Impact of a diet intervention program on the serum albumin concentrations, antropometrical status and quality of life of breast cancer patients receiving chemotherapy
English: Breast cancer patients receiving chemotherapy at ECOC, often present with lowered serum albumin concentrations, so much so that the lowered serum albumin concentrations first has to be treated before the next cycle of chemotherapy can be administered. The delay in chemotherapy treatment had financial, medical and emotional effects on the patients. The objective of this study was to determine the effect of an optimal energy increased protein (OEIP) dietary treatment on serum albumin concentrations, anthropometrical status and quality of life of breast cancer patients receiving chemotherapy. In a clinical trial, 27 female breast cancer patients were randomised to an experimental group (E) (n=13), receiving an individualized OEIP diet consisting of food and a nutritional supplement, or a control group (C) (n=14), receiving no dietary intervention. Baseline and three-weekly visits involved determining serum albumin concentrations; anthropometrical assessment, including body weight; BMI, MUAC, TSF, MAFA, MAMA, BF% and LM%; and the completion of a quality of life questionnaire. Both groups kept a food diary for the duration of the study. Median ages of the E-and C-groups were 52.62 and 51.19 years respectively, ranging from 29 to 59 years. Statistical analysis included, median and percentiles for continuous data, and frequencies and percentages for categorical data, with 95% CI for median differences. Due to the small sample size, nonparametric statistics were used to compare results. By taking a daily nutritional supplement, the E-group was able to consume a significantly better amount of all macro- and micronutrients. The C-group showed a median drop of 3 g/dL in serum albumin concentrations with a median end value of 36.5 g/dL, while the E-group showed a statistically significant [2; 6] median increase of 1.5 g/dL, with a median end value of 39 g/dL, suggesting that the dietary intervention had been successful in improving serum albumin concentrations over the treatment period. No statistically significant changes were noted in either the E- or C- group’s performance status scoring. The Rotterdam Quality of Life Survey found the Egroup had a significant improved quality of life scoring during Visits 5:B, compared to the C-group for the same period. Other studies have also shown an improvement in quality of life measurement after the implementation of a dietary intervention programme in cancer patients. An optimal energy diet, sufficient to maintain the patient’s ideal body weight and not actual body weight, with a protein intake of 1.04 g/kg/day was sufficient to significantly improve serum albumin concentrations, to such an extent, that chemotherapy cycles did not have to be postponed. Regardless of nutritional intake, no statistically significant changes were found in weight, BMI, MUAC, TSF, MAFA or MAMA. The E-group showed a significant increase in BF% and a decrease in LM% for the duration of the study, compared to the C-group. The increase in BF% could possibly be explained by the high-energy, increased fat intake of the E-group. Changes in protein metabolism and the increased protein needs of the body could possibly explain the changes in LM%. From this study it may be concluded that an OEIP diet is not effective in preventing LM wasting. An OEIP (1-1.5 g/kg/day) dietary intervention, is therefore recommended for breast cancer patients receiving chemotherapy. Nutritional intervention should commence at an earlier point to determine the effect of such intervention on patients’ quality of life. It is recommended that the study be repeated with a larger sample size, to confirm tendencies found in the present study and to determine the long-term effect of an OEIP diet intervention on serum albumin concentrations, the anthropometrical status, and the quality of life of breast cancer patients receiving chemotherapy.
Afrikaans: Borskankerpasiënte wat chemoterapie by ECOC ontvang, presenteer dikwels met verlaagde serumalbumienkonsentrasie, dermate dat die verlaagde serumalbumienkonsentrasie eers behandel moet word voordat die volgende siklus chemoterapie toegedien kan word, met ‘n finansiële, mediese en emosionele uitwerking op die pasiënte. Die doel van dié studie was om die uitwerking van ’n optimale energie, hoëproteïen (OEIP) (1,5 g/kg) dieetbehandeling op die serumalbumienkonsentrasies, antropometriese status en lewenskwalitieit van borskankerpasiënte wat chemoterapie ontvang, te bepaal. In ‘n kliniese ewekansigheidsproef, is 27 vroulike borskankerpasiënte ingedeel in ‘n eksperimentele groep (E) (n=13) wat ‘n geïndividualiseerde OEIP dieet, bestaande uit voedsel en ‘n voedingsaanvulling ontvang het, of in ‘n kontrolegroep (K) (n=14), met geen dieetintervensie nie. Die basislyn- en drieweeklikse besoeke het die volgende behels: die bepaling van serumalbumienkonsentrasies; antropometriese evaluering, insluitende massa, lengte, ; liggaamsmassa indeks (LMI); bo-arm-omtrek (BAO); triseps-velvou (TSV); boarm-vetarea (BAVA); bo-armspierarea (BASA); persentasie liggaamsvet (LV%); en persentasie liggaamspiere (LS%); asook die invul van ‘n lewenskwaliteitsvraelys. Beide groepe het ‘n voedseldagboek gehou vir die duur van die studie. Die mediane ouderdom van die E- en die K-groep was onderskeidelik 52.62 en 51.19 jaar, en het van 29 tot 59 jaar gewissel. Statistiese ontleding het mediane en persentiele vir voortgesette data behels, en frekwensies en persentasies vir kategoriese data, met ’n vertrouens interval (VI) van 95% vir mediaanverskille. Weens die klein steekproefgrootte is nie-parametriese statistieke gebruik om resultate te vergelyk. Pasiënte in die E-groep wat ‘n daaglikse voedingsaanvulling geneem het, het ’n statisties betekenisvolle verbeterde mikro- en makrovoedingstof inname getoon. ‘n Mediaandaling van 3 g/dL in serumalbumienkonsentrasies is vir die K-groep aangeteken, met ‘n mediaaneindwaarde van 36.5 g/dL, terwyl die E-groep ’n statisties betekenisvolle mediaanstyging [2; 6] van 1.5 g/dL getoon het, met ‘n mediaan-eindwaarde van 39 g/dL, wat daarop dui dat die dieetintervensie daarin geslaag het om die serumalbumienkonsentrasies oor die behandelingstydperk te verbeter. Geen statisties beduidende verskille is in óf die E- óf die K-groep se prestasiestatus-puntetelling bemerk nie. By gebruik van die Rotterdam Lewenskwaliteit-opname, is daar gevind dat die E-groep ‘n aanmerkbaar verbeterde lewenskwaliteit-puntetelling gedurende Besoeke 5:B aangeteken het, vergeleke met die K-groep vir dieselfde tydperk. Ander studies het ook ‘n verbetering in die gemete lewenskwaliteit getoon na die implementering van ’n dieetintervensieprogram. ’n Optimale energie dieet, wat genoegname energie voorsien om die pasiënt se ideale massa in stand te hou en nie haar werklike massa nie, met ‘n proteïeninname van 1,04 g/kg/dag was genoeg om serumalbumienkonsentrasies aansienlik te verbeter, in so ‘n mate dat dit nie nodig was om chemoterapiesiklusse uit te stel nie. Ongeag die voedingsinname, is geen statisties beduidende verskille in gewig, LMI, BAO, TSV, BAVA of BASA aangeteken nie. Die E-groep het ’n betekenisvolle toename in BF% en verlaging in LS% vir die duur van die studie getoon, vergeleke met die K-groep. Die toename in LV% kan moontlik deur die hoë energie- en verhoogde vetinname van die E-groep verduidelik word. Veranderinge in proteïenmetabolisme en die verhoogde proteïenbehoeftes van die liggaam kan moontlik die veranderings in LS% verduidelik. Uit dié studie kan die gevolgtrekking gemaak word dat ’n OEIP dieet nie LS-uittering verhoed nie. ’n OEIP (1-1.5 g/kg/dag) dieetintervensie, word aanbeveel vir borskankerpasiënte wat chemoterapie ontvang. Voedingsintervensie moet op ‘n vroeër stadium begin word om die uitwerking van sodanige intervensie op lewenskwaliteit te bepaal. Daar word aanbeveel dat die studie met ‘n groter steekproefgrootte herhaal word, om tendense wat in die huidige studie aangetref is, te bevestig en om die langtermynuitwerking van ’n OEIP dieet op serumalbumienkonsentrasies te bepaal, asook op die antropometriese status en die lewensgehalte van borskankerpasiënte wat chemoterapie ontvang.
Brachytherapy for cervical cancer : guidelines to facilitate quality patient management in a multidisciplinary environment ﻿
Long, Deirdré (University of the Free State, 2014-10)
English: This study was undertaken to establish guidelines to facilitate quality patient management for cervical cancer patients, receiving high dose rate-intracavitary brachytherapy, in a multidisciplinary environment. ...