Study On Nutritional Status And Quality Of Life In Patients With Chemotherapy

Background:Malnutrition is common in cancer patients. At abroad the incidence of weight loss in patients with tumor is 31～87%. In China, the incidence of malnutrition is 9.52～54.55%.,of which gastrointestinal tumors are the most common. Weight loss is an independent risk factor for cancer patients. At present the main cause of malnutrition is thought to be cancer cachexia syndrome. Meanwhile radiotherapy and chemotherapy can also make it much worse. The parameters of malnutrition include the following 7 aspects:anthropometry, body composition, weight loss, anorexia, reduce of food, biochemical markers and subjective assessment. Subjective assessment tools used most commonly are NRS2002, PG-SGA and EORTC QLQ-C 30. A large number of studies have shown that nutritional counseling (NC) and enteral nutrition (EN) can both improve the nutritional status and quality of life of patients with tumor. This study is carried out to further verify the effectiveness and to compare the impact of NC and EN on cancer patients receiving chemotherapy.Objectives:1, To assess the incidence of nutritional risk and of malnutrition in cancer patients.2, To study the effects of chemotherapy on nutritional status and quality of life of cancer patients.3, To study the effect of enteral nutrition support on nutritional status and quality of life of cancer patients with chemotherapy.Methods:Patients admitted to Oncology Department of Pecking Union Medical College Hospital during December 2014 to April 2015,> 18 years old, diagnosed as cancer, expected survival duration more than three months, planning to receive continual chemotherapy for≥3 cycles (including surgical and non-surgical) in this hospital were recruited in this research with patients’ consent. Baseline data records include:clinical aspects include:age, sex, height, weight, BMI, tumor type, tumor stage, surgery or not, initial chemotherapy or not; laboratory terms include:albumin (ALB), hemoglobin (HGB); anthropometric aspects include:arm circumference (AC), triceps skinfold thickness (TSF). Then under the guidance of researchers, patient independently completed three scales:NRS2002 (≥3 points defined as nutritional risk), PG-SGA (divided into two parts:qualitative and quantitative), EORTC QLQ-C30. According to the wishes of patients, they were divided into two groups: enteral nutrition group (EN group) and nutritional counseling group (NC group). Before each chemotherapy cycle, record the patient’s weight, BMI, ALB, HGB, and after three cycles patients would complete NRS2002, PG-SGA, and EORTC QLQ-C30 again.Results:The first part of this study was descriptive and included 96 patients.61 cases were males and 35 females. The average age was 54.73 ± 11.92 years (18-75 years). Main tumor types are gastrointestinal tumors (67.7%), and tumor stage III (36.5%) and IV (41.7%) dominated. The incidence of nutritional risk in 96 cases was 65.6%. Depending on the definition of malnutrition, the incidence of malnutrition varied (definition:incidence):1, BMI<18.5 kg/m2:8.3%; 2, ALB<35 g/L 8.3%; 3, HGB less than Normal:24.0%; 4, PG-SGA quantitative>4 points:77.1%; 5, PG-SGA qualitative (B+C):71.9%. If malnutrition is defined as qualitative PG-SGA (B+C), depending on the type of tumor, excluding hematological malignancies (0.0%), the occurrence rate of malnutrition varied from 50% to 100%, of which the most common were esophageal cancer, stomach cancer and pancreatic cancer. The incidence of malnutrition was related to tumor types, digestive tract cancer more frequent than non-gastrointestinal cancer. If malnutrition was defined as quantitative PG-SGA≥ 4 points, depending on the tumor type, the malnutrition rate ranged from 50 to 100%, of which the most common were esophageal cancer, stomach cancer and other types of the digestive system neoplasm.59 patients were included in the second part of this study.38 cases were males (64.4%), and 21cases females (35.6%). According to the wishes of patients,31 patients (52.5%) were recruited to nutritional counseling (NC) group, and 28 cases (47.5%) recruited to enteral nutrition (EN) group. This part was to find out the change of nutritional status and quality of life of the 59 patients, EN group and NC groups before and after chemotherapy. AC, HGB, quantitative PG-SGA values occurred in patients with significant changes, indicating chemotherapy reduces the nutritional status of 59 patients. In NC group, AC has undergone significant changes, indicating more nutritional problems after chemotherapy. It suggests that chemotherapy can reduce the nutritional status of cancer patients. The study also found that chemotherapy can reduce the quality of life for patients. EN group and 59 patients after chemotherapy felt more tired, and in NC group patients after chemotherapy experienced worse nausea and vomiting.The third part of this study included the same patients as the second part. We haven’t seen the significant difference of either nutritional status or quality of life of cancer patients with chemotherapy between EN and NC group. Because we didn’t have a perfect control group, it can not be concluded that NC or EN should improve nutritional status or quality of life of cancer patients with chemotherapy.Conclusions:1, The occurrence of cancer patients at nutritional risk was 65.6%. 2, Depending on the definition of malnutrition, the incidence of malnutrition was (definition:incidence):(1) BMI<18.5 kg/m2:8.3%; (2) ALB<35 g/L:8.3%; (3) HGB below normal:24.0%; (4) quantitative PG-SGA>4 points:77.1%; (5) qualitative PG-SGA (B+C):71.9%.3, If malnutrition was defined as quantitative PG-SGA> 4 points, depending on the tumor type, excluding hematological malignancies (0.0%), malnutrition rate varied from 50% to 100%, and the most common were esophageal cancer and stomach cancer. The incidence of malnutrition were related to tumor types, and digestive tract cancer more frequent than non-gastrointestinal cancer.4, Chemotherapy can reduce both nutritional status and quality of life of patients.5, The impact of enteral nutrition and nutrition counseling to nutritional status and quality of life of cancer patients with chemotherapy did not differ significantly.