<p>Weight loss and other nutritional problems are common in cancer patients. The problems are of importance for response to treatment and survival and the well-being of the patients.</p><p>Nutritional support can be carried out in different ways. The efforts considered in this thesis are; assessment of nutritional status to find the patients who are at risk to become or already are malnourished, assessment of dietary intake, dietary advice, information and support to the families, information and education to the caregivers, and supplementation with drugs that possibly could influence the weight development. The Swedish version of the Patient Generated Subjective Global assessment of nutritional status, PG-SGA, is useful in assessment of nutritional status in cancer patients. Dietary advice and support to patients and their families combined with information and education to the staff, at the hospital and in the home care, turned out to have a positive influence at the weight development and other parameters related to nutrition. The effects were seen in consecutive patients with small cell lung cancer in comparison with a historical control group, and in patients in a randomised trial. Fish oil and melatonin could stabilise weight development in patients with advanced gastrointestinal cancer, but had no marked influence on factors reflecting cachexia. Problems with nutrition in cancer patients are possible to recognise and various interventions may be beneficial.</p>

Weight loss and other nutritional problems are common in cancer patients. The problems are of importance for response to treatment and survival and the well-being of the patients. Nutritional support can be carried out in different ways. The efforts considered in this thesis are; assessment of nutritional status to find the patients who are at risk to become or already are malnourished, assessment of dietary intake, dietary advice, information and support to the families, information and education to the caregivers, and supplementation with drugs that possibly could influence the weight development. The Swedish version of the Patient Generated Subjective Global assessment of nutritional status, PG-SGA, is useful in assessment of nutritional status in cancer patients. Dietary advice and support to patients and their families combined with information and education to the staff, at the hospital and in the home care, turned out to have a positive influence at the weight development and other parameters related to nutrition. The effects were seen in consecutive patients with small cell lung cancer in comparison with a historical control group, and in patients in a randomised trial. Fish oil and melatonin could stabilise weight development in patients with advanced gastrointestinal cancer, but had no marked influence on factors reflecting cachexia. Problems with nutrition in cancer patients are possible to recognise and various interventions may be beneficial.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Introdução: O diagnóstico secundário mais frequente em pacientes oncológicos é a desnutrição, que pode afetar até 80% dos doentes. Evidências apontam que a desnutrição está associada a maior morbidade e mortalidade, pior resposta ao tratamento, aumento de custos hospitalares e piora da qualidade de vida. Objetivo: determinar a prevalência de desnutrição e mensurar a qualidade de vida nos pacientes oncológicos submetidos à quimioterapia na UNACON-RR. Materiais e métodos: o estudo quantitativo, tipo corte transversal, avaliou o estado nutricional dos pacientes através de métodos objetivos (IMC, percentual de gordura e área muscular do braço) e subjetivos (ANSG-PPP) e a qualidade de vida através do WHOQOL-Bref. Para caracterizar a população foram coletados dados sócioeconômicos e clínicos. Resultados: Entre os homens, os tumores do TGI foram mais prevalentes (58,5%), enquanto entre as mulheres destacou-se o de mama (52%). A maioria dos pacientes foi classificado como eutrófico (52,2%) e apenas 7,5% estavam desnutridos quando avaliados pelo IMC. Todos os pacientes com desnutrição tinham câncer do TGI, representando 24% destes. Nenhuma mulher com câncer de mama apresentou desnutrição por este método de avaliação. A avaliação pela ANSG-PPP mostrou que 70,1% dos pacientes estavam desnutridos. Dos pacientes com câncer do TGI 88% apresentaram desnutrição, enquanto 35,3% das mulheres com câncer de mama apresentaram esse diagnóstico. Quanto a qualidade de vida o domínio mais afetado foi o físico em todos os grupos de pacientes. Os pacientes bem nutridos apresentaram qualidade de vida significativamente superior aos pacientes desnutridos. Conclusão: Houve comprometimento do estado nutricional nos pacientes, sobretudo quando avaliados pela ASNG-PPP, sendo este um método mais sensível em relação aos métodos objetivos. A qualidade de vida dos pacientes apresentou-se comprometida, sobretudo no domínio físico e houve forte correlação com o estado nutricional. / Introduction: The most common secondary diagnosis in cancer patients is malnutrition, affecting up to 80% of patients. Evidences show that malnutrition is associated with increased morbidity and mortality, poorer response to treatment, increased hospital costs and poorer quality of life. Objective: To determine the prevalence of malnutrition and measure the quality of life in cancer patients undergoing chemotherapy at Unacon-RR. Materials and methods: Quantitative, cross-sectional study, assessing the nutritional status of patients through objective methods (BMI, percentage of fat and arm muscle area) and subjective methods using the PG-SGA assessment, and the quality of life WHOQOL-Bref questionnaire. Socioeconomic and clinical data were collected to characterize the population. Results: Among men, gastrointestinal tumors were more prevalent (58.5%), while among women, breasts were the prevalent site (52%). The majority of patients were classified as eutrophic (52.2%) and only 7.5% were malnourished based by their BMI. All malnourished patients had gastrointestinal cancer, representing 24% of the cases. No woman with breast cancer presented malnutrition by this method of assessment. The assessment by PG-SGA, showed that 70.1% of patients were malnourished, represented by 88% of patients with gastrointestinal cancer, and 35.3% of women with breast cancer. The quality of life assessment reveled that the most affected domain was the physical, in all groups of patients. The well-nourished patients had significantly higher quality of life than malnourished patients. Conclusion: There was compromised nutritional status in patients, especially when evaluated by PG-SGA, which turned out as a more sensitive method, compared to the other objective methods. The quality of life of patients was compromised, especially in the physical domain and there was a strong correlation with nutritional status.

Patients with liver disease have an increased risk for malnutrition because of side effects of the disease. The Nutrition Focused Physical Exam (NFPE) was developed for nutrition professionals to aid physicians in a nutrition-based diagnosis of malnutrition. The purpose of this study was to examine the NFPE for its validity in liver disease patients being evaluated for transplant. In addition, the NFPE was used to assess incidence and severity of malnutrition in end stage liver disease patients and compare these results to already developed malnutrition tools such as the Patient Generated-Subjective Global Assessment (PG-SGA), Triceps Skinfolds (TSF), Mid-Arm Circumference (MAC), Lumbar Index, and Total Psoas Muscle Area (TPA). The NFPE was found to be highly correlated with PG-SGA results. There was a weak correlation between the NFPE and the TSF, MAC, and Lumbar Index/TPA, except when comparing the bottom 25% quartile of the Lumbar Index to severe malnutrition using the NFPE. This resulted in a moderate correlation. The odds-ratio for hospital admission based on malnutrition and severe malnutrition were both extremely high (14.571, 18.857 respectively). These preliminary results reinforce the significance of the NFPE and the need for additional studies using this tool.