Evaluation of the nutritional profile of patients with total laryngectomy

Abstract

Background and aims: Nursing care requires knowledge of the best possible care techniques and plays a significant role in the nutritional status of cancer patients. The main purpose was assessing the changes in the nutritional profile between the preoperative and postoperative periods for patients with laryngeal cancer and their relationship to pharyngocutaneous fistula. Methods: Observational study of 40 patients. During April 2010 and December 2011 nutritional risk assessment on admission and evaluation of nutritional parameters on admission (t 0 ), at 7 (t 1 ) and 14 (t 2 ) days were carried out. Statistical techniques for longitudinal (or repeated) data and Generalised Estimating Equations models (GEE) were used. Results: On admission, 37.5% of patients had reduced their usual weight by a percentage greater than or equal to 5%, and had a moderate risk of suffering malnutrition; of the patients, 62.5% for [t o , t 1 ] and 80% for [t 1 , t 2 ] reduced their weight by a percentage greater than or equal to 2%. The average of weight loss was 4.32 (SD 2.20 [3.62e5.03]) kg for [t 0 , t 2 ]. Three quarters of these had C-reactive protein levels over 5 mg/l. Weight loss was associated with decreased caloric intake at 7 and 14 days, (r ¼ 0.05, p ¼ 0.031 (r ¼ 0.438, p ¼ 0.005) respectively. Decreased caloric intake was associated with a feeling of satiety. 27.5 percent of the patients had a pharyngocutaneous fistula, which was significantly associated with the percentage of weight loss (p-value ¼ 0.032) and lower levels of albumin and prealbumin, with a mean difference of 0.36 g/dl (p ¼ 0.014) and 7.65 mg/dl (p ¼ 0.005) and 0.68 g/dl (p ¼ 0.0001) respectively. Conclusion: Patients lose weight before and during treatment and this weight loss is a poor prognosis for the development of pharyngocutaneous fistula in patients with total laryngectomy.