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Abstract(s)
Introdução: O cancro gastrointestinal (CG) é um dos tipos de cancro mais frequente em todo o mundo e com uma elevada taxa de mortalidade. O diagnóstico da maioria dos tumores gastro intestinais é, por norma, tardio, conduzindo a estadios localmente avançados e metastáticos que pressupõem sintomas debilitantes com impacto no estado nutricional. A malnutrição (perda de peso não intencional, desnutrição, caquexia e sarcopenia), altamente prevalente em doentes com CG, reflete um mau prognóstico com complicações significativas para o doente, incluindo a diminuição do estado funcional e da sobrevida e aumento da morbimortalidade. Objetivos e métodos: Estudo de coorte observacional em doentes com CG hospitalizados ou em Hospital de Dia (HD) do Hospital Garcia de Orta que visa rastrear, avaliar e associar o estado nutricional (através do Nutritional Risk Screening 2002 (NRS 2002®) e do Patient Generated Subjective Global Assessment (PG-SGA©), critérios GLIM (Global Leadership Initiative on Malnutrition) e dados antropométricos) e funcional (escalas Eastern Cooperative Oncology Group (ECOG) e Karnofsky Performance Scale Index (KPSI) e dinamometria de preensão palmar) dos doentes e a sintomatologia adjacente com impacto nutricional (com recurso ao PG-SGA©) e associar os mesmos com o tempo de sobrevida/ mortalidade. Resultados: 155 doentes com CG (93 – hospitalizados e 62 – HD). 75,4% dos doentes com diagnóstico de CG estadio IV. 65,1% dos doentes apresenta perda ponderal, sendo que 40,2% apresenta uma perda de peso severa. 60,6% apresenta um quadro de caquexia e 73,1% apresenta um diagnóstico provável de sarcopenia. 67,1% a 71,6% encontra-se desnutridos de acordo com os critérios GLIM e PG-SGA©, respetivamente. 86,1% apresenta valores de força de preensão palmar inferior ao percentil 30. 85,8% manifesta sintomatologia com impacto nutricional. 98,1% a 100% dos doentes desnutridos de acordo com os critérios GLIM e PG-SGA©, respetivamente, manifesta sintomatologia. A maior parte dos mesmos (51,4% a 55,8%, respetivamente) apresenta um índice de prognóstico nível 4 e mais de 80% não sobreviveram. Conclusão: Existe uma relação entre o estado nutricional e funcional e a sintomatologia adjacente que, por sua vez, se correlacionam com o índice de prognóstico da patologia e o tempo de sobrevida/ mortalidade, pois quanto maior a gravidade da desnutrição e pior os outcomes do estado funcional, maior a prevalência da mortalidade e menor o tempo de sobrevida. Mais ainda, o mesmo se verifica quanto à relação entre a sintomatologia e: o índice de prognóstico e o tempo de sobrevida/mortalidade.
ABSTRACT - Introduction: Gastrointestinal cancer (GC) is one of the most frequently diagnosed types of cancer worldwide and has a high mortality rate. The diagnosis of most gastrointestinal tumors is usually late, leading to locally advanced and metastatic stages that presuppose debilitating symptoms with an impact on nutritional status. Malnutrition (unintentional weight loss, malnutrition, cachexia, and sarcopenia), highly prevalent in patients with GC, reflects a poor prognosis with significant complications for the patient, including decreased functional status. These are strongly correlated with decreased survival and increased mortality. Aims and methods: Observational cohort study in patients with GC hospitalized or in a Day Hospital (DH) of the Garcia de Orta Hospital, which aims to track, assess, and associate the nutritional status (using the Nutritional Risk Screening 2002 (NRS 2002®), the Patient-Generated Subjective Global Assessment (PG-SGA©), the GLIM (Global Leadership Initiative on Malnutrition) criteria and anthropometric data) and functional (Eastern Cooperative Oncology Group (ECOG) and Karnofsky Performance Scale Index (KPSI) scales and Handgrip Dynamometry) of cancer patients and the adjacent symptoms with nutritional impact (using the PG-SGA©) and associating them with survival time/mortality. Results: 155 patients with GC (93 – Hospitalized and 62 – HD). 75.4% in stage IV of the tumor. 65.1% with a weight loss and 40.2% had a severe weight loss. 60.6% had cachexia and 73.1% had a probable diagnosis of sarcopenia. 67.1% to 71.6% are malnourished according to the GLIM and PG-SGA© criteria, respectively. 86.1% had a value of handgrip strength below the 30th percentile. 85.8% had symptoms with nutritional impact. 98.1% to 100% of malnourished patients according to the GLIM and PG-SGA© criteria, respectively, manifest symptoms. Most of them (51.4% to 55.8%, respectively) had a level 4 prognostic index and more than 80% did not survive. Conclusion: There is a relationship between nutritional and functional status and adjacent symptoms, which, in turn, correlate with the pathology prognostic index and survival time/ mortality, as the greater the severity of malnutrition and the worse the outcomes of the functional status, the higher the prevalence of mortality and the shorter the survival time. Furthermore, the same is true for the relationship between symptomatology and: the prognostic index and the survival time/mortality.
ABSTRACT - Introduction: Gastrointestinal cancer (GC) is one of the most frequently diagnosed types of cancer worldwide and has a high mortality rate. The diagnosis of most gastrointestinal tumors is usually late, leading to locally advanced and metastatic stages that presuppose debilitating symptoms with an impact on nutritional status. Malnutrition (unintentional weight loss, malnutrition, cachexia, and sarcopenia), highly prevalent in patients with GC, reflects a poor prognosis with significant complications for the patient, including decreased functional status. These are strongly correlated with decreased survival and increased mortality. Aims and methods: Observational cohort study in patients with GC hospitalized or in a Day Hospital (DH) of the Garcia de Orta Hospital, which aims to track, assess, and associate the nutritional status (using the Nutritional Risk Screening 2002 (NRS 2002®), the Patient-Generated Subjective Global Assessment (PG-SGA©), the GLIM (Global Leadership Initiative on Malnutrition) criteria and anthropometric data) and functional (Eastern Cooperative Oncology Group (ECOG) and Karnofsky Performance Scale Index (KPSI) scales and Handgrip Dynamometry) of cancer patients and the adjacent symptoms with nutritional impact (using the PG-SGA©) and associating them with survival time/mortality. Results: 155 patients with GC (93 – Hospitalized and 62 – HD). 75.4% in stage IV of the tumor. 65.1% with a weight loss and 40.2% had a severe weight loss. 60.6% had cachexia and 73.1% had a probable diagnosis of sarcopenia. 67.1% to 71.6% are malnourished according to the GLIM and PG-SGA© criteria, respectively. 86.1% had a value of handgrip strength below the 30th percentile. 85.8% had symptoms with nutritional impact. 98.1% to 100% of malnourished patients according to the GLIM and PG-SGA© criteria, respectively, manifest symptoms. Most of them (51.4% to 55.8%, respectively) had a level 4 prognostic index and more than 80% did not survive. Conclusion: There is a relationship between nutritional and functional status and adjacent symptoms, which, in turn, correlate with the pathology prognostic index and survival time/ mortality, as the greater the severity of malnutrition and the worse the outcomes of the functional status, the higher the prevalence of mortality and the shorter the survival time. Furthermore, the same is true for the relationship between symptomatology and: the prognostic index and the survival time/mortality.
Description
Mestrado em Nutrição Clínica
Keywords
Nutrição Neoplasias gastrointestinais Desnutrição Sintomas Estado funcional Índice de prognóstico Taxa de sobrevida Nutrition Gastrointestinal cancer Malnutrition Symptoms Functional status Prognostic index Survival time
Citation
Santos IM. Estado nutricional e funcional dos doentes com cancro gastrointestinal e o impacto da sintomatologia adjacente [dissertation]. Lisboa: Escola Superior de Tecnologia da Saúde de Lisboa/Instituto Politécnico de Lisboa - Faculdade de Medicina da Universidade de Lisboa; 2022.
Publisher
Instituto Politécnico de Lisboa, Escola Superior de Tecnologia da Saúde de Lisboa