Natural killer cells over time in patients with colorectal cancer.

PURPOSE: The purposes of the investigation were: 1) to examine the natural killer (NK) cell levels in a homogeneous group of patients with cancer between the presurgical period and 6 months after surgery; 2) to identify changes in the number of NK cells over time; and 3) to determine whether an association exists among the number of NK cells, demographics, stage of cancer, and treatment variables. DESCRIPTION OF STUDY: A longitudinal descriptive design was used to study biopsychosocial factors in persons newly diagnosed with colorectal cancer over a 6-month period. RESULTS: Patients without ostomies had a significant decrease in NK levels over time, whereas patients with ostomies had a significant increase in NK levels over time. There was a difference in NK level over time for patients who were receiving the additional therapy of radiation alone and a combination of radiation and chemotherapy from those patients who were not receiving additional therapy. Natural killer levels in patients who were receiving radiation alone or a combination of radiation and chemotherapy significantly declined over time, where NK levels in patients receiving no additional treatment significantly increased over time. CLINICAL IMPLICATIONS: Patients with low NK levels should be monitored during the course of their illness and cancer treatment to determine the relationship to immune status of other variables such as nutritional status, infection rates, and functional status.

A descriptive study of immune status in patients undergoing colorectal surgery: lymphocyte phenotypes.

PURPOSE/OBJECTIVES: To describe immune status in patients prior to colorectal surgery for cancer, to establish values to serve as a baseline for subsequent analyses, and to describe a procedure for studying phenotypes of the immune system, elucidating its advantages. DESIGN: One component of a larger longitudinal survey. SETTING: Two large, inner-city university hospitals and two of their affiliated hospitals in the northeastern United States. SAMPLE: Patients undergoing surgery for colorectal cancer (N = 94). Subjects were primarily male (n = 57) and Caucasian (n = 85) and ranged in age from 26-88 years (mean = 63). Seventy-seven percent (n = 73) had cancer, 23% (n = 21) had benign diseases or conditions. METHODS: Flow cytometry analysis of lymphocyte phenotypes was performed on blood samples drawn from patients before they underwent surgery for colorectal cancer. MAIN OUTCOME MEASURES: The average absolute lymphocyte subset levels and the average relative lymphocyte subset levels of blood samples taken from patients undergoing surgery for colorectal cancer were compared (using t-tests) with the subset levels of two normal reference samples. FINDINGS: The average absolute lymphocyte subset levels and average relative lymphocyte subset levels of patients undergoing surgery for colorectal cancer fell within normal ranges. CONCLUSIONS: These findings suggest that this sample of patients undergoing surgery has one essential element of an intact immune system--normal levels of lymphocyte subsets. IMPLICATIONS FOR NURSING PRACTICE: There is no indication preoperatively that this population is at a higher risk for infection or delayed wound healing. However, there may be other times in the illness trajectory when the immune system does become compromised, and these values prior to surgery will serve as a baseline to identify changes in patients' immune status over time. Further longitudinal studies are necessary.