaplan-Meier y se realizaron análisis supervivencia utilizando el modelo de riesgos proporcionales de Cox. Resultados: La frecuencia de muerte entre los pacientes del estudio fue del 10,7% (28). Entre los pacientes fallecidos, el 99,2% (26) presentaba algún grado de desnutrición (p=0,004). En el análisis multivariado, la albúmina sérica (<3 g/dL) se asoció de forma independiente con la mortalidad hospitalaria (HR=3,43, IC 95% 1,11-10,63). Por otro lado, el IPN no se asoció con mortalidad intrahospitalaria. Conclusión: Los niveles de albúmina sérica durante la hospitalización fueron predictores de mortalidad intrahospitalaria en la población evaluada. Nuestros resultados sugieren que los niveles séricos de esta proteína se pueden utilizar en la práctica clínica, agregando información de pronóstico en pacientes con cáncer.

Introdução: O câncer é uma das principais causas de morbidade e mortalidade em todo o mundo. Existem poucos estudos mostrando modelos ajustados com outros preditores de mortalidade por uma perspectiva de modelo conceitual. Objetivo: Verificar a predição de albumina e do Índice Nutricional Prognóstico (IPN) com mortalidade intra-hospitalar em pacientes com câncer. Método: Estudo retrospectivo realizado de 2014 a 2016 com 262 pacientes com câncer (trato gastrointestinal, órgãos genitais masculinos, mama, metástases, trato urinário, cabeça e pescoço e outros). Foram coletados dados demográficos, hemograma, proteína C reativa, albumina e índices hematológicos (índice de prognóstico nutricional - IPN; relação neutrófilo por linfócitos - RNL; relação monócitos por linfócitos - RML; relação plaquetas por linfócitos - RPL; e relação plaquetas por albumina ­ RPA), diagnósticos nutricionais e desfechos hospitalares (alta ou óbito). A probabilidade cumulativa de morte foi calculada pelas curvas de Kaplan-Meier e as análises de sobrevivência realizadas usando o modelo de risco proporcional de Cox. Resultados: A frequência de óbito entre os pacientes do estudo foi de 10,7% (28). Entre os pacientes que morreram, 99,2% (26) apresentavam algum grau de desnutrição (p=0,004). Na análise multivariada, a albumina sérica (<3 g/dL) associou-se de forma independente à mortalidade hospitalar (HR=3,43, IC95% 1,11-10,63). Por outro lado, o IPN não foi associado com mortalidade intra-hospitalar. Conclusão: Os níveis de albumina sérica durante a internação foram preditores de mortalidade intra-hospitalar na população avaliada. Esses resultados sugerem que os níveis séricos dessa proteína podem ser utilizados na prática clínica, agregando informações prognósticas em pacientes com câncer

Relationship between food perceptions and health-related quality of life in a prospective study with breast cancer patients undergoing chemotherapy

OBJECTIVE: To correlate the perceptions related to dietary intake with the domains and subscales of health-related quality of life (HRQL) in women with breast neoplasms receiving chemotherapy. METHODS: In this prospective study, 55 women with breast cancer were followed up during chemotherapy at three different times (T0, T1, T2). Before chemotherapy, perceptions related to food consumption were evaluated. HRQL was analyzed with the EORTC QLQ-C30 and Br23 instruments 21 days after each investigated cycle. The differences (T2-T0) in the subscales and HRQL domains were correlated with the differences (T2-T0) in the appetite scores. Spearman's correlation was used to verify a possible correlation between differences in functional and overall HRQL domains (T2-T0) and differences in appetite scores for certain foods and between the differences in some subscales of EORTC QLQ-C30 and Br23 (T2-T0) and differences in appetite scores for certain food groups (T2-T0). RESULTS: Correlations between pain and appetite for bitter taste and between an increased appetite for juices and pain intensification or fatigue were identified, and pain was correlated with an appetite for starchy foods. An appetite for vegetables, legumes and meat/eggs was correlated with physical function. The only significant correlation with social functions occurred between the appetite for sweet foods and these functions. We found a correlation between overall health, emotional function, social function and physical function and the appetite for juices. CONCLUSION: Chemotherapy alters the individual's relationship with food and, consequently, the individual's HRQL.

Consumo alimentar e estado nutricional de mulheres em quimioterapia / Food intake and the nutritional status of women undergoing chemotherapy

Resumo O objetivo deste estudo foi analisar o consumo alimentar e o estado nutricional de mulheres com câncer de mama (CM) em quimioterapia (QT). A avaliação dietética quantitativa foi realizada de acordo com as Dietary Reference Intakes (DRI) e a avaliação qualitativa pelo Índice de Qualidade da Dieta Revisado (IQD-R). Dentre o total de pacientes (n = 20), 60% (n = 12) apresentaram circunferência da cintura igual ou superior a 88 cm. Foi verificado 75% (n = 15) de indivíduos com excesso de peso. A média da ingestão de cálcio, cobre, ferro, fibra alimentar, magnésio, potássio, vitamina A, niacina, vitamina B6 e zinco encontrava-se abaixo da recomendação de ingestão adequada e o consumo de vitamina C, fósforo, manganês, sódio e tiamina encontrava-se acima. Quanto à análise do IQD-R, 80% (n = 16) das pacientes apresentaram uma “dieta que requer modificações”, enquanto que 20% (n = 4) apresentaram uma “dieta saudável”. Observou-se elevado excesso de peso, desequilíbrio na ingestão de micronutrientes e dieta que necessita melhorias. Dessa forma, a criação e a utilização de um protocolo de intervenção nutricional são de grande relevância para melhorar a dieta de pacientes com CM que realizam QT.

Abstract The objective behind this study was the analysis of food intake and the nutritional status of women with breast cancer (BC) undergoing chemotherapy (CT). The quantitative dietary evaluation was performed in accordance with Dietary Reference Intakes (DRI), whereas the qualitative evaluation was performed through the Brazilian Healthy Eating Index – Revised (BHEI-R).From among the total number of patients (n = 20), 60% (n = 12) presented waist circumference, equal to or higher than 88cm. It was noted that 75% (n = 15) individuals were overweight. The average intake for calcium, copper, iron, dietary fiber, magnesium, potassium, vitamin A, niacin, vitamin B6 and zinc, were found to be below adequate intake levels, while the intake of vitamin C, phosphorus, manganese, sodium and thiamine were all found to be above DRIs recommendations. As for the analysis of the BHEI-R, 80% (n = 16) of the patients presented a “diet that needs modifications”, while 20% (n = 4) presented a “healthy diet”. Noted from these observations was the presence of a high overweight rate, a discrepancy in the intake of micronutrients and a diet that needed improvements. In this manner, the establishment and use of a nutritional intervention protocol are very important when it comes to the improvement of the diet in patients with BC and who are undergoing CT.