Evaluation of Nutritional Status in Cancer Patients Underwent Radiotherapy: The Results of Biochemical, Body Composition with Bioelectrical Impedance Analysis, Anthropometric Measurements, and Patient-Generated Subjective Global Assessment

Year 2023, Volume: 33 Issue: 6, 746 - 752, 31.12.2023

Sümerya Duru Birgi , Dilşat Baş , Şeniz Öztürk , Pervin Hürmüz , Erdem Karabulut , Ahmetcan Çağlar , Melis Gültekin , Gözde Yazıcı , Gökhan Özyiğit

https://doi.org/10.54005/geneltip.1320764

Abstract

Aim: This study aims to evaluate the nutritional status and the effect of radiotherapy (RT) on nutrition in all ambulatory cancer patients.
Material and Method: In this prospective observational study 105 cancer patients with various diagnoses treated between 2013 and 2014 were evaluated. All patients were ≥18 years old and had Karnofsky Performance Status ≥70. Anthropometric measurements, body composition with bioelectric impedance, and patient-generated Subjective Global Assessment (PG-SGA) tools were used. The height, weight, body mass index (BMI), triceps skin fold thickness, mid-upper arm circumference, hemoglobin, and serum albumin levels were determined twice before and after RT. Additionally, nutrition-related symptoms and short-term weight loss results were determined by PG-SGA questionnaires.
Results: The patients’ median age was 53 years (range, 18-82 years). At initial evaluation 74 patients were well nourished using the PG-SGA global rating. Malnutrition developed in totally 33 of these 74 patients after RT. The PG-SGA results after RT were significantly worse than before treatment. PG-SGA revealed no significant relationship between nutritional status prior to RT and the parameters including gender, age, mean weight, BMI, disease duration, pre-RT hemoglobin and albumin levels. Post-RT evaluation showed a significant relationship between deterioration (PG-SGA B-C) and mean weight, BMI, serum albumin, hemoglobin levels, and concomitant chemotherapy. Gastrointestinal and head and neck cancer patients had the most deterioration after RT. The patients' weight, BMI, fat-free mass, total body water, and the percentage weight loss at the end of RT were significantly lower than the initial assessment.
Conclusion: It is considerable to use multiple tools for nutritional monitoring. Patients who received RT to the head and neck and upper abdomen region had a high risk of deterioration after treatment. These patients should be monitored carefully during all treatment periods.

Keywords

Nutrition assessment, Cancer, Radiotherapy, Bioelectrical impedance, Anthropometry

Radyoterapi Alan Kanser Hastalarında Beslenme Durumunun Değerlendirilmesi: Biyokimyasal, Biyoelektrik İmpedans Analizi ile Vücut Bileşimi, Antropometrik Ölçümler ve Hasta Tarafından Yapılan Subjektif Global Değerlendirme Sonuçları

Abstract

Amaç: Bu çalışma ayaktan tedavi gören tüm kanser hastalarında beslenme durumunu ve radyoterapinin (RT) beslenme üzerine etkisini değerlendirmeyi amaçlamaktadır.
Gereç ve Yöntem: Bu prospektif gözlemsel çalışmada 2013-2014 yılları arasında çeşitli tanılarla tedavi edilen 105 kanser hastası değerlendirildi. Tüm hastalar ≥18 yaşındaydı ve Karnofsky Performans Durumu ≥70 idi. Antropometrik ölçümler, biyoelektrik impedans ile vücut kompozisyonu ölçümü ve hasta tarafından oluşturulan Subjektif Global Değerlendirme (PG-SGA) araçları kullanıldı. RT öncesi ve sonrası olmak üzere iki kez boy, kilo, vücut kitle indeksi (VKİ), triseps deri kıvrım kalınlığı, orta-üst kol çevresi, hemoglobin ve serum albumin düzeyleri belirlendi. Ayrıca beslenme ile ilgili semptomlar ve kısa süreli kilo kaybı sonuçları PG-SGA anketleri ile değerlendirildi.
Bulgular: Hastaların medyan yaşı 53 yıl (aralık; 18-82 yıl) idi. PG-SGA global değerlendirmesine göre ilk değerlendirmede 74 hasta iyi beslenmiş grupta yer almaktaydı. Bu 74 hastanın 33’ünde RT’den sonra malnütrisyon gelişti. RT sonrası PG-SGA sonuçları, tedavi öncesine göre önemli ölçüde daha kötüydü. PG-SGA, RT öncesi beslenme durumu ile cinsiyet, yaş, ortalama ağırlık, VKİ, hastalık süresi, RT öncesi hemoglobin ve albumin seviyeleri gibi parametreler ile anlamlı bir ilişki göstermedi. RT sonrası değerlendirmede, beslenmede bozulma (PG-SGA B-C) ile ortalama ağırlık, VKİ, serum albumin, hemoglobin düzeyleri ve eş zamanlı kemoterapi arasında anlamlı bir ilişki gösterildi. Gastrointestinal ve baş-boyun tümörleri olan hastalar, RT'den sonra en fazla kötüleşmeye sahipti. Hastaların kilosu, VKİ, yağsız kitlesi, toplam vücut suyu ve RT sonunda kilo kaybı yüzdesi ilk değerlendirmeye göre anlamlı derecede düşüktü.
Sonuç: Beslenme monitörizasyonu için çoklu ölçekler kullanılması oldukça önemlidir. Baş-boyun ve üst karın bölgesine RT uygulanan hastalarda tedavi sonrası beslenmede kötüleşme riski yüksektir. Bu hastalar tüm tedavi dönemlerinde dikkatle izlenmelidir.

Keywords

Beslenme Değerlendirmesi, Kanser, Radyoterapi, Biyoelektriksel impedans analizi, Antropometri

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