nutrition_dysphagie

Cancer cachexia in adult patients: ESMO Clinical Practice Guidelines

Sat, 21 May 2022 08:18:50 +0000

Author Names: Arends J.,Strasser F.,Gonella S.,Solheim T.S.,Madeddu C.,Ravasco P.,Buonaccorso L.,de van der Schueren M.A.E.,Baldwin C.,Chasen M.,Ripamonti C.I.

Database Source: Embase Weekly Updates

Journal Title: ESMO Open

Article Title: Cancer cachexia in adult patients: ESMO Clinical Practice Guidelines<sup></sup>

Year: 2021

Issue: 3

Volume: 6

Abstract:

Nursing management and prevention of malnutrition in the patient with head-neck cancer

Fri, 01 Apr 2022 00:00:00 +0000

Prof Inferm. 2021 Oct-Dec;74(4):269. doi: 10.7429/pi.2021.744269a.

ABSTRACT

BACKGROUND The nursing record is often devoid of tools for nutritional evaluation: detection of signs and symptoms, nutritional screening such as the Malnutrition Universal Screening Tool (MUST) and the Mini Nutritional Assessment (MNA), anthropometric parameters: such as weight; with these tools. Therefore, it is possible to frame the patient according to his nutritional status and establish the most appropriate care path. Inappropriate documentation can create a negative nutritional spiral that carries an increased risk of serious health-related complications. It also hinders follow-up. In the literature it emerges the importance of using dysphagia screening and nutritional status assessment, these must be introduced into the hospital routine to avoid the damage caused by dysphagia and malnutrition. The literature shows how nutritional risk affects the increase in mortality, morbidity, days of hospitalization and re-admission to hospital one year after discharge. Malnourished patients had a longer hospital stay than normally fed patients, used more drugs and underwent more diagnostic tests and finally greater mortality. Malnutrition, to treat it appropriately, would be enough to be detected with simple screening tools.

AIM: This study aimed to estimate the prevalence of hypoalbuminemia in hospidalized elders before treatment for free flap plastic surgery after intervention for head-neck cancer, their nutritional status and lenght of stay.

METHODS: Retrospective observational study with 28 patients with head and neck cancer who underwent free flap recostruction in hospital at the Galliera Hospital Genoa during two years from Jenuary 2017 to December 2018. Clinical and surgical procedure-related factors were retrieved from a database and analyzed.

RESULTS: 28 patients ( 19 men, 9 women) were included in this study. The mean age of the study population was 61 years (range, 18 to 80 yr). The mean BMI was 23.30 kg/m2 ( range, 17.53 to 30.9 kg/m2). The mean lenght of stay was 35 days ( range, 11 to 122 days). The mean of the level albumin was 3.34 g/dl ( range, 2.1 to 4.5 g/dl). One surgical mortality was noted. The data emerged from the survey report the values of albumin and lymphocytes decreasing compared to the entrance, an extremely significant figure is also that of the days of hospitalization, which almost double in presence of one or more complications. The comparison between the average value of the days of stay of the stitches in patients without complications and the mean value of the days of stay of sutures in patients with complications, with a percentage deviation of 51.96%. The difference in patients with a lower incoming plasma albumin level compared to the group with normal levels allowed comparative analyses with respect to outcomes. 13 patients demonstrated albuminemia levels below the threshold of normal input, 15 adequate levels. The 13 patients with different albumenemic libellus developed site infection with an increase in average hospitalization days of 49.92 days (st.dev 26.26) against an average of the other group of 22.80 days (st.dev 10.50) the difference was significant The two-tailed P value equals 0.0011; also the permanence of the stitches in site is different between the two groups with an average of 45.77 days (st.dev 20.31) against an average of the other group of 23.80 days (st.dev 6.20) The two-tailed P value equals 0.0003 CONCLUSIONS: The prevalence of hypoalbuminemia, and the nutritional status and the length of stay seems to be related. Thus, it is suggested that monitoring albumin levels should be done to evaluate the risk that the patient has to develop malnutrition and other complications during hospital stays.

PMID:35363985 | DOI:10.7429/pi.2021.744269a

Rehabilitation nutrition for individuals with frailty, disability, sarcopenic dysphagia, or sarcopenic respiratory disability.

Sat, 01 Jan 2022 05:00:00 +0000

Current Opinion in Clinical Nutrition & Metabolic Care; 01/01/2022
(AN 154516663); ISSN: 13631950
CINAHL Complete

The health risks of dysphagia for patients with head and neck cancer: a multicentre prospective observational study

Tue, 23 Nov 2021 00:00:00 +0000

J Transl Med. 2021 Nov 22;19(1):472. doi: 10.1186/s12967-021-03144-2.

ABSTRACT

It is well known that malnutrition is a frequent co-morbidity in cancer patients, especially in those with head and neck neoplasms. This may be due both to the presence of dysphagia symptoms and to the appearance of adverse effects on chemotherapy and / or radiotherapy. The aim of this retrospective observational multicentric study is to evaluate the nutritional status between dysphagia cancer patients and non-dysphagia cancer patients. Data from 60 patients were analysed, 31 of which without dysphagia and 29 with dysphagia. Results highlight that patients with dysphagia had higher involuntary body weight loss than non-dysphagia ones (p < 0.001). By analysing the entire population, it stands out a weight loss rate of 12 ± 9% compared to the usual weight was observed and a prevalence of moderate / severe malnutrition diagnosis of 53%. Furthermore, 76% of the population who manifested the symptom of dysphagia presented severe malnutrition already at the first visit, compared to 32% of non-dysphagia subjects.

PMID:34809654 | PMC:PMC8607588 | DOI:10.1186/s12967-021-03144-2

The health risks of dysphagia for patients with head and neck cancer: a multicentre prospective observational study.

Mon, 22 Nov 2021 05:00:00 +0000

Journal of Translational Medicine; 11/22/2021
(AN 153702706); ISSN: 14795876
CINAHL Complete

Swallowing, nutritional status, and salivary flow in patients after head and neck cancer treatment, a pilot study

Wed, 13 Oct 2021 00:00:00 +0000

Sci Rep. 2021 Oct 12;11(1):20233. doi: 10.1038/s41598-021-99208-w.

ABSTRACT

Determine the relationship between swallowing function, nutritional status, and salivary flow in patients after head and neck cancer treatment. This pilot study included 17 patients. Swallowing was assessed through videofluoroscopy and surface electromyography (sEMG), nutritional status through anthropometry and dietary assessment, and salivary flow both with and without mechanical stimulation. Test analysis showed that 66.7% of patients had functional limitations in swallowing in 58.3%, 66.7%, and 58.3% residue scale with an average of a line of barium on a structure for pudding, honey, and liquid consistencies, respectively. Laryngeal penetration was found in 8.3% during the swallowing of liquid. Surface electromyography (sEMG) showed above normal values for muscle activity time during the swallowing of pudding. Anthropometric assessment and muscle and adipose tissue indicated eutrophy. Salivary flow test with mechanical stimulus showed that 82.3% of patients' salivary production was well below the appropriate level. There was a significant correlation between muscle tissue reserve and muscle activity time during swallowing in the studied muscles (left masseter p = 0.003, right masseter p = 0.001, suprahyoid p = 0.001, orbicularis oris = 0.020), all in pudding consistency. This pilot study confirmed the relationship between swallowing and nutritional status for its participants, showing that appropriate protein intake influences muscle activity during swallowing in head and neck cancer survivors.

PMID:34642369 | PMC:PMC8511146 | DOI:10.1038/s41598-021-99208-w

Treatment-Related Dysgeusia in Oral and Oropharyngeal Cancer: A Comprehensive Review.

Fri, 01 Oct 2021 04:00:00 +0000

Nutrients; 10/01/2021
(AN 153345882); ISSN: 20726643
CINAHL Complete

Relationship between GLIM criteria and disease-specific symptoms and its impact on 5-year survival of esophageal cancer patients.

Wed, 01 Sep 2021 04:00:00 +0000

Clinical Nutrition; 09/01/2021
(AN 152367645); ISSN: 02615614
CINAHL Complete

Estudio SeDREno: prevalencia de la desnutrición hospitalaria según los criterios GLIM, diez años después del estudio PREDyCES.

Wed, 01 Sep 2021 04:00:00 +0000

Nutricion Hospitalaria; 09/01/2021
(AN 153088146); ISSN: 02121611
CINAHL Complete

Rehabilitation nutrition for individuals with frailty, disability, sarcopenic dysphagia, or sarcopenic respiratory disability

Mon, 30 Aug 2021 00:00:00 +0000

Curr Opin Clin Nutr Metab Care. 2022 Jan 1;25(1):29-36. doi: 10.1097/MCO.0000000000000787.

ABSTRACT

PURPOSE OF REVIEW: We describe the recent advances in rehabilitation nutrition, which is especially important for disabled or frail older individuals.

RECENT FINDINGS: Recent evidence pertaining to rehabilitation nutrition conducted in rehabilitation wards and acute care hospitals has been accumulating. The combination of rehabilitation nutrition and rehabilitation pharmacotherapy is important for eliciting higher functions. The 2020 update of the clinical practice guidelines for rehabilitation nutrition provides a weak recommendation for enhanced nutritional care for patients with cerebrovascular disease, hip fracture, cancer, or acute illness who are undergoing rehabilitation. Rehabilitation nutritional care process and the International Classification of Functioning, Disability and Health-Dietetics are used to implement high-quality rehabilitation nutrition. Aggressive nutrition therapy incorporates the daily energy expenditure plus daily energy accumulation to increase body weight and muscle mass. Preventing and treating sarcopenic dysphagia should include iatrogenic sarcopenia prevention and aggressive nutrition therapy. The diagnosis criteria for respiratory sarcopenia and sarcopenic respiratory disability have been established.

SUMMARY: The International Association of Rehabilitation Nutrition and Total Nutrition Therapy Rehabilitation program may contribute to international expansion of rehabilitation nutrition. Improving evidence-practice gaps in rehabilitation nutrition and increasing national health insurance coverage of aggressive nutrition therapy and rehabilitation nutrition teams are warranted.

PMID:34456248 | PMC:PMC8694258 | DOI:10.1097/MCO.0000000000000787

Relationship between GLIM criteria and disease-specific symptoms and its impact on 5-year survival of esophageal cancer patients

Sun, 29 Aug 2021 00:00:00 +0000

Clin Nutr. 2021 Sep;40(9):5072-5078. doi: 10.1016/j.clnu.2021.08.008. Epub 2021 Aug 21.

ABSTRACT

BACKGROUND & AIMS: Malnutrition is common in patients with esophageal cancer, which affects their prognosis. The global leadership initiative on malnutrition (GLIM) criteria was recently proposed as the world's first diagnostic criteria for malnutrition. However, the association between esophageal cancer patients and the GLIM criteria is unclear. The purpose of this study was to evaluate the percentage of patients diagnosed with malnutrition preoperatively using the GLIM criteria, assess the impact of disease-specific symptoms on the severity of malnutrition, and assess the prognostic relevance of GLIM defined malnutrition in patients with esophageal cancer.

METHODS: This was a retrospective single-center cohort study. Preoperative nutritional status of patients with esophageal cancer hospitalized between June 2009 and July 2011 was evaluated according to the GLIM criteria. Factors related to severe malnutrition as per the GLIM criteria were analyzed using multivariable logistic regression analysis. The association between the severity of malnutrition based on the GLIM criteria and 5-year survival was assessed using a multivariable Cox proportional hazard model.

RESULTS: Overall, 117 esophageal cancer patients were nutritionally assessed. The percentage of moderate malnutrition and severe malnutrition was 21% and 23%, respectively. Subjective dysphagia [odds ratio (OR): 7.39, 95% confidence interval (CI): 1.46-37.52] and subjective esophageal obstruction (OR: 10.49, 95% CI: 3.47-31.70) were independent risk factors for severe malnutrition. The hazard ratio (HR) for 5-year mortality tended to be higher for moderate malnutrition (HR: 2.12, 95% CI: 0.91-4.95); however, it was not significantly associated with either moderate malnutrition or severe malnutrition (HR: 1.30, 95% CI: 0.52-3.27). Cases that were censored during the follow-up period probably affected the survival results.

CONCLUSION: Subjective feelings of dysphagia and esophageal obstruction might be related to malnutrition severity in esophageal cancer patients. Malnutrition assessed by the GLIM criteria was not significantly associated with 5-year survival.

PMID:34455266 | DOI:10.1016/j.clnu.2021.08.008

Change in Nutritional Status and Dysphagia after Resection of Head and Neck Cancer

Tue, 10 Aug 2021 00:00:00 +0000

Nutrients. 2021 Jul 16;13(7):2438. doi: 10.3390/nu13072438.

ABSTRACT

Nutritional status is well-known to influence patient recovery after resection of head and neck cancer (HNC). The influence of preoperative nutritional status on dysphagia was assessed in patients who underwent surgical resection of HNC along with the assessment of nutritional status during the acute and subacute phases. Eighty-six patients underwent surgical resection and dysphagia assessments (repetitive saliva-swallowing test, water-swallowing test, and functional oral intake scale) and had their tongue pressure assessed five times (before surgery, after 1-2 weeks, and 1, 2, and 3 months after surgery). The nutritional status was assessed according to the body mass index, total protein, and albumin. The prognostic nutritional index was calculated from preoperative data, and the subjects were classified into three groups: Low-risk, Attention and High-risk groups. After surgery, the nutritional status index values were low, and the High-risk group showed significantly lower values in comparison to the other two groups. The water-swallowing test and functional oral intake scale findings were worse than they had been preoperatively until 2 months after surgery, and a significant correlation was noted between the postoperative nutritional status and the presence of dysphagia. The results indicated that the preoperative nutritional status of HNC patients influenced their ability to ingest/swallow, which in turn influenced their nutritional status after HNC resection.

PMID:34371947 | PMC:PMC8308483 | DOI:10.3390/nu13072438

Malnutrition screening in head and neck cancer patients with oropharyngeal dysphagia

Sat, 31 Jul 2021 00:00:00 +0000

Clin Nutr ESPEN. 2021 Aug;44:348-355. doi: 10.1016/j.clnesp.2021.05.019. Epub 2021 May 31.

ABSTRACT

BACKGROUND & AIMS: Malnutrition in head and neck cancer (HNC) patients is associated with increased morbidity and mortality. The purpose of this study is two-fold: to identify the risk of malnutrition in patients with oropharyngeal dysphagia (OD) secondary to HNC, and to determine the relationship between the risk of malnutrition versus tumor characteristics, treatment modality, time interval (between the end of oncological treatment and swallowing assessment date), level of oral intake, body mass index (BMI), aspiration, pharyngeal pooling, and OD-related quality of life (QoL).

METHODS: The Short Nutritional Assessment Questionnaire (SNAQ) was used to screen patients for the risk of malnutrition. Patients underwent a standardized swallowing examination protocol including an endoscopic evaluation of swallowing.

RESULTS: Seventy-five dysphagic HNC patients were included. Forty-eight percent of the patients presented a high risk of malnutrition using SNAQ. The majority of the patients (81.3%) was on a total oral diet. Moreover, BMI did not appear to be a reliable measure to screen for malnutrition as a normal BMI was often associated with an increased risk of malnutrition on the SNAQ. In contrast, patients who were underweight or overweight did not show an association with a high risk of malnutrition. With the exception of BMI, no other patient and tumor characteristics were found to be associated with the risk of malnutrition.

CONCLUSIONS: This study emphasizes the importance of early nutritional screening in dysphagic HNC patients, as almost half of these patients presented a high risk of malnutrition. Malnutrition screening using SNAQ can identify HNC patients with OD who are at risk of malnutrition and subsequently need to be referred to a dietician for additional nutritional assessment, diagnosis of malnutrition, and nutritional support, even when their BMI is within normal range.

PMID:34330489 | DOI:10.1016/j.clnesp.2021.05.019

Change in Nutritional Status and Dysphagia after Resection of Head and Neck Cancer.

Thu, 01 Jul 2021 04:00:00 +0000

Nutrients; 07/01/2021
(AN 151587866); ISSN: 20726643
CINAHL Complete

SeDREno study - prevalence of hospital malnutrition according to GLIM criteria, ten years after the PREDyCES study

Wed, 23 Jun 2021 00:00:00 +0000

Nutr Hosp. 2021 Oct 13;38(5):1016-1025. doi: 10.20960/nh.03638.

ABSTRACT

Background & aims: the last large multicenter study on disease-related malnutrition (DRM) in Spain (the PREDyCES study) showed a 23.7 % prevalence of malnutrition, according to the Nutritional Risk Screening (NRS-2002) tool. The main objective of the SeDREno study was to assess the prevalence of hospital malnutrition upon admission, according to GLIM criteria, ten years later. Methods: a cross-sectional, observational, multicenter study in standard clinical practice, conducted in 17 hospitals during a period of five to seven days. Patients were initially screened using the Malnutrition Universal Screening Tool (MUST), and then assessed using the GLIM criteria for diagnosis and severity grading. Results: a total of 2,185 patients, 54.8 % males, mean age 67.1 (17.0) years (50.2 % aged ≥ 70 years), were evaluated. Malnutrition was observed in 29.7 % of patients according to GLIM criteria (12.5 % severe, 17.2 % moderate). In patients ≥ 70 years malnutrition was observed in 34.8 %. The clinical conditions significantly associated with a higher prevalence of malnutrition were dysphagia (47.6 %), cognitive impairment (43.4 %), cancer (39.1 %), gastrointestinal disease (37.7 %), diabetes (34.8 %), and cardiovascular disease (33.4 %). The multivariate analysis revealed that gender, BMI, diabetes, cancer, gastrointestinal disorders, and polypharmacy were the main independent factors associated with DRM. Malnutrition was associated with an increase in length of hospital stay and death (p < 0.001). Conclusions: DRM in admitted patients has increased in Spain in the last 10 years paralleling ageing of the population. In the SeDREno study almost one in three patients are malnourished. A systematic assessment of nutritional status allows early detection and implementation of nutritional interventions to achieve a better clinical outcome.

PMID:34157845 | DOI:10.20960/nh.03638

Comprehensive assessment of nutritional status and nutritional-related complications in newly diagnosed esophageal cancer patients: A cross-sectional study.

Tue, 01 Jun 2021 04:00:00 +0000

Clinical Nutrition; 06/01/2021
(AN 151058576); ISSN: 02615614
CINAHL Complete

Effect of Preoperative Nutritional Risk Screening and Enteral Nutrition Support in Accelerated Recovery after Resection for Esophageal Cancer.

Sat, 01 May 2021 04:00:00 +0000

Nutrition & Cancer; 05/01/2021
(AN 149121485); ISSN: 01635581
CINAHL Complete

Comprehensive assessment of nutritional status and nutritional-related complications in newly diagnosed esophageal cancer patients: A cross-sectional study

Fri, 29 Jan 2021 00:00:00 +0000

Clin Nutr. 2021 Jun;40(6):4449-4455. doi: 10.1016/j.clnu.2021.01.003. Epub 2021 Jan 11.

ABSTRACT

BACKGROUND & AIMS: Malnutrition is prevalent in upper gastrointestinal cancer patients. The purpose of this study was a comprehensive assessment of nutritional status in newly diagnosed patients with esophageal cancer.

METHODS: Newly diagnosed esophageal cancer patients were referred to a chemo-radiation referral center in Mashhad, Iran, between February 2017 to February 2019. Anthropometric indices, a Patient-Generated Subjective Global Assessment (PG-SGA) tool, body composition, dietary intake, nutritional-related complications, and laboratory tests were assessed.

RESULTS: One hundred and eighty-nine patients with a mean age of 67.1 ± 12 and a male to female ratio of 98 to 91 were included. Ninety-seven (51.3%) of patients had experienced significant weight loss and 56 (29.6%) were underweight at diagnosis. According to PG-SGA, 179 (94.7%) needed nutritional interventions. Reduced muscle mass and low handgrip strength were observed in 70 (39.4%) and 26 (14.4%) of patients, respectively. Inadequate intakes of energy (less than 24 kcal/kg/day) and protein (less than 1.2 g/kg/day) were found in 146 (77.8%) and 171 (91%) patients, respectively. The mean total daily energy and protein intakes of subjects were 943.8 ± 540 kcal/day, and 30.6 ± 21 g/day, respectively. The most common nutritional-related complications were as follows: dysphagia (84.8%), anorexia (31.6%), constipation (62.1%), esophageal pain (48.4%), and dyspepsia (41.1%).

CONCLUSION: Our study demonstrated a high prevalence of malnutrition in newly diagnosed esophageal cancer patients. This fact demonstrates the importance of early screening of nutritional status via PG-SGA tool, clinical evaluation, dietary intake evaluations, and laboratory tests, based on which effective nutritional interventions and Symptoms management may be introduced in these patients.

PMID:33509666 | DOI:10.1016/j.clnu.2021.01.003

Nutrition and swallowing therapy strategies for patients with head and neck cancer.

Thu, 07 Jan 2021 08:31:57 +0000

Author Names: Kristensen MB,Isenring E,Brown B

Database Source: Ovid MEDLINE(R) <January Week 4 2019 to December Week 5 2020>

Journal Title: Nutrition

Article Title: Nutrition and swallowing therapy strategies for patients with head and neck cancer.

Year: 2020

Issue:

Volume: 69

Abstract: Patients with head and neck cancer experience many problems with eating which make them at high risk of malnutrition. Pre-habilitation swallowing exercises as overseen by a speech pathologist can improve swallowing function. A multidisciplinary approach to care, including effective nutritional screening, assessment and intervention has demonstrated improved outcomes in terms of meet nutritional requirements, improved nutritional status and quality of life. Nutritional recommendations are 1.2-1.5 g protein per kilogram per day and 125kJ/kg body weight per day but as these are guides close monitoring of intake and weight is important. Multidisciplinary teams and telehealth have shown better outcomes for nutrition and swallowing status for head and neck cancer patients and ongoing support is required for best patient care.<ovid:br/><ovid:br/> Copyright © 2019. Published by Elsevier Inc.

Sarcopenia as an early complication of patients with head and neck cancer with dysphagia.

Fri, 01 Jan 2021 05:00:00 +0000

European Journal of Cancer Care; 01/01/2021
(AN 148363126); ISSN: 09615423
CINAHL Complete

Health services research in colorectal cancer: a quasi-experimental interventional pilot study on in- and outpatient oncology

Tue, 29 Dec 2020 00:00:00 +0000

J Cancer Res Clin Oncol. 2021 Jun;147(6):1789-1802. doi: 10.1007/s00432-020-03454-w. Epub 2020 Dec 29.

ABSTRACT

INTRODUCTION: Due to frequent treatment side effects and weight loss, colorectal cancer patients require oncologic care and nutritional counseling both during and after hospitalization. The current study evaluated differences in discharge and side effects management and nutritional behavior between colorectal cancer patients of a control group without systematic counseling and of an intervention group with access to structured in- and outpatient oncology nurse and nutritional counseling.

METHODS: The presented explorative, quantitative, single-center, interventional pilot study is a health services research project with a quasi-experimental design. Using a self-designed standardized questionnaire, data were collected from the control group (n = 75) before and from the intervention group (n = 114) after the introduction of in- and outpatient oncology nurse and structured systematic nutritional counseling. The in- and outpatient counseling services were developed and evaluated in the form of a structured nurse-led counseling concept.

RESULTS: Intervention group patients profited significantly from inpatient oncology nurse counseling in seven different areas of discharge management. No differences were observed concerning patient-reported general and gastrointestinal side effects except for xerostomia and dysphagia, but of the patients participating in both in- and outpatient oncology nurse counseling, 90.0% were better able to cope with general side effects of treatment. Patients with in- and outpatient structured systematic nutritional counseling more frequently received nutritional information (p = 0.001), were better at gauging food intolerances (p = 0.023), and followed the dietician's advice in cases of gastrointestinal side effects significantly more often (p = 0.003) than control patients. Counselor-reported outcomes concerning gastrointestinal side effects showed improvement in most of the patients taking part in systematic in- and outpatient nutritional counseling, except for weight loss in 4 patients.

CONCLUSION: In- and outpatient counseling in discharge and side effects management and nutrition improve the outcomes of colorectal cancer patients. Outpatient counseling should be further developed and evaluated in future studies.

PMID:33373026 | PMC:PMC8076149 | DOI:10.1007/s00432-020-03454-w

GASTROINTESTINAL CHANGES DURING NUTRITIONAL FOLLOW-UP OF CANCER PATIENTS UNDERGOING OUTPATIENT CHEMOTHERAPY

Wed, 25 Nov 2020 00:00:00 +0000

Arq Gastroenterol. 2020 Sep-Dec;57(4):354-360. doi: 10.1590/S0004-2803.202000000-68.

ABSTRACT

BACKGROUND: Cancer patients may have gastrointestinal changes that influence nutritional status.

OBJECTIVE: To investigate the occurrence of gastrointestinal changes resulting from outpatient chemotherapy treatment in cancer patients.

METHODS: In a retrospective longitudinal study, the nutritional status and chemotherapy gastrointestinal changes (nausea, vomit, diarrhea, constipation, mucositis, dysphagia, xerostomia, inappetence, dysgeusia and heartburn) in cancer patients (n=187) were investigated in an outpatient follow-up. For the study of the parameters over time, the generalized estimating equation (GEE) method was used. Kruskal-Wallis, Mann-Whitney tests and Spearman coefficient, at a significance level of 5% were also used.

RESULTS: The majority of the patients were female (63.64%) and the mean age was 57.5±12.1 years. The most frequent symptoms were nausea (18.54%); inappetence (18.31%); intestinal constipation (11.58%); diarrhea (7.98%); xerostomia (7.59%) and vomiting (7.43%). The nutritional status did not exhibit any relevant changes (P=0.7594). However, a higher prevalence of eutrophy was observed, followed by overweight; vomiting exhibited a significant difference (P=0.0211). The nausea symptom exhibited a significant difference with a higher prevalence of colorectal neoplasia when compared to breast neoplasia (P=0.0062); as well as vomiting in lung and colorectal neoplasias (P=0.0022), and dysphagia, in head and neck neoplasia, when compared to other neoplasms (P<0.001). There was a statistically significant difference between the number of medical appointments and gender (P=0.0102) and between dysphagia and gender (P<0.0001).

CONCLUSION: The study findings enhance the need for signs and symptoms follow up, as well as nutritional status follow up of patients undergoing outpatient chemotherapy.

PMID:33237213 | DOI:10.1590/S0004-2803.202000000-68

Home artificial nutrition in palliative care cancer patients: Impact on survival and performance status.

Sun, 01 Nov 2020 04:00:00 +0000

Clinical Nutrition; 11/01/2020
(AN 146712872); ISSN: 02615614
CINAHL Complete

Head and Neck Cancer Survivors' Experiences with Chronic Nutrition Impact Symptom Burden after Radiation: A Qualitative Study.

Thu, 01 Oct 2020 04:00:00 +0000

Journal of the Academy of Nutrition & Dietetics; 10/01/2020
(AN 145935054); ISSN: 22122672
CINAHL Complete

食管癌病人围术期营养护理循证实践方案的构建.

Tue, 15 Sep 2020 04:00:00 +0000

Chinese Nursing Research; 09/15/2020
(AN 146443686); ISSN: 10096493
CINAHL Complete

Nutritional Status in Patients with Esophageal Cancer Receiving Chemoradiation and Assessing the Efficacy of Usual Care for Nutritional Managements

Sat, 29 Aug 2020 00:00:00 +0000

Asian Pac J Cancer Prev. 2020 Aug 1;21(8):2315-2323. doi: 10.31557/APJCP.2020.21.8.2315.

ABSTRACT

BACKGROUND: Malnutrition is prevalent in esophageal cancer patients which affects cancer prognosis. The purpose of this study was a comprehensive assessment of nutritional status during Chemoradiation (CRT).

METHODS: Newly diagnosed adults with esophageal cancer were recruited for this study. Patient-Generated- Subjective Global Assessment (PG-SGA), anthropometric indices, body composition, dietary intake, laboratory tests, and nutritional-related complications were assessed before, after, and 4 to 6 weeks after CRT.

RESULTS: Seventy-one cases were enrolled. The mean age was 66.8±12 years. Patients' mean weight loss was 2.42±2.4 kilograms during treatment. A significant reduction observed in mean MUAC (26.68±4.9 vs. 25.42±5.1 cm), fat mass percentage (24.11±11.8 vs. 22.8±12.5), fat free mass index (16.87±2.4 vs. 16.47±2.6 kg/m2) and hand grip strength (43.2±19 vs. 36.1±20 kg) during CRT (all p-values <0.0001). We had also a non-significant change in mean energy intake (19.5±11 vs. 18.3±11 kcal/kgw. day) and protein intake (0.56±0.4 vs. 0.66±0.5 g/kgw.day) during CRT. In our assessment before, immediately after and 4-6 weeks following CRT, we recorded energy intake insufficiency in 55.7%, 58.7% and 27.3% and protein intake inadequacy in 89.8%, 89.1% and 72.7% of cases, respectively. The most common complications were dysphagia (56.7%), anorexia (25%), and constipation (47.9%) at admission. Dysphagia improved in some cases (42%), but anorexia (35%), early satiety (25%), Esophagitis (25%), dysosmia (21%) and dysgeusia (17%) were increased as CRT complication. yet, 25% of patients had dysphagia and 34.4% had constipation 4-6 weeks after CRT. The twelve-months mortality was significantly associated with lower BMI after CRT, primary PG-SGA score, weight loss, BMI<18.5, MUAC, physical performance, living in rural or urban areas, addiction.

CONCLUSION: Our study demonstrated a high prevalence of malnutrition among esophageal cancer patients which worsened during Chemoradiotherapy. Our findings warrant early screening and monitoring of nutritional status and effective nutritional interventions with symptoms management during treatment in these patients.<br />.

PMID:32856860 | PMC:PMC7771945 | DOI:10.31557/APJCP.2020.21.8.2315

Palliation of dysphagia in metastatic oesogastric cancers: An international multidisciplinary position.

Sat, 01 Aug 2020 04:00:00 +0000

European Journal of Cancer; 08/01/2020
(AN 144622333); ISSN: 09598049
CINAHL Complete

Tipping point: When patients stop eating and drinking in the last phase of their life

Wed, 22 Jul 2020 00:00:00 +0000

Clin Nutr ESPEN. 2020 Aug;38:280-282. doi: 10.1016/j.clnesp.2020.04.012. Epub 2020 May 6.

ABSTRACT

BACKGROUND: Eating and drinking are essential also in social life. Nutrition and hydration (N&H) at end of life are often a source of discussion and distress. Stopping eating and drinking is a defining element of the dying phase, however, this time point is not well defined. The aim of this retrospective analysis was to investigate whether such a time point can be detected, whether there are specific characteristics associated.

METHODS: The time point when patients stopped oral intake was analyzed in relation to time until death on a specialist palliative care ward (sPCW) of a tertiary comprehensive cancer center. This "tipping point" (TP) was defined as the time point when total food intake fell below 25% of normal solid intake (TP-S) and "tipping point fluid" (TP-F) when fluid intake fell below 500 ml/day (oral/intravenous/subcutaneous). Demographic and medical data, the N&H-module in the electronic patient management system and the daily multiprofessional treatment notes at TP (±3 days) were analyzed in all patients cared on the sPCW between 1/15 and 9/17.

RESULTS: In these 32 months, of 1194 treated patients 683 (57%) died on the ward. A TP-S was identified in 291 patients prior to dying on the ward (43%) with a median time of six days from to TP-S death. In 75% of these patients, TP-S occurred within two weeks prior to death (range: 0-5 weeks). A TP-F was detected in 202 patients (30%) with a median TP-F-time of two days prior to death. In 75% of these patients, the TP-F was within three days prior to death (range: 0-14 days). The cancer entities in patients in whom TPs could be detected were heterogeneous. No specific disease-related or sociodemographic characteristics for patients with TPs could be determined. In the daily treatment notes, oral and swallowing problems, taste alterations and discussions about stopping artificial nutrition were mentioned.

CONCLUSION: In less than half of dying patients a definitive TP could be detected. In these patients, TP-S occurred within two weeks and TP-F within few days before death. No specific characteristics of patients with TPs could be observed. This indicates the individual nature of the trajectory at end of life.

PMID:32690171 | DOI:10.1016/j.clnesp.2020.04.012

Head and Neck Cancer Survivors' Experiences with Chronic Nutrition Impact Symptom Burden after Radiation: A Qualitative Study

Sat, 11 Jul 2020 00:00:00 +0000

J Acad Nutr Diet. 2020 Oct;120(10):1643-1653. doi: 10.1016/j.jand.2020.04.016. Epub 2020 Jul 7.

ABSTRACT

BACKGROUND: Head and neck cancer (HNC) survivors may face an array of nutrition impact symptoms (NIS), including dysphagia, xerostomia, taste alterations, and difficulty chewing, which occur as a result of tumor location and treatment with radiation. Few qualitative studies have assessed the chronic impact of NIS on everyday life.

OBJECTIVE: The aim of this study was to obtain a comprehensive understanding of the lived experience of chronic NIS burden on HNC survivors.

DESIGN AND PARTICIPANTS: Semi-structured, face-to-face interviews were conducted with 31 HNC survivors to address the research aims and objectives. An interview guide was utilized to consider themes that had been generated through the review of literature and through the researchers' clinical experience within the field. There were probes within the interview for participants to raise unanticipated issues and flexibility to follow such leads. Interviews were conducted between March 2018 and May 2019.

ANALYSIS: A single researcher conducted the interviews to maintain consistency in data collection. Interviews lasted approximately 1 hour and were audio-recorded. All interview transcripts were professionally transcribed verbatim and checked for accuracy to ensure a complete account of participants' responses. Two researchers applied qualitative thematic content analysis to identify major themes.

RESULTS: The following 4 major thematic categories emerged from the interview data: symptom presence, dietary preferences, eating adjustments, and addressing symptoms. The most common symptoms were dysphagia, xerostomia, taste alterations, and bothered chewing. As a result of dietary preferences, survivors avoided citrus fruits, dry foods, raw vegetables, sweets, and meats. Survivors preferred soft and moist foods, spices or seasonings, and sauces or gravies. Eating adjustments were described as increased time to consume meals, cutting food into smaller pieces, consuming less food, and consuming more fluid. As a result of food preference changes and eating adjustments, survivors reported dietary pattern changes from pre to post treatment. All survivors experienced 1 or more chronic NIS, yet nearly 40% were unaware before treatment that NIS had the potential to persist chronically.

CONCLUSIONS: The results of this study provide unique qualitative insight into the lived experience of chronic NIS burden on HNC survivors. By recognizing the daily challenges, health care team members can better support HNC survivors in the transition from active treatment to follow-up care.

PMID:32646742 | DOI:10.1016/j.jand.2020.04.016

Alleviation of dry mouth by saliva substitutes improved swallowing ability and clinical nutritional status of post-radiotherapy head and neck cancer patients: a randomized controlled trial.

Mon, 01 Jun 2020 04:00:00 +0000

Supportive Care in Cancer; 06/01/2020
(AN 142867429); ISSN: 09414355
CINAHL Complete

Prevision of multidisciplinary head and neck cancer survivorship care during the 2019 novel coronavirus pandemic

Tue, 19 May 2020 00:00:00 +0000

Head Neck. 2020 Jul;42(7):1668-1673. doi: 10.1002/hed.26256. Epub 2020 May 18.

ABSTRACT

The 2019 Coronavirus Pandemic challenges the delivery of care for patients with head and neck cancer. An important aspect of this care has been the evolution of enhanced survivorship services, which include surveillance for recurring cancer and prevention of second primaries. The application of evidence-based approaches to the identification and management of treatment and tumor-related toxicities has embraced the use of validated patient-reported outcomes instruments, health promotion, and care coordination. In this manuscript, we describe how our multidisciplinary team of survivorship providers has accommodated to the need to provide patients with social distancing while acknowledging the importance of continued care during treatment and through the spectrum of survivorship.

PMID:32420631 | PMC:PMC7276867 | DOI:10.1002/hed.26256

Swallowing functional outcomes and nutritional status in head and neck cancer radiotherapy: longitudinal study

Fri, 15 May 2020 00:00:00 +0000

BMJ Support Palliat Care. 2020 Dec;10(4):452-461. doi: 10.1136/bmjspcare-2020-002216. Epub 2020 May 13.

ABSTRACT

OBJECTIVE: To explore the relationships between swallowing functional outcomes and nutritional status in patients with head and neck cancer undergoing radiotherapy (RT).

METHODS: This longitudinal study included 122 patients. Data were collected at three time points: baseline (T₁), the third week of RT (T₂) and the completion of RT (T₃). The Common Terminology Criteria for Adverse Events was used to assess the symptom of dysphagia and other toxicities; the MD Anderson Dysphagia Inventory (MDADI) was used to assess the patient-perceived swallowing functional outcomes; the nutritional status was evaluated by the weight ratio and the Patient-Generated Subjective Global Assessment (PG-SGA). The generalised estimating equation (GEE) was used to measure the correlation of MDADI with the weight ratio or PG-SGA and also to analyse the influential factors of swallowing functional outcomes.

RESULTS: The participants' acute dysphagia rates were 5.7% at T₁, 69.7% at T₂ and 77.9% at T₃. The swallowing functional outcomes worsen over RT (p<0.001) and were associated with weight ratio (β=0.032, p=0.008) and PG-SGA (β=-0.115, p<0.001). GEE models showed that patients with cancer of the pharynx region, advanced stage, chemoradiotherapy and high RT dose perceived worse swallowing functional outcomes. Oral mucositis, pharynx mucositis and salivary gland inflammation were positively correlated with swallowing functional outcomes, and the pharynx mucositis presented the highest absolute value of β.

CONCLUSION: The swallowing functional outcomes were negatively correlated with nutritional status. Healthcare professionals should identify early on the population at higher risk and focus on multiple toxicities, especially the management of pharynx mucositis, to improve nutritional status.

PMID:32404303 | DOI:10.1136/bmjspcare-2020-002216

Meeting nutritional need and managing patients with dysphagia.

Wed, 01 Apr 2020 04:00:00 +0000

Journal of Community Nursing; 04/01/2020
(AN 142927340); ISSN: 02634465
CINAHL Complete

Rationale and design of a randomised controlled trial investigating the effect of multidisciplinary nutritional rehabilitation for patients treated for head and neck cancer (the NUTRI-HAB trial)

Thu, 19 Mar 2020 00:00:00 +0000

Nutr J. 2020 Mar 17;19(1):21. doi: 10.1186/s12937-020-00539-7.

ABSTRACT

BACKGROUND: Eating problems frequently affect quality of life and physical, psychological and social function in patients treated for head and neck cancer (HNC). Residential rehabilitation programmes may ameliorate these adverse effects but are not indicated for all individuals. Systematic assessment of rehabilitation needs may optimise the use of resources while ensuring referral to rehabilitation for those in need. Yet, evidence lacks on which nutrition screening and assessment tools to use. The trial objectives are: 1) To test the effect of a multidisciplinary residential nutritional rehabilitation programme compared to standard care on the primary outcome body weight and secondary outcomes health-related quality of life, physical function and symptoms of anxiety and depression in patients curatively treated for HNC and 2) To test for correlations between participants' development in outcome scores during their participation in the programme and their baseline scores in Nutritional Risk Screening 2002 (NRS 2002), the Scored Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF), and M. D. Anderson Dysphagia Inventory (MDADI) and to assess sensitivity, specificity and predictive values of the three tools in relation to a clinically relevant improvement in outcome scores.

METHODS: In a randomised controlled trial, 72 patients treated for HNC recruited through a nationwide survey will be randomised to a multidisciplinary residential nutritional rehabilitation programme or to a wait-list control group. Data are collected at baseline, three and six months. Primary outcome is change in body weight, and secondary outcomes include changes in quality of life, physical function and symptoms of anxiety and depression. Potential correlations between intervention effect and baseline scores in NRS 2002, PG-SGA-SF and MDADI will be tested, and sensitivity, specificity and predictive values of the three tools in relation to a clinically relevant improvement in outcome scores will be assessed.

DISCUSSION: This is the first randomised controlled trial to test the effect of a multidisciplinary residential nutritional rehabilitation programme in patients treated for HNC. Recruitment through a nationwide survey gives a unique possibility to describe the trial population and to identify potential selection bias. As the trial will explore the potential of different nutrition screening and assessment tools in the assessment of rehabilitation needs in patients treated for HNC, the trial will create knowledge about how selection and prioritisation of nutritional rehabilitation aimed at patients treated for HNC should be offered. The results may contribute to a better organisation and use of existing resources in benefit of patients treated for HNC.

TRIAL REGISTRATION: The trial is registered by The Danish Data Protection Agency (registration 2012-58-0018, approval number 18/14847) and the Regional Committees on Health Research Ethics for Southern Denmark (journal number 20182000-165). ClinicalTrials.gov Identifier: NCT03909256. Registered April 9, 2019.

PMID:32183835 | PMC:PMC7079410 | DOI:10.1186/s12937-020-00539-7

Rationale and design of a randomised controlled trial investigating the effect of multidisciplinary nutritional rehabilitation for patients treated for head and neck cancer (the NUTRI-HAB trial).

Tue, 17 Mar 2020 04:00:00 +0000

Nutrition Journal; 03/17/2020
(AN 142293619); ISSN: 14752891
CINAHL Complete

The effectiveness of a nurse-led exercise and health education informatics program on exercise capacity and quality of life among cancer survivors after esophagectomy: A randomized controlled trial.

Wed, 01 Jan 2020 05:00:00 +0000

International Journal of Nursing Studies; 01/01/2020
(AN 140318291); ISSN: 00207489
CINAHL Complete

Mucositis-Induced Pain due to Barrier Dysfunction may have a Direct Effect on Nutritional Status and Quality of Life in Head and Neck Cancer Patients Receiving Radiotherapy.

Wed, 01 Jan 2020 05:00:00 +0000

Turkish Journal of Oncology / Türk Onkoloji Dergisi; 01/01/2020
(AN 142016989); ISSN: 13007467
CINAHL Complete

Use of esophageal stents to relieve dysphagia during neoadjuvant therapy prior to esophageal resection: a systematic review

Fri, 13 Dec 2019 00:00:00 +0000

Dis Esophagus. 2020 Jan 16;33(1):doz090. doi: 10.1093/dote/doz090.

ABSTRACT

Esophageal cancer stenting offers symptomatic relief for patients suffering from dysphagia. There are limited data to support their use to relieve dysphagia and improve nutrition during neoadjuvant therapy with some concern that they may negatively impact oncological outcomes. The aim of this systematic review was to quantify the impact of esophageal stents on outcomes prior to resection with curative intent. A literature search was performed using Embase, Medline, PubMed, PubMed Central, the Cochrane library for articles pertaining to esophageal stent use prior to or during neoadjuvant chemotherapy or chemoradiotherapy in patients planned for curative esophagectomy. Data extracted included basic demographics, clinical, nutritional and oncologic outcomes. A total of 9 studies involving 465 patients were included. Esophageal stent use resulted in a significant improvement in mean dysphagia scores in the immediate post stent period but failed to demonstrate any positive changes in weight, body mass index (BMI) or albumin. Only 33% of stented patients ultimately progressed to potential curative surgical resection and stents were associated with reduced R0 resection rates and lower overall survival. This systematic review shows that, although esophageal stenting is associated with improvements in dysphagia during neoadjuvant therapy, their effect on improving patient nutritional status is less clear and they may be associated with poorer long-term oncological outcomes. Stents should be used with caution in patients who are being considered for potentially curative resection of esophageal malignancies and other strategies of nutritional supplementation should be considered.

PMID:31828290 | DOI:10.1093/dote/doz090

Alleviation of dry mouth by saliva substitutes improved swallowing ability and clinical nutritional status of post-radiotherapy head and neck cancer patients: a randomized controlled trial

Sun, 17 Nov 2019 00:00:00 +0000

Support Care Cancer. 2020 Jun;28(6):2817-2828. doi: 10.1007/s00520-019-05132-1. Epub 2019 Nov 15.

ABSTRACT

PURPOSE: The aim of this study is to investigate the effect of an edible saliva substitute, oral moisturizing jelly (OMJ), and a topical saliva gel (GC) on dry mouth, swallowing ability, and nutritional status in post-radiotherapy head and neck cancer patients.

METHODS: Sixty-two post-radiation head and neck cancer patients with xerostomia completed a blinded randomized controlled trial. They were advised to swallow OMJ (n = 31) or apply GC orally (n = 31) for 2 months. Outcome measures were assessed at baseline, 1, and 2 months, including subjective and objective dry mouth (Challcombe) scores, subjective swallowing problem scores (EAT-10), water swallowing time, clinical nutritional status (PG-SGA), body weight, and dietary intake.

RESULTS: After 1 and 2 months of interventions, subjective and objective dry mouth scores, subjective swallowing problem scores, swallowing times, and clinical nutritional status in both groups were significantly improved (p < 0.0001). Compared to GC, OMJ group had higher percent improvement in all outcome measures (p < 0.001) except swallowing time and clinical nutritional status. Interestingly, subjective dry mouth scores were significantly correlated with subjective swallowing problem scores (r = 0.5321, p < 0.0001).

CONCLUSIONS: Continuous uses of saliva substitutes (OMJ or GC) for at least a month improved signs and symptoms of dry mouth and enhanced swallowing ability. An edible saliva substitute was superior to a topical saliva gel for alleviating dry mouth and swallow problems. These lead to improved clinical nutritional status. Thus, palliation of dry mouth may be critical to support nutrition of post-radiotherapy head and neck cancer patients.

CLINICAL TRIAL REGISTRY: Clinicaltrials.gov NCT03035825.

PMID:31732852 | PMC:PMC7181446 | DOI:10.1007/s00520-019-05132-1

Nutrition and swallowing therapy strategies for patients with head and neck cancer

Sun, 29 Sep 2019 00:00:00 +0000

Nutrition. 2020 Jan;69:110548. doi: 10.1016/j.nut.2019.06.028. Epub 2019 Jul 2.

ABSTRACT

Patients with head and neck cancer experience many problems with eating which make them at high risk of malnutrition. Pre-habilitation swallowing exercises as overseen by a speech pathologist can improve swallowing function. A multidisciplinary approach to care, including effective nutritional screening, assessment and intervention has demonstrated improved outcomes in terms of meet nutritional requirements, improved nutritional status and quality of life. Nutritional recommendations are 1.2-1.5 g protein per kilogram per day and 125kJ/kg body weight per day but as these are guides close monitoring of intake and weight is important. Multidisciplinary teams and telehealth have shown better outcomes for nutrition and swallowing status for head and neck cancer patients and ongoing support is required for best patient care.

PMID:31563019 | DOI:10.1016/j.nut.2019.06.028

Pretreatment Dietary Patterns Are Associated with the Presence of Nutrition Impact Symptoms 1 Year after Diagnosis in Patients with Head and Neck Cancer

Fri, 19 Jul 2019 00:00:00 +0000

Cancer Epidemiol Biomarkers Prev. 2019 Oct;28(10):1652-1659. doi: 10.1158/1055-9965.EPI-19-0128. Epub 2019 Jul 17.

ABSTRACT

BACKGROUND: Dietary inflammatory potential could impact the presence and severity of chronic adverse treatment effects among patients with head and neck cancer. The objective of this study was to determine whether pretreatment dietary patterns are associated with nutrition impact symptoms (NIS) as self-reported 1 year after diagnosis.

METHODS: This was a longitudinal study of 336 patients with newly diagnosed head and neck cancer enrolled in the University of Michigan Head and Neck Specialized Program of Research Excellence. Principal component analysis was utilized to derive pretreatment dietary patterns from food frequency questionnaire data. Burden of seven NIS was self-reported 1 year after diagnosis. Associations between pretreatment dietary patterns and individual symptoms and a composite NIS summary score were examined with multivariable logistic regression models.

RESULTS: The two dietary patterns that emerged were prudent and Western. After adjusting for age, smoking status, body mass index, tumor site, cancer stage, calories, and human papillomavirus status, significant inverse associations were observed between the prudent pattern and difficulty chewing [OR 0.44; 95% confidence interval (CI), 0.21-0.93; P = 0.03], dysphagia of liquids (OR 0.38; 95% CI, 0.18-0.79; P = 0.009), dysphagia of solid foods (OR 0.46; 95% CI, 0.22-0.96; P = 0.03), mucositis (OR 0.48; 95% CI, 0.24-0.96; P = 0.03), and the NIS summary score (OR 0.45; 95% CI, 0.22-0.94; P = 0.03). No significant associations were observed between the Western pattern and NIS.

CONCLUSIONS: Consumption of a prudent diet before treatment may help reduce the risk of chronic NIS burden among head and neck cancer survivors.

IMPACT: Dietary interventions are needed to test whether consumption of a prudent dietary pattern before and during head and neck cancer treatment results in reduced NIS burden.

PMID:31315911 | PMC:PMC6774815 | DOI:10.1158/1055-9965.EPI-19-0128

Comparison of enteral nutrition with total parenteral nutrition for patients with locally advanced unresectable esophageal cancer harboring dysphagia in definitive chemoradiotherapy

Fri, 21 Jun 2019 00:00:00 +0000

Jpn J Clin Oncol. 2019 Oct 1;49(10):910-918. doi: 10.1093/jjco/hyz089.

ABSTRACT

BACKGROUND: The nutritional status of patients with esophageal squamous cell carcinoma (ESCC) harboring dysphagia is often poor. The efficacy and safety of enteral nutrition (EN) versus total parenteral nutrition (TPN) have not been addressed in patients with ESCC requiring nutritional support during definitive chemoradiotherapy (dCRT).

METHODS: We performed a retrospective analysis of 51 locally advanced unresectable ESCC patients with dysphagia receiving EN (n = 28) or TPN (n = 23) during dCRT between 2009 and 2016.

RESULTS: Patient characteristics in EN vs. TPN were as follows: median age (range), 67 (34 to 82) vs. 66 (57 to 83); ECOG performance status 0/1/2, 11/15/2 vs. 7/14/2; dysphagia score 2/3/4, 11/15/2 vs. 14/8/1; and primary tumor location Ce/Ut/Mt/Lt/Ae, 4/6/14/3/1 vs. 2/2/16/1/2. Median changes in serum albumin level one month after dCRT were +8.8% (-36 to 40) in EN and -12% (-64 to 29) in TPN (P = 0.00377). Weight, body mass index, and skeletal muscle area were not significantly different between the groups. Median durations of hospitalization were 50 days (18 to 72) in EN and 63 days (36 to 164) in TPN (P = 0.00302). Adverse events during dCRT in EN vs. TPN were as follows: catheter-related infection, 0 vs. 6 (27%); aspiration pneumonia, 3 (11%) vs. 2 (9%); mediastinitis, 3 (11%) vs. 1 (5%); grade ≥3 neutropenia, 6 (21%) vs. 14 (64%) (P = 0.00287); and febrile neutropenia, 0 vs. 6 (27%) (P = 0.00561).

CONCLUSIONS: EN may be advantageous for improving serum albumin level, and reducing hematological toxicity and duration of hospitalization compared with TPN during dCRT in ESCC patients.

PMID:31219161 | DOI:10.1093/jjco/hyz089

Considerations for the Development of Innovative Foods to Improve Nutrition in Older Adults

Sat, 15 Jun 2019 00:00:00 +0000

Nutrients. 2019 Jun 5;11(6):1275. doi: 10.3390/nu11061275.

ABSTRACT

The population of older adults is growing globally. This increase has led to an accumulation of chronic illnesses, so-called age-related diseases. Diet and nutrition are considered the main drivers of the global burden of diseases, and this situation applies especially to this population segment. It relates directly to the development of coronary heart disease, hypertension, some types of cancer, and type 2 diabetes, among other diseases, while age-associated changes in body composition (bone and muscle mass, fat, sarcopenia) constitute risk factors for functional limitations affecting health status and the quality of life. Older adults present eating and swallowing problems, dry mouth, taste loss, and anorexia among other problems causing "anorexia of aging" that affects their nutritional status. The strategies to overcome these situations are described in this study. The impact of oral food processing on nutrition is discussed, as well as approaches to improve food acceptance through the design of innovative foods. These foods should supply a growing demand as this group represents an increasing segment of the consumer market globally, whose needs must be fulfilled.

PMID:31195630 | PMC:PMC6627386 | DOI:10.3390/nu11061275

Malnutrition associated with nutrition impact symptoms and localization of the disease: Results of a multicentric research on oncological nutrition.

Sat, 01 Jun 2019 04:00:00 +0000

Clinical Nutrition; 06/01/2019
(AN 136178082); ISSN: 02615614
CINAHL Complete

Considerations for the Development of Innovative Foods to Improve Nutrition in Older Adults.

Sat, 01 Jun 2019 04:00:00 +0000

Nutrients; 06/01/2019
(AN 137190935); ISSN: 20726643
CINAHL Complete

Simplified percutaneous endoscopic transgastric conduit feeding jejunostomy for dysphagia after esophagectomy

Fri, 10 May 2019 00:00:00 +0000

Dis Esophagus. 2020 Mar 5;33(2):doz042. doi: 10.1093/dote/doz042.

ABSTRACT

Unexpected dysphagia is an important problem affecting life prognosis in patients who have undergone an esophagectomy for esophageal cancer. For nutritional support in patients suffering from dysphagia after a previous esophagectomy, a simplified percutaneous endoscopic transgastric conduit feeding jejunostomy approach was developed that can be performed regardless of the patient's condition. The feasibility of this procedure in 25 patients with esophageal cancer who underwent three-stage esophagectomy with retrosternal gastric conduit reconstruction from April 2009 to December 2016 was evaluated retrospectively. Under fluoroscopy, a percutaneous endoscopic transgastric conduit feeding jejunostomy catheter (9 French) was introduced into the jejunum in the epigastric region using the Seldinger's technique. The following patient data were analyzed retrospectively: operating time, complications, reasons for oral intake difficulty, and clinical data describing patients' nutritional status before and 1 month after percutaneous endoscopic transgastric conduit jejunostomy treatment, such as serum albumin and clinical course. Median patients' age was 68 years (range 50-76 years). Indications for the procedure were late swallowing dysfunction (n = 12), early swallowing dysfunction secondary to surgical complication (n = 8), anastomotic leakage (n = 3), and anorexia (n = 2). Causes of late swallowing dysfunction were radiation injury (n = 8), advanced age (n = 2), or cerebral infarction (n = 2). The median operating time was 29 minutes (range 14-82 minutes). Four patients developed mild erosions at the stoma secondary to bile reflux along the side of the catheter. No patient experienced severe complications such as ileus and peritonitis. Patients were treated for a median of 160 days (range 18-3106 days) with percutaneous endoscopic transgastric conduit jejunostomy. Patient's serum albumin significantly increased from 2.8 to 3.3 g/dl in 1 month. Of the eight patients with early swallowing dysfunction, six successfully regained sufficient oral nutrition after receiving enteral feeding nutritional management. Although all except one late swallowing dysfunction patient could not discontinue tube feeding, five patients were long-term survivors at the time this report was written. This jejunostomy procedure is simple, safe, and useful for patients with unexpected dysphagia and accompanying malnutrition after esophagectomy.

PMID:31069391 | DOI:10.1093/dote/doz042

Clinical study on two reconstruction methods of proximal gastrectomy and piggyback jejunal interposition for Siewert Ⅱ or Ⅲ adenocarcinoma of esophagogastric junction

Sat, 02 Feb 2019 00:00:00 +0000

Zhonghua Wai Ke Za Zhi. 2019 Feb 1;57(2):114-118. doi: 10.3760/cma.j.issn.0529-5815.2019.02.008.

ABSTRACT

Objective: To evaluate the clinical efficacy of two different digestive tract reconstruction methods in the Siewert Ⅱ or Ⅲ adenocarcinoma of esophagogastric junction underwent proximal gastrectomy and piggyback jejunal interposition. Methods: A total of 84 patients with Siewert Ⅱ or Ⅲ AEG who underwent proximal gastrectomy and interposition jejunal anastomosis were enrolled prospectively according to the exclusion criteria, from October 2015 to August 2017 at Department of Digestive Minimally Invasive Surgery, Shanxi Cancer Hospital. There were 61 male and 23 female patients, aged 48-69 years with an average age of 59.7 years. They were divided into single-tract reconstruction group (n=41) and double-tract reconstruction group (n=43) according to random number table. Both groups underwent proximal gastrectomy and piggyback jejunal interposition. After side-to-side anastomosis of the remnant stomach and jejunum was performed in the single-tract group, jejunum 3 cm below the anastomosis was ligated or closed. The jejunum in the double-tract group was not treated during the operation. Relevant nutritional indicators were collected at 3 months and 6 months after operation. The data were analyzed by repeated measurement of variance analysis to determine the nutritional status. Results: There was no significant difference in preoperative general condition between single-tract reconstruction group and double-tract reconstruction group (P>0.05). There was no significant difference in perioperative related indicators (P>0.05). Nutritional indicators in single-channel reconstruction group were higher than those in double-channel reconstruction group (hemoglobin: F=23.374, P=0.000; albumin: F=6.149, P=0.003; total protein: F=18.362, P=0.000; weight: F=74.255, P=0.000). The quality of life was compared half year after operation, there was no significant difference in the incidence of subjective symptoms such as reflux, heart burning, nausea and vomiting, dysphagia and sternum discomfort in the two groups (P>0.05), as well as the results of QLQ-STO22 score (27.0±3.8 vs. 27.6±3.3, t=-0.688, P=0.494). The results of gastroscopy showed that the incidence and degree of the two groups were almost the same whether in the incidence of reflux esophagitis (2/41 vs. 2/43, P=1) or in the contrast of reflux degree (Z=-1.528, P=0.127). Conclusion: For patients with type Siewert Ⅱ or Ⅲ esophagogastric junction adenocarcinoma who underwent proximal gastrectomy and piggyback jejunal operation, single tract reconstruction is ideal.

PMID:30704214 | DOI:10.3760/cma.j.issn.0529-5815.2019.02.008

Nutrition and Clinical Factors for Determining the Need of Enteral Nutrition for Head and Neck Cancer Patients.

Fri, 01 Feb 2019 05:00:00 +0000

Scan's Pulse; 02/01/2019
(AN 148102121); ISSN: 15285707
CINAHL Complete

nutrition_dysphagie

Cancer cachexia in adult patients: ESMO Clinical Practice Guidelines

Nursing management and prevention of malnutrition in the patient with head-neck cancer

Rehabilitation nutrition for individuals with frailty, disability, sarcopenic dysphagia, or sarcopenic respiratory disability.

The health risks of dysphagia for patients with head and neck cancer: a multicentre prospective observational study

The health risks of dysphagia for patients with head and neck cancer: a multicentre prospective observational study.

Swallowing, nutritional status, and salivary flow in patients after head and neck cancer treatment, a pilot study

Treatment-Related Dysgeusia in Oral and Oropharyngeal Cancer: A Comprehensive Review.

Relationship between GLIM criteria and disease-specific symptoms and its impact on 5-year survival of esophageal cancer patients.

Estudio SeDREno: prevalencia de la desnutrición hospitalaria según los criterios GLIM, diez años después del estudio PREDyCES.

Rehabilitation nutrition for individuals with frailty, disability, sarcopenic dysphagia, or sarcopenic respiratory disability

Relationship between GLIM criteria and disease-specific symptoms and its impact on 5-year survival of esophageal cancer patients

Change in Nutritional Status and Dysphagia after Resection of Head and Neck Cancer

Malnutrition screening in head and neck cancer patients with oropharyngeal dysphagia

Change in Nutritional Status and Dysphagia after Resection of Head and Neck Cancer.

SeDREno study - prevalence of hospital malnutrition according to GLIM criteria, ten years after the PREDyCES study

Comprehensive assessment of nutritional status and nutritional-related complications in newly diagnosed esophageal cancer patients: A cross-sectional study.

Effect of Preoperative Nutritional Risk Screening and Enteral Nutrition Support in Accelerated Recovery after Resection for Esophageal Cancer.

Comprehensive assessment of nutritional status and nutritional-related complications in newly diagnosed esophageal cancer patients: A cross-sectional study

Nutrition and swallowing therapy strategies for patients with head and neck cancer.

Sarcopenia as an early complication of patients with head and neck cancer with dysphagia.

Health services research in colorectal cancer: a quasi-experimental interventional pilot study on in- and outpatient oncology

GASTROINTESTINAL CHANGES DURING NUTRITIONAL FOLLOW-UP OF CANCER PATIENTS UNDERGOING OUTPATIENT CHEMOTHERAPY

Home artificial nutrition in palliative care cancer patients: Impact on survival and performance status.

Head and Neck Cancer Survivors' Experiences with Chronic Nutrition Impact Symptom Burden after Radiation: A Qualitative Study.

食管癌病人围术期营养护理循证实践方案的 构建.

Nutritional Status in Patients with Esophageal Cancer Receiving Chemoradiation and Assessing the Efficacy of Usual Care for Nutritional Managements

Palliation of dysphagia in metastatic oesogastric cancers: An international multidisciplinary position.

Tipping point: When patients stop eating and drinking in the last phase of their life

Head and Neck Cancer Survivors' Experiences with Chronic Nutrition Impact Symptom Burden after Radiation: A Qualitative Study

Alleviation of dry mouth by saliva substitutes improved swallowing ability and clinical nutritional status of post-radiotherapy head and neck cancer patients: a randomized controlled trial.

Prevision of multidisciplinary head and neck cancer survivorship care during the 2019 novel coronavirus pandemic

Swallowing functional outcomes and nutritional status in head and neck cancer radiotherapy: longitudinal study

Meeting nutritional need and managing patients with dysphagia.

Rationale and design of a randomised controlled trial investigating the effect of multidisciplinary nutritional rehabilitation for patients treated for head and neck cancer (the NUTRI-HAB trial)

Rationale and design of a randomised controlled trial investigating the effect of multidisciplinary nutritional rehabilitation for patients treated for head and neck cancer (the NUTRI-HAB trial).

The effectiveness of a nurse-led exercise and health education informatics program on exercise capacity and quality of life among cancer survivors after esophagectomy: A randomized controlled trial.

Mucositis-Induced Pain due to Barrier Dysfunction may have a Direct Effect on Nutritional Status and Quality of Life in Head and Neck Cancer Patients Receiving Radiotherapy.

Use of esophageal stents to relieve dysphagia during neoadjuvant therapy prior to esophageal resection: a systematic review

Alleviation of dry mouth by saliva substitutes improved swallowing ability and clinical nutritional status of post-radiotherapy head and neck cancer patients: a randomized controlled trial

Nutrition and swallowing therapy strategies for patients with head and neck cancer

Pretreatment Dietary Patterns Are Associated with the Presence of Nutrition Impact Symptoms 1 Year after Diagnosis in Patients with Head and Neck Cancer

Comparison of enteral nutrition with total parenteral nutrition for patients with locally advanced unresectable esophageal cancer harboring dysphagia in definitive chemoradiotherapy

Considerations for the Development of Innovative Foods to Improve Nutrition in Older Adults

Malnutrition associated with nutrition impact symptoms and localization of the disease: Results of a multicentric research on oncological nutrition.

Considerations for the Development of Innovative Foods to Improve Nutrition in Older Adults.

Simplified percutaneous endoscopic transgastric conduit feeding jejunostomy for dysphagia after esophagectomy

Clinical study on two reconstruction methods of proximal gastrectomy and piggyback jejunal interposition for Siewert Ⅱ or Ⅲ adenocarcinoma of esophagogastric junction

Nutrition and Clinical Factors for Determining the Need of Enteral Nutrition for Head and Neck Cancer Patients.

食管癌病人围术期营养护理循证实践方案的构建.