Nutritional status assessed by Patient-Generated Subjective Global Assessment is associated with toxicity to chemoradiotherapy in women with cervical cancer: a prospective study.

BACKGROUND: Patient-generated subjective global assessment (PG-SGA), a validated tool for nutritional assessment, has been associated with worse clinical outcomes in patients with cancer. However, studies assessing its relationship in chemoradiotherapy outcomes are scarce. The study aimed to determine the prevalence of malnutrition according to PG-SGA and its association with the incidence of toxicity to chemoradiotherapy treatment in women with cervical cancer. METHODS: In a single-centre prospective observational study, we enrolled 391 women with locally advanced cervical cancer. Patients were assessed on the day of their first chemotherapy infusion, when nutritional status was evaluated by the PG-SGA form and anthropometric measurements. Sociodemographic and clinical data were also collected. Toxicity to chemoradiotherapy was assessed weekly and toxicity-induced modification of treatment (TIMT) was defined as any serious adverse event that resulted in treatment delay, interruption, or dose reduction. Multivariate mixed-effects Poisson and Logistic regression models were performed to identify the factors contributing to the outcome number of adverse events ≥ grade 3 and TIMT, respectively. RESULTS: Malnutrition was found in 47.6% of the population. Roughly 1/3 had TIMT and 54.2% experienced at least one symptom ≥grade 3. In the adjusted models, PG-SGA B and C, as well as the score ≥9 were independent predictors of the number of toxicity events ≥grade 3 and higher incidence of TIMT. CONCLUSIONS: PG-SGA may represent an important assessment tool to predict toxicity outcomes in women with cervical cancer, besides being considered a simple, fast, and low-cost tool, which allows early nutritional care.

Quality of life and its relation with nutritional status in patients with incurable cancer in palliative care.

BACKGROUND: Nutritional impairment is common in cancer patients and adversely affects quality of life (QoL). The aim of this study was to investigate the association between nutritional status and QoL in incurable cancer patients in palliative care. METHODS: A prospective cohort with incurable cancer patients referred to the specialized Palliative Care Unit of the National Cancer Institute in Brazil was conducted. The nutritional risk (NR) was assessed using the Patient-Generated Subjective Global Assessment short form (PG-SGA SF), and cancer cachexia (CC) was defined according to the international consensus. QoL was evaluated using the Quality of Life Questionnaire Core 15 Palliative (QLQ-C15-PAL). Multivariate linear regressions analyses were performed to assess the relationship between the nutritional status and QoL scores. RESULTS: A total of 1039 consecutive patients were included. A high prevalence of NR (85.4%) and CC (78.7%) were observed. The patients with worse nutritional status presented significantly poorer physical, emotional, symptoms domains scales, and overall QoL. CC were significantly associated with QoL scores for dyspnea (p = 0.013), insomnia (p = 0.046), and appetite loss (p = 0.015), while NR were associated with all the QoL domains scales covered in QLQ-C15-PAL. CONCLUSION: Our findings support that impaired nutritional status was associated with poor QoL in incurable cancer patients. NR assessed by PG-SGA SF better reflects physical, emotional, symptom burden, and overall QoL scores. Thus, this tool may contribute in identifying patients at risk of deterioration QoL.

Efficacy of ω-3 supplementation on nutritional status, skeletal muscle, and chemoradiotherapy toxicity in cervical cancer patients: A randomized, triple-blind, clinical trial conducted in a middle-income country.

OBJECTIVES: Supplementation with ω-3 has been shown to favor the preservation of body weight and skeletal muscle. The aim of this study was to evaluate the efficacy of ω-3 supplementation on nutritional status, skeletal muscle quantity and quality, and toxicity for treatment of women with cervical cancer. METHODS: This was a randomized, triple-blinded, placebo-controlled clinical trial in women diagnosed with cervical cancer who underwent chemoradiotherapy between March 2016 and August 2017. The intervention group received four capsules with ω-3 (2.5 g/d) and the control group (CG) received the same number of identical-looking capsules with olive oil, for 45 d. Nutritional status was measured by anthropometry and Patient-Generated Subjective Global Assessment. Body composition was assessed by computed tomography. The skeletal muscle index was calculated using the range -29 to +150 HU. For skeletal muscle quality, the area comprised between -29 and +29 HU was denominated low-radiodensity skeletal muscle index and the range between +30 and +150 HU high-radiodensity skeletal muscle index, representing the skeletal muscle area with high or low intramuscular fat infiltration, respectively. RESULTS: The study population comprised 40 patients, with an average age 44.53 ± 8.73. The intervention group maintained body weight and showed an improvement in Patient-Generated Subjective Global Assessment score. A significant reduction in skeletal muscle index was observed in both groups. However, in regard to skeletal muscle quality, patients in the intervention group preserved low- and high-radiodensity skeletal muscle index, whereas those in the control group had increased low-radiodensity skeletal muscle index and significantly reduced high-radiodensity skeletal muscle index, reflecting high intramuscular fat infiltration only in the control group. The incidence of chemotherapy toxicity was significantly lower in the intervention group. CONCLUSIONS: The results suggest that ω-3 supplementation is effective in maintaining nutritional status, skeletal muscle quality, and reduced symptoms of chemoradiotherapy among women with cervical cancer.

Influence of chemoradiotherapy on nutritional status, functional capacity, quality of life and toxicity of treatment for patients with cervical cancer / Influência da quimiorradioterapia no estado nutricional, capacidade funcional, qualidade de vida e toxicidade do tratamento para pacientes com câncer cervical

Introduction: The adverse effects provoked by antineoplastic therapy may aggravate preexisting alterations of the nutritional status and can result in a larger chance of toxicity, bringing about other adverse consequences, such as a diminished response and tolerance of the treatment and reduction of quality of life (QoL). Objective: The objective of this study was to assess the influence of chemoradiotherapy on the nutritional status, functional capacity, and quality of life (QoL), associating these indicators with toxicity and interruption of oncologic treatment in women with cervical cancer. Methods: Prospective cohort study performed on 49 women, who underwent treatment between August 2015 and January 2016. For data collection, two appointments took place with the researcher in charge: the first one occurring the day before the first chemotherapy session (T0) and the other one after 35 days (T1). Nutritional status was measured by anthropometry and computed tomography (skeletal muscle index ­ SMI), functional capacity by handgrip strength (HGS) and Karnofsky Perfomace Status (KPS), and application of QoL questionnaire (EORTC QLQ-C30). Results: There was significant reduction in weight, BMI, HGS, KPS and QoL between T0 and T1. The interruption of chemotherapy was significantly associated with the variables of nutritional status assessed, in addition to a significant QoL reduction according to worsening nutritional status. Women that interrupted their treatment due to acute toxicity also had an SMI median significantly smaller in relation to those who concluded the treatment and 83% of these patients presented cachexia. Conclusion: Chemoradiotherapy treatment in patients with cervical cancer had changed negatively nutritional parameters, function capacity and QoL.(AU)

Introdução: Os efeitos adversos provocados pela terapia antineoplásica podem agravar alterações preexistentes do estado nutricional, que resultam em maior chance de toxicidade, além de outras consequências adversas, como diminuição da resposta e tolerância ao tratamento e redução da qualidade de vida (QV). Objetivo: O objetivo do estudo foi avaliar a influência da quimiorradioterapia sobre o estado nutricional, capacidade funcional e QV, associando esses indicadores à toxicidade e interrupção do tratamento oncológico em mulheres com câncer de colo uterino. Método: Foi realizado um estudo de coorte prospectivo com 49 mulheres submetidas ao tratamento quimiorradioterápico entre agosto de 2015 e janeiro de 2016. Para coleta de dados, foram realizadas duas consultas com o pesquisador responsável: a primeira ocorreu no dia anterior à primeira sessão de quimioterapia (T0) e a outra após 35 dias (T1). Em ambas as consultas, o estado nutricional foi avaliado por antropometria, a capacidade funcional pela força de preensão palmar (FPP) e pelo Karnofsky Performance Status (KPS) e foi aplicado um questionário específico para QV (EORTC QLQ-C30). Adicionalmente, foi utilizada a tomografia computadorizada para avaliação da massa magra (índice de músculo esquelético - IME) disponível no T0. Resultados: Houve redução significativa no peso, IMC, FPP, KPS e QV entre T0 e T1. A interrupção da quimioterapia foi significativamente associada às variáveis de estado nutricional, além de uma redução significativa da QV de acordo com a piora do estado nutricional. As mulheres que interromperam seu tratamento devido à toxicidade aguda também apresentavam mediana de IME significativamente menor em relação àquelas que concluíram o tratamento e 83% dessas pacientes apresentaram caquexia. Conclusão: O tratamento quimiorradioterápico em pacientes com câncer de colo uterino impactou negativamente nos parâmetros nutricionais, na capacidade funcional e na QV.(AU)

Communication between the health team in a surgical clinic: the look of professionals of a program of multiprofessional residence in health / A comunicação entre a equipe de saúde em uma clínica cirúrgica: o olhar dos profissionais de um programa de residência multiprofissional em saúde / Comunicación entre el equipo de salud en una clínica quirúrgica: la mirada del programa de multiprofesionales de residencia en salud

Objetivo: Relatar a experiência de um grupo multiprofissional de residentes de um hospital universitário público na assistência ao indivíduo hospitalizado em uma clínica cirúrgica e discorrer sobre as formas de comunicação utilizadas pelos profissionais de saúde. Método: Consiste em um relato de experiência sobre atuação e observação de residentes de enfermagem, fisioterapia e nutrição pertencentes a um Programa de Residência Multiprofissional de um Hospital Universitário no Rio de Janeiro. Resultados: O estudo trata do processo de comunicação interpessoal em uma clínica cirúrgica. A abordagem do paciente cirúrgico aconteceu nos períodos pré e pós-operatório. Observamos alguns tipos de comunicação: profissional-paciente, profissional-profissional, paciente-paciente, profissional-familiar e paciente-familiar. Conclusão: a vivência possibilitou o aprendizado de questões relevantes a cada área assim como um cuidado integrado. Percebemos que a comunicação proporcionou interligação dos conhecimentos, proporcionando um cuidado otimizado, melhorando a qualidade da assistência.

Objective: To report the experience of a multidisciplinary group of residents of a public university hospital in assisting the individual hospitalized in a surgical clinic and discuss the forms of communication used by health professionals. Method: Consists of an experience report on activities and observation of residents of nursing, physiotherapy and nutrition belonging to a Multidisciplinary Residency Program at a University Hospital in Rio de Janeiro. Results: The study deals with the process of interpersonal communication in a surgical clinic. The approach of the surgical patient happened in the pre-and postoperatively. We observed some types of communication: professional-patient, professional-professional, patient-patient, professional and patient-family-family. Conclusion: The experience enabled learning issues relevant to each area as well as an integrated care. We realize that communication has provided interconnection of knowledge, providing an optimized care, improving quality of care.

Objetivo: Presentar la experiencia de un grupo multidisciplinario de los residentes de un hospital universitario público en la asistencia a la persona hospitalizada en una clínica quirúrgica y discutir las formas de comunicación utilizadas por los profesionales de la salud. Método: Se compone de un relato de experiencia sobre las actividades y la observación de los residentes de enfermería, fisioterapia y nutrición que pertenece a un Programa de Residencia multidisciplinario en un Hospital Universitario de Río de Janeiro. Resultados: El estudio aborda el proceso de comunicación interpersonal en una clínica quirúrgica. El enfoque del paciente quirúrgico ocurrió en el pre y postoperatorio. Hemos observado algunos tipos de comunicación: profesional-paciente, profesional-profesional, paciente-paciente, profesional y paciente-familia-familia. Conclusión: La experiencia permitió temas de aprendizaje pertinentes a cada área, así como una atención integral. Nos damos cuenta de que la comunicación ha facilitado la interconexión de conocimiento, proporcionando una atención óptima, mejorando la calidad de la atención.