Procjena nutritivnog rizika bolesnika tijekom sustavnog antineoplastičnog liječenja

This study aims to explore if there is a change in nutritional risk and body mass index (BMI) in cancer patients during the systemic antineoplastic treatment. We retrospectively analyzed data collected from 216 cancer patients treated at the Department of Medical Oncology, University Hospital for tumors, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia, with systemic antineoplastic therapy in the period from 05/2016 to 05/2018. In our study, we included both patients treated with systemic therapy for the first time and patients treated repeatedly (only patients who have had at least six months free period after the last treatment course were eligible). We included male and female patients with breast cancer, colorectal cancer, pancreatic cancer, and head and neck cancer. Around 75% of patients had metastatic disease. We analyzed data collected from Nutritional Risk Score-2002 (NRS-2002) screening and results of BMI, at first hospitalization, and after three months of systemic antineoplastic treatment. All patients at high nutritional risk (NRS 3-4) received the nutritional intervention, which included enteral nutritional supplement and education of patient and patient’s family about nutrition in oncological patients. We used the Wilcoxon test for the NRS score and t-test for a depended variable for BMI data. The initial average BMI of all patients was 26,45 kg/m². Of all screened patients, around 78% of them were at mild nutritional risk (NRS 1-2), while around 22% of them were at high nutritional risk (NRS 3-4). We recorded a statistically significant decrease both in NRS of the entire screened population of patients after three months of systemic antineoplastic treatment and after specific nutritional intervention in high-risk patients (most patients were at mild nutritional risk, while less than 8% of them were at high nutritional risk). There was no significant change in BMI in the observed period (average BMI was 26, 59 kg/m²). It seems, systemic antineoplastic treatment, along with early nutritional intervention with enteral nutritive supplementation and education, can significantly contribute to the decrease of the nutritional risk.Cilj ovog rada je procijeniti promjena u nutritivnom riziku i indeksu tjelesne mase (ITM) onkoloških bolesnika tijekom sustavnog antineoplastičnog liječenja. Retrospektivno su analizirani podatci 216 bolesnika koji su od 05/2016 do 05/2018 liječeni na Odjelu internističke onkologije Klinike za tumore, KBC Sestre milosrdnice, Zagreb, Hrvatska. Obuhvaćeni su bolesnici po prvi put liječeni sustavnom antineoplastičnom terapijom i/ili koji u prethodnih 6 mjeseci nisu bili liječeni niti jednim vidom onkološkog liječenja. Zastupljeni su bolesnici obaju spolova, oboljeli od raka dojke, debelog i završnog crijeva, gušterače te glave i vrata. Oko 75% bolesnika imalo je metastatsku bolest. Korišteni su rezultati NRS 2002 nutritivnog probira te rezultati indirektne procjene sastava tijela izračunom indeksa tjelesne mase (ITM) prilikom prve hospitalizacije te nakon 3 mjeseca sustavnog antineoplastičnog liječenja. U svih bolesnika koji su bili u visokom nutritivnom riziku (NRS 3-4) je provedena nutritivna intervencija uvođenjem enteralne prehrane te edukacije bolesnika i obitelji o prehrani onkoloških bolesnika. Za statistički izračun su korišteni Wilcoxonov test za podatke o NRS-u te t-test za zavisne uzorke za podatke o ITM-u. Inicijalni prosječni ITM je na početku liječenja bio 26,45 kg/m². Inicijalnim nutritivnim probirom je utvrđen blagi nutritivni rizik (NRS 1-2) u oko 78% bolesnika, a oko 22% bolesnika je bilo u visokom nutritivnom riziku (NRS 3-4). Nakon 3 mjeseca specifičnog onkološkog liječenja te provođenja nutritivne potpore u visoko ugroženih bolesnika, zabilježen je statistički značajan pad u nutritivnom riziku u ukupnoj ispitivanoj populaciji (većina bolesnika je bila u blagom nutritivnom riziku, dok je manje od 8% bolesnika bilo visokog nutritivnog rizika). U periodu praćenja nije bila zabilježena značajnija promjena u indeksu tjelesne mase (prosječni ITM je bio 26,59 kg/m²). Sustavno antineoplastično liječenje uz ranu nutritivnu intervenciju i edukaciju doprinosi smanjenju znakova bolesti i poboljšanju općeg stanja bolesnika te može značajno smanjiti nutritivni rizik