Assessment of the nutritional status of adult patients with acute myeloid leukemia during induction chemotherapy

Sales

Rev. Brasileira.De.Cancerologia

et al. 2019

Introdução: O diagnóstico precoce do risco nutricional pode melhorar o prognóstico dos pacientes onco-hematológicos. Objetivo: Descrever o estado nutricional nos pacientes onco-hematológicos e avaliar os fatores associados ao risco nutricional nos pacientes onco-hematológicos de um hospital universitário terciário de Fortaleza - Ceará. Método: Estudo transversal que incluiu 127 pacientes adultos internados. Os dados de diagnóstico clínico e demográficos foram coletados por meio da análise de prontuários. O estado nutricional foi avaliado pelo índice de massa corporal (IMC), circunferência braquial (CB) e pela aplicação da ferramenta de triagem de risco nutricional - NRS-2002. Resultados: Pelos diferentes parâmetros, houve divergências no estado nutricional. A maioria da amostra apresentava risco nutricional de acordo com a avaliação da NRS-2002 (70,1%; n=89), seguida pela CB (33,9%; n=43) e pelo IMC (8,7%; n=11). Houve correlação positiva significativa entre IMC e idade [r=0,313, p<0,001] e CB [r=0,846, p<0,001] e associação significativa entre NRS-2002≥3 e IMC<18,5 kg/m² (p=0,023); NRS-2002 ≥3 e CB classificada como desnutrição (p=0,001); IMC<18,5kg/m² e CB classificada como desnutrição; e residir em zona urbana e apresentar CB adequado (p=0,023). Conclusão: Este estudo revelou alta prevalência de risco nutricional, bem como uma associação significativa entre risco nutricional e baixos valores de IMC e CB, e residir em zona rural. Assim, há a necessidade de utilizar uma combinação de indicadores, a fim de diagnosticar, de forma mais precisa e precoce, o estado nutricional desses pacientes.

Section: Discussionunclassified

“…Em onco-hematologia, o comprometimento nutricional é um fator de risco para complicações infecciosas e maior tempo de hospitalização. Além disso, o estado nutricional inadequado nesse grupo de pacientes é um fator que impacta negativamente na tolerância e resposta ao tratamento antineoplásico e na mortalidade 4 .…”

unclassified

Avaliação do Risco Nutricional em Pacientes Onco-Hematológicos Hospitalizados

Sales

Rev. Brasileira.De.Cancerologia

et al. 2019

“…The complete geriatric assessment (CGA) has been used in ALL and AML patients in order to better characterize differences between patients of the same age . However, to this point no CGA tool incorporates nutritional status assessment, a known prognostic factor in AML and ALL patients of all ages . Furthermore, no nutritional assessment tool (such as body mass index [BMI], weight, or subjective global assessment [SGA] questionnaires) or any of the various serum markers (albumin, pre‐albumin, and transthyretin) are consistently used in clinical practice …”

Section: Introductionmentioning

confidence: 99%

“…3,[13][14][15] However, to this point no CGA tool incorporates nutritional status assessment, a known prognostic factor in AML and ALL patients of all ages. [16][17][18] Furthermore, no nutritional assessment tool (such as body mass index [BMI], weight, or subjective global assessment [SGA] questionnaires) or any of the various serum markers (albumin, pre-albumin, and transthyretin) are consistently used in clinical practice. 18 Bioelectrical impedance analysis is a method used to estimate body composition and cell membrane integrity.…”

mentioning

confidence: 99%

The prognostic value of standardized phase angle in adults with acute leukemia: A prospective study

et al. 2020

Standardized phase angle (SPhA) is a tool used to estimate body composition and cell membrane integrity. Standardized phase angle has been shown to predict survival in solid malignancies and hematopoietic stem cell transplant patients. We investigated the predictive value of SPhA on 60‐day mortality, overall survival (OS), and length of hospital stay (LHS) for adults with acute myelogenous and lymphoblastic leukemia (AML and ALL). Consecutive patients ≥18 years with newly diagnosed acute leukemia receiving intensive chemotherapy were enrolled. Phase angle measurements were taken on day 1 of therapy for all patients and on the day of nadir marrow for AML patients. Measurements were standardized by BMI, gender, and age to calculate the SPhA. The difference between SPhA at nadir bone marrow compared to day 1 of induction was used to calculate change in SPhA. A cutoff of 25th percentile was used to dichotomize baseline SPhA. Among 100 patients, 88% were AML, 56% were female, and mean age was 59 years. Though not statistically significant, OS by Kaplan‐Meier analysis was shorter for those below the 25th percentile SPhA compared to those above (median OS: 11.0 months vs 19.5 months; P = .09). Lower baseline SPhA was associated with increased incidence of 60‐day mortality in univariable (odds ratio [OR] = 5.25; 1.35, 20.44; P = .02) but not multivariable analysis (OR = 3.12; 0.67, 14.48; P = .15) adjusted for age, creatinine, and cytogenetics. Increased change in SPhA was associated with worse OS (hazard ratio = 1.15; 1.00,1.33; P = .05) in multivariable analysis. Standardized phase angle is a rapid, noninvasive, and objective measure that may be used to inform risk stratification.

“…Undernutrition or malnutrition is a serious clinical condition that causes adverse effects on patient quality of life and survival ( 15 , 16 ). During cancer treatment, undernutrition is a risk factor for infectious complications and treatment intolerance ( 17 ).…”

Section: Introductionmentioning

confidence: 99%

Analysis of Dietary Intake during Consecutive-Day Chemotherapy for Bone and Soft-Tissue Sarcomas

et al. 2018

BackgroundBone and soft tissue sarcomas are commonly treated with consecutive-day chemotherapy regimens consisting of multiple anticancer agents. Chemotherapy-induced nausea and vomiting (CINV) is a serious adverse effect of these regimens and may result in decreased energy intake during chemotherapy. Decreased energy intake may lead to undernutrition and may cause adverse effects on patient quality of life and survival.MethodsPatients with bone and soft tissue sarcomas who received consecutive-day chemotherapy were retrospectively evaluated. CINV and dietary energy intake were assessed, as well as the occurrences of hiccups and constipation during chemotherapy.ResultsA total of 13 patients, 10 males and 3 females, with a total 16 chemotherapy courses were included in the study. All patients received antiemetic prophylaxis. The CINV control rate, defined as no emesis and no rescue therapy, gradually decreased from chemotherapy day 1 (94%) to day 5 (75%). Four patients experienced emesis, two of whom had been treated with a cisplatin-containing regimen. Decreased dietary energy intake was possibly associated with CINV during chemotherapy. Anorexia was grade 2 except for one case of grade 3. The incidences of hiccups and constipation were high on days 3–5.ConclusionAntiemetic prophylaxis treatment did not prevent emesis due to consecutive-day chemotherapy, especially with cisplatin-containing regimens, in patients with bone and soft-tissue tumors. Dietary energy intake decreased during chemotherapy, and this appeared to be associated with CINV. In addition, the incidence of hiccups and constipation increased during the course of consecutive-day chemotherapy regimens. Although these results are based on a small number of patients, it may be important to observe nutritional status during chemotherapy, as this may reflect a patient’s general condition. Nutritional counseling might be useful in supporting nutritional status in patients undergoing chemotherapy.