Ageing-related considerations for medication used in supportive care in cancer.

Both randomized controlled trials (RCTs) and retrospective studies have shown that a comprehensive geriatric assessment (CGA) prior to a patient commencing systemic anti-cancer therapy (SACT) results in improved quality of life outcomes and is associated with a decreased risk of grade 3-5 toxicity; however, data are lacking in relation to adverse drug events (ADE) associated with supportive care medications. Supportive care medications are prescribed as prophylactic agents in a SACT regimen, for management of treatment related toxicity and for symptoms caused by the disease itself. While necessary, the commencement of SACT and supportive medications may cause, or exacerbate, a significant drug burden in older patients, some of whom may have existing comorbidities. For many medications, older adults are underrepresented in pharmacokinetic and pharmacodynamic modelling studies. In this article we will review ageing-related changes in pharmacokinetics and pharmacodynamics, as well as how these changes may impact supportive care medications. Additional considerations for prescribing these medications in older adults with cancer, such as polypharmacy, potentially inappropriate medications, drug-drug interactions, and anticholinergic burden, as well as ageing-related considerations and recommendations for supportive care medications commonly used in older adults with cancer are also reviewed.

Trascendencia de la detección precoz del riesgo nutricional en nuestros pacientes. Experiencia en un hospital de media-larga estancia / Transcendence of the early detection of nutritional risk in our patients. Experience at a half-long stay hospital

FUNDAMENTO: El cribado de riesgo nutricional permite detectar el riesgo de desnutrición desde su inicio y antes de su manifestación clínica. OBJETIVO: Evidenciar la utilidad del CONUT en el cribado nutricional al ingreso en un hospital de media-larga estancia. MÉTODOS: Se realizaron dos estudios longitudinales (2014n=121-2018n=155), utilizando CONUT para detectar precozmente el riesgo de desnutrición y evaluar la eficacia de la intervención nutricional. Las variables respuesta fueron el tipo y grado de desnutrición al ingreso y al alta. RESULTADOS: La prevalencia de desnutrición/riesgo nutricional detectada con CONUT al ingreso fue de 85,9%. Con la Valoración Nutricional Completa (VNC), la prevalencia de desnutrición al ingreso fue del 81,0% (5% desnutrición calórica, 17,4% mixta y 58,7% proteica). Un 5% de los pacientes en riesgo detectados mediante CONUT, todavía no podían ser diagnosticados mediante la VNC. Los valores al alta fueron 5% desnutrición calórica, 7,7% mixta y 36,4% proteica. CONUT permitió identificar y seguir la evolución del paciente desnutrido con mayor sensibilidad que los parámetros antropométricos. La intervención nutricional redujo la prevalencia y severidad de la desnutrición, mejorando fundamentalmente a expensas de corregir la desnutrición proteica. Los pacientes desnutridos presentaron mayor número de categorías diagnósticas. Se observaron diferencias significativas entre los perfiles nutricionales de las patologías más prevalentes. CONCLUSIONES: CONUT permitió automatizar eficientemente el cribado nutricional. La aplicación de un protocolo estructurado para la detección, monitorización y tratamiento de la desnutrición permitió identificar pacientes subsidiarios de beneficiarse del soporte nutricional, lo que se reflejó en una mejora del estado nutricional al alta

BACKGROUND: Nutritional risk screening enables the risk of malnutrition to be detected from its beginning and before its clinical expression. OBJECTIVE: To demonstrate the usefulness of CONUT in nutritional screening at admission to a medium-to-long stay hospital. METHODS: Two longitudinal studies (2014n=121-2018n=155) were conducted using CONUT for the early detection of the risk of malnutrition and to evaluate the efficacy of the nutritional intervention. The response variables were the type and degree of malnutrition at admission and discharge. RESULTS: The prevalence of malnutrition/nutritional risk detected with CONUT at admission was 85.9%. With the Comprehensive Nutritional Assessment (CNA), the prevalence of malnutrition at admission was 81.0% (caloric malnutrition 5%, mixed malnutrition 17.4%, and protein malnutrition 58.7%). 5% of the patients at risk detected by CONUT still could not be diagnosed by the CNA. The values at discharge were caloric malnutrition 5%, mixed malnutrition 7.7%, and protein malnutrition 36.4%. CONUT enabled the evolution of the malnourished patient to be identified and followed up with greater sensitivity when compared to the anthropometric parameters. Nutritional intervention reduced the prevalence and severity of malnutrition, essentially improving it upon protein malnutrition correction. Malnourished patients showed a greater number of diagnostic categories. Significant differences were observed among the nutritional profiles of the most prevalent diseases. CONCLUSIONS: CONUT enabled nutritional screening to be efficiently automated. The application of a structured protocol for the detection, monitoring and treatment of malnutrition made it possible to identify subsidiary patients to benefit from nutritional support, which was reflected in an improvement in nutritional status at discharge

Resolución completa de hidrocefalia crónica del adulto con acetazolamida / Complete resolution of chronic hydrocephalus of adult with acetazolamide

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