Dietary Changes and Its Impact on Quality of Life among Malay Breast and Gynaecological Cancer Survivors in Malaysia.

OBJECTIVE: Fear of cancer recurrent, side effects of treatment and belief in food taboos encourage cancer survivors to make changes in their dietary practices after diagnosis of cancer. The objective of this study was to determine the impact of dietary changes on quality of life (QoL) among Malay breast and gynaecological cancer survivors. METHODS: Questionnaire of dietary changes was modified from WHEL study and adapted to typical Malay's food intake in Malaysia. A total of 23 items were listed and categorized by types of food and cooking methods.  Four categories of changes "increased", "decreased", "no changes" or "stopped" were used to determine the changes in dietary practices. Score one (+1) is given to positive changes by reference to WCRF/AICR and Malaysia Dietary Guideline healthy eating recommendations. Malay EORTC QLQ-C30 were used to determine the QoL. Sociodemographic, clinical characteristics and anthropometric measurement were also collected. RESULTS: The mean age of the subjects (n=77) was 50.7±7.8 years old with duration of survivorship 4.0±3.1 years. Subjects mean BMI was 27.8±4.9 kg/m2 which indicate subjects were 31.2% overweight and 32.5% obese. The percentage score of positive dietary changes was 34.7±16.4%. Positive dietary changes were increased intake of green leafy vegetable (49.4%), cruciferous vegetable (46.8%) and boiling cooking methods (45.5%). Subjects reduced their intake of red meat (42.9%), sugar (53.2%) and fried cooking method (44.2%). Subjects stopped consuming milk (41.6%), c 2008-5862 heese (33.8%) and sweetened condensed milk (33.8%). With increasing positive dietary changes, there was a significant improvement on emotional function (rs=0.27; p=0.016) and reduced fatigue symptoms (rs=-0.24; p=0.033). CONCLUSION: Positive changes in dietary intake improved emotional function and reduced fatigue symptoms after cancer treatment. By knowing the trend of food changes after cancer treatment, enables the formation of healthy food intervention implemented more effective.

Terapia nutricional em ginecologia e obstetrícia em Hospital Público Universitário do Brasil / Nutrition therapy in gynecology and obstetrics in Hospital Public University of Brazil

Introdução: Terapia nutricional (TN) é definida como a provisão de nutrientes por via oral, enteral ou parenteral com intenção terapêutica. Métodos: Estudo retrospectivo transversal no período de 2009 a 2013, no qual foi avaliada a TN (oral, enteral, parenteral) de 183 pacientes internadas no Hospital das Clínicas da Universidade Federal de Pernambuco, por meio de informações contidas no banco de dados dos serviços de nutrição/farmácia. Para as análises estatísticas, foram aplicados os testes t de Student, χ2 e ANOVA. Resultados: A clínica predominante foi a ginecologia (82%). A idade média geral foi de 49,0 ±17,1 anos. O tipo de TN mais freqüente foi oral (67,2%). Na ginecologia, a patologia mais encontrada foi a neoplasia de colo de útero (27,1%), na obstetrícia 56,3% eram gestantes de alto risco. A anorexia foi a indicação mais frequente independente da clínica. A maioria das pacientes recebeu terapia nutricional oral (TNO) normocalórica, com maior percentual das fórmulas poliméricas. Quanto às fibras, 79,3% das fórmulas da terapia nutricional enteral (TNE) continham fibras, diferindo da TNO (p=0,0023). Na TN parenteral houve predominância de neoplasias ginecológicas (85,7%). Pode-se perceber que a TNE possuiu teor calórico maior do que a TNO (p < 0,0001). O tempo médio de administração foi de 10,3±10,9 dias (1-83 dias), sem diferença entre as clínicas estudadas (p = 0,6). Conclusões: A TNO polimérica normocalórica, normoprotéica, normoglicídica e normolipídica predominou no grupo estudado, sendo as pacientes de ginecologia as que mais fizeram uso da terapêutica (AU)

Introduction: Nutritional therapy (TN) is defined as the supply of nutrients orally, enterally or parenterally with therapeutic intent. Methods: Retrospective study from 2009 to 2013, where NT (oral, enteral, parenteral) was evaluated in 183 patients admitted to the Hospital of the Federal University of Pernambuco, through information contained in the database of nutrition/pharmacy services. To perform the statistical analysis, were applied the Student t, χ2 and ANOVA tests. Results: The predominant clinical was the gynecology (82%). The overall mean age was 49.0 ± 17.1 years. The most frequent type of NT was oral (67.2%). In gynecology, the most frequent pathology was neoplasm of the cervix (27.1%), obstetrics 56.3% were high-risk pregnants. Anorexia was the most frequent indication independent of the clinic. Most patients received oral NT normocaloric, with the highest percentage of polymeric formulas. As for fiber, 79.3% of EN (enteral nutrition) formulas contained fibers, differing from oral NT (p = 0.0023). Parenteral nutrition predominated gynecological patients (85.7%). One can see that the EN owned calorie greater than the oral NT (p <0.0001). The time of administration mean was 10.3 ± 10.9 days (1-83 days), with no difference between the studied clinics (p = 0.6). Conclusions: polymer, normocaloric, normoproteic, normoglicidic and normolipidic oral NT predominated in the study group, and the gynecology patients the ones that took the therapy (AU)

Aspects of Health-Related Factors and Nutritional Care Needs by Survival Stage among Female Cancer Patients in South Korea.

PURPOSE: This study examined diet-related problems and needs associated with nutritional care according to survival stage in Korean female cancer survivors. METHODS: 186 outpatients (breast or gynecologic cancer survivors) recruited. Subjects were classified as (1) extended stage (ES, 2-5 years from diagnosis) and (2) long-term stage (LS, ≥5 years from diagnosis). Eating habits, changes in health related factors, nutritional needs, and quality of life were investigated. RESULTS: 43% of ES survivors had diet-related problems (p = .031); ES group reported dyspepsia and LS group reported anorexia/nausea as the major problem. Half of ES survivors had taste change, decreasing amount of intake, and reduced quality of life (p < .05). The LS group had a greater preference for sweet tastes than the ES group. According to their diagnosis, ES survivors with breast cancer gained weight (27.1%), whereas ES survivors with gynecologic cancer lost their body weight (34.5%) significantly. LS breast cancer patients showed great food preference for vegetables, whereas those with gynecologic cancer showed an increased preference for fish, meat and grain. Approximately 90% of survivors demanded nutritional care regarding restricted foods, preventing recurrence, particularly in ES survivors (p < .01). Moreover, main factors for nutritional care needs were body weight control for breast cancer and food environment for gynecologic cancer. CONCLUSION: Survivors have different aspects of diet-related problems by survival stage as dyspepsia in ES and anorexia in LS. ES stage had changes in dietary patterns and their food consumption have decreased. Most of survivors have demanded nutritional care regardless of survival stage. These features of each stage should be considered to improve their health.

Experience with the intravenous totally implanted port in patients with gynecologic malignancies.

The purpose of this paper was to assess the intraoperative and long-term complications associated with intravenous totally implanted devices in women with pelvic cancers. Retrospective review of medical records was performed for 67 consecutive women with pelvic cancers who underwent port insertion. Seventy catheters were successfully placed in 67 patients. Pneumothorax occurred in three cases (4.3%), none requiring chest tube placement. Malposition of the catheter occurred in four patients (5.7%). Two infected ports (2.9%) were removed after a failed trial of antibiotics. Venous thrombosis developed in one woman, requiring removal of the system. In conclusion, semipermanent central venous catheters facilitate delivery of chemotherapy, parenteral nutrition, blood products, antibiotics, and hydration in cancer patients. This is the first report detailing the experience with a totally implanted subcutaneous port in patients with gynecologic malignancies. We demonstrate that such devices may be inserted and utilized with a low incidence of complications in this patient population.

Outcome assessment of home parenteral nutrition in patients with gynecologic malignancies: what have we learned in a decade of experience?

Recent improvements in parenteral nutrition and home care delivery systems have made home parenteral nutrition (HPN) a reality for patients with gynecologic malignancies. The records of 61 patients with gynecologic cancers who received HPN between 1981 and 1990 were retrospectively reviewed for outcome, complications, survival, and quality of life. Indications for HPN included mechanical bowel obstruction, short bowel syndrome, malnutrition during cancer therapy, or complications of cancer therapy. Ninety-two percent of patients had disease present at initiation of HPN. Fifty-six percent of patients had ovarian cancer; the remainder had other gynecologic malignancies. The vast majority of patients had prior surgery, radiotherapy, or chemotherapy before receiving HPN. Sixty-four percent of patients underwent cancer treatment (chemotherapy, surgery, or radiation) during HPN. Median survival for ovarian cancer patients on HPN was 72 days and 52.5 days for nonovarian patients (not statistically significant, P = 0.95). Minimal complications were noted from HPN with 9% of hospitalizations due to HPN. Nutritional parameters initially improved in most patients on HPN but then decreased prior to death. Quality of life parameters improved significantly in patients on HPN as compared to pre-HPN status (P < 0.05). In conclusion, HPN is a viable option in gynecologic cancer patients and offers improved quality of life even during the terminal phase of their illness.