Effect of chemoradiotherapy on nutrition status of patients with nasopharyngeal cancer

We aimed to assess the effect of chemoradiotherapy on the nutritional status of patients with nasopharyngeal cancer (NPC) and to detect the risk factors for poor nutrition status in NPC patients after radiotherapy. A total of 104 NPC patients participated in this clinical observational study. Psychological distress and nutritional indicators were measured prior to chemoradiotherapy. During the course of radiation therapy, side effect symptoms were assessed weekly. At the end of radiotherapy, nutritional indicators were measured again. Logistic regression was used to identify the risk factors for poor nutritional status after radiotherapy. The values of the 9 nutritional indicators were significantly lower after radiotherapy (P < 0.001) than the initial values before treatment. After radiotherapy, 20.19% of patients had more than 10% weight loss. At a significance level of α = 0.05, the risk factors for poor nutritional status were old age (P = 0.042), female gender (P < 0.001), late stage of the disease (P = 0.013), depression (P = 0.024), high side effect score (P = 0.007), and moderate nutritional status before radiotherapy (P = 0.015). Radiotherapy affects the nutritional status of NPC patients. To prevent malnutrition during radiotherapy, nutritional assessment and intervention should be an integral part of treatment.     

Effects of Preoperative Enteral Nutrition on Postoperative Recent Nutritional Status in Patients with Siewert II and III Adenocarcinoma of Esophagogastric Junction after Neoadjuvant Chemoradiotherapy

Objective: To study the effects of preoperative enteral nutrition (EN) on postoperative recent nutritional status (PRNS) in patients with Siewert II and III adenocarcinomas of esophagogastric junction (AEG) after neoadjuvant chemoradiotherapy (NCRT).

Methods: A total of 66 patients with resectable AEG (Siewert II and III) were randomly divided into two groups. The trial group accepted oral nutrition supplementation (ONS) for 7 days before surgery while the control not.

Results: Nutrition indexes were higher in trial group after surgery whereas the opposite was true for the diamine oxidase (DAO) and d-lactate (P?<?0.05). The rate of malnutrition and nutritional risk became lower in trial group on the 8th day after surgery (P?<?0.05). Injury levels of intestinal mucosa were more severe among control group. The recent prognosis was better in trial group. For patients with or without nutritional risks at admission, the PRNS and recent prognosis were improved by preoperative EN. Logistic regression analysis suggested that preoperative EN could be an independent protective factor of PRNS.

Conclusions: Preoperative EN may improve the PRNS and recent prognosis of patients with Siewert II and III AEG after NCRT.     

Long-Term Quality of Life and Nutritional Status of Patients with Head and Neck Cancer

Disease and therapy of head and neck cancer impair quality of life (QOL). QOL varies profoundly during therapy and follow-up.

Aim: We sought to monitor QOL and nutritional status of patients before, during and after therapy (AT).

Patients and methods: This study evaluates QOL by using the EORTC-questionnaires QLQ-C30 and H&N35, body weight and plasma albumin up to two years AT.

Results: Chemoradiotherapy is the period of the most profound QOL-impairment. Postoperative QOL almost reaches preoperative levels just before adjuvant therapy and does not differ significantly from pretherapeutic QOL. Long-term QOL is not significantly deteriorated. Patients have an average weight loss of 17%. Nutritional supplements are used continuously. Xerostomia and sticky saliva are chronic symptoms that persist AT.

Conclusions: QOL is an important parameter for the evaluation of therapy success. Head and neck cancer and its therapy cause permanent xerostomia, sticky saliva and need of nutritional supplements. Adequate patient information, psychooncological counseling, analgesia and nutritional support may alleviate QOL impairment.     

Results of High-Protein,High-Calorie Oral Nutritional Supplementation in Malnourished Older People in Nursing Homes: An Observational,Multicenter, Prospective,Pragmatic Study (PROT-e-GER)

ObjectivesTo assess if the impact of oral nutritional supplements (ONS) on nutritional and functional status in malnourished older persons living in nursing homes shown by clinical trials are also found outside a trial setting.DesignObservational, multicenter, prospective, pragmatic study.Setting and ParticipantsThis study was carried out in 38 nursing homes throughout Spain. Nursing home physicians recruited consecutive residents, older than 65 years, with a diagnosis of malnutrition, when a clinical decision to start ONS had been taken after unsuccessful initial management with dietary interventions.InterventionThe participants received daily 2 bottles of an energy-rich, high-protein commercial ONS for 3 months.MeasuresPrimary outcomes were changes in nutritional status [body weight, body mass index (BMI), and Mini Nutritional Assessment-Short Form (MNA-SF)]; secondary outcomes were functional changes [Functional Ambulation Classification, Barthel index, handgrip strength, and Short Physical Performance Battery (SPPB)], as well as safety and adherence after 12 weeks of follow-up.ResultsA total of 282 residents (median age 86 years, 67% women) were included, and 244 (86.5%) completed the follow-up. At baseline, 77.3% of the participants were malnourished (BMI 19.7 kg/m², interquartile range 18.3–21.8). After 12 weeks of follow-up, participants experienced significant increases in body weight (2.6 ± 3.1 kg, 5.2 ± 5.9%), BMI (1.0 ± 1.2 kg/m²) and MNA-SF (4.0 ± 2.5 points). There were also significant improvements in functional status measured by the Barthel index, handgrip strength, SPPB, and gait speed. Good adherence was registered in 94.6% of the participants. No relevant side effects were found.Conclusions and ImplicationsImprovements in nutritional and functional status can be found when using a high-protein, high-calorie ONS in older undernourished people living in nursing homes.     

Quality of life of cancer patients at palliative care units in developing countries: systematic review of the published literature

Purpose

This systematic review aims to summarize factors that influence the quality of life (QOL) of advanced cancer patients in palliative care (PC) in developing countries. Understanding this context in developing countries milieu is necessary; however, this outcome is rarely reported.

Methods

Following the PRISMA guidelines, the electronic databases MEDLINE, Embase, CINAHL, and Web of Science were systematically searched using the search terms: QOL, cancer, PC, and names of all developing countries. Studies with less than ten subjects, qualitative or pilot studies, reviews, conference abstracts, and that reported validation of QOL questionnaires were excluded.

Results

Fifty-five studies from 15 developing countries in the African (n?=?5), Latin America and the Caribbean (n?=?10), and Asian (n?=?40) region were included in the narrative synthesis. 65.4% were cross-sectional, 27.3% were cohort studies, 7.3% were RCTs or quasi-experimental studies. Around 30 QOL factors were studied with 20 different types of QOL instruments. Advanced cancer patients who were older, married/ever married, participated in additional care within PC, used complementary and alternative medicine (CAM), and practiced spirituality/religiosity showed higher QOL score. Low educational level and high depression were associated with a lower QOL.

Conclusion

Various factors affect QOL among cancer patients in PC. Patients valued the use of CAMs; however, the quality and safety aspects should be properly addressed. Important factors that influenced the QOL score were social and spiritual support. While there is a general need to develop PC strategies further, recognizing patients’ needs should be prioritized in national cancer programs.

     

Neutrophil-lymphocyte ratio and nutritional status are clinically useful in predicting prognosis in colorectal cancer patients

Abstract

Background: Neutrophil-lymphocyte ratio (NLR) and nutritional status may provide a prognostic value in colorectal cancer (CRC). Thus, aim of this study was to evaluate the prognostic value of nutritional status and NLR in CRC patients.

Methods: A retrospective analysis was conducted in CRC patients. The independent variables were body mass index (BMI), weight loss (WL) and NLR. Logistic regression was used to estimate the odds chance of low NLR. Kaplan-Meier curves and Cox regression were used to evaluate the overall survival at 5?years old.

Results: In the 148 patients evaluated, the most prevalent nutritional status was overweight/obesity (43.2%) and 27.0% had severe WL. Sixty-seven subjects (45.3%) had NLR ≥ 3 that was associated with the lower OS (P?<?0.001). There was a higher OS for overweight/obese patients (P?=?0.002) and a lower among subjects with severe WL (P?=?0.009). The NLR ≥3 (HR: 3.639; 95% CI, 1.708–7.771) was an independent poor prognostic factor for OS. Patients without WL (HR: 0.367, 95% CI, 0.141–0.954) and classified as overweight/obesity (HR: 0.260; 95% CI, 0.106–0.639) presented better prognostic.

Conclusion: NLR, WL, BMI assessments are promising prognostic indicators in the CRC.     

The Potential Influence of Dietary Counseling on Nutritional Status and Dietary Supplement Consumption in Breast Cancer Patients: A Pilot Study

Introduction: Cancer, in particular breast cancer, is one of the leading causes of death among women. Good nutritional status contributes to the efficacy of treatment and recovery, and nutritional interventions can minimize the adverse effects of cancer therapy.

Aim: The aim of this study was to describe the potential role of dietary counseling in breast cancer patients. The impact of nutritional advice on the nutritional status of patients, the use of dietary supplements, and the knowledge of phytoestrogens were assessed.

Materials and Methods: The study was conducted between April and July 2016 in the Lublin Oncology Center on a group of 173 female patients undergoing breast cancer treatment. The patients filled out a questionnaire containing 34 open-ended and closed-ended questions. The collected data were processed in Excel and Statistica 5.0 programs, and the results were regarded as significant at P?<?0.05.

Results: The mean age of the evaluated patients was 66.8?±?11.3 years. The duration of disease was significantly correlated with the patients’ nutritional status expressed by the body mass index (P?=?0.0368). The main sources of knowledge about nutrition in cancer care were nurses (29.71%), physicians (12.31%), and nutritionists (13.78%). Patients who received nutritional advice had significantly greater knowledge about phytoestrogens (P?=?0.0001), and they were of the opinion that a diet rich in phytoestrogens was safe (P?=?0.001). More than 85% of the polled subjects used dietary supplements during treatment, and 2/3 of them did so without professional advice. In this study, 73.07% of the respondents regularly monitored their body weight. Patients who did not receive dietary advice less frequently informed their physician about weight changes.

Conclusions: The nutritional status of patients was correlated with access to nutrition and dietary advice during illness. The risk of malnutrition was minimized when patients received and understood educational materials. The patients who did not receive dietary advice more frequently overdosed on dietary supplements. Phytoestrogens were more widely used by patients who regularly attended a dietitian.     

Nutritional counseling improves quality of life and nutrient intake in hospitalized undernourished patients

ObjectiveUp to 60% of hospitalized patients are undernourished. We studied the impact of nutritional therapy on quality of life and food intake.MethodsUndernourished patients were randomized into two groups. The nutritional therapy group (NT group) received individual nutritional counseling and interventions, including oral nutritional supplements if appropriate, by a dietitian. The oral nutritional supplement group (ONS group) received oral nutritional supplements in addition to hospital meals without further instruction or counseling. Study duration was 10 to 15 d. At baseline and before discharge (time point 1) we measured energy and protein intakes and quality of life. Quality of life was measured again 2 mo after discharge (time point 2).ResultsEnergy and protein intakes increased between baseline and time point 1 in both groups (P = 0.001). The NT group (n = 18) met the energy requirements at time point 1 by 107% and of protein by 94%, the ONS group (n = 18) by 90% and 88%, respectively. Hospital meals alone did not cover the requirements. From baseline to time point 1, quality of life increased in both groups. Quality of life increased further in the NT group from time point 1 to time point 2 (P = 0.016), but not in the ONS group.ConclusionBoth interventions caused a significant increase in energy and protein intakes and quality of life. In the NT group every patient received an efficacious individualized intervention. In contrast, the 7 of 18 patients in the ONS group who did not consume ONS had no intervention at all. Therefore, undernourished patients should be counseled individually by a dietitian.     

Oral Nutritional Supplements in Adults with Cystic Fibrosis: Effects on Intake,Levels of Fat-Soluble Vitamins,and Bone Remodeling Biomarkers

Background: The use of oral nutritional supplements (ONS) is common practice in patients suffering from cystic fibrosis (CF). We aimed to describe the rate of ONS use to assess their contribution to dietary intake and to determine if they are associated with respiratory status, body composition, muscle strength, bone mineral density (BMD), bone remodeling biomarkers, and plasmatic levels of vitamins. Methods: Cross-sectional study. Patients were clinically stable adults recruited from the CF unit. A 4-day prospective dietary questionnaire was conducted; in addition to respiratory variables, body composition, and BMD (through densitometry, DXA), muscle strength (JAMAR dynamometer), fat-soluble vitamins, and bone remodeling biomarkers (vitamins A, D, and E; osteocalcin, OC; undercarboxylated osteocalcin, ucOC; degradation of the C-terminal telopeptides of type I collagen, CTX; and receptor activator of nuclear factor-kappaB ligand, RANKL) were also evaluated. Results: The study included 59 subjects with CF (57.6% female, mean age 29.3 ± 9.4 years, and BMI 22.0 ± 3.6 kg/m²). In this study, 22% (13) patients were taking ONS and presented, compared with those not taking them, significantly more total and mild exacerbations and lower BMI; moreover, they showed a significantly higher total daily calorie intake in addition to a higher consumption of carbohydrates, proteins, and lipids per kg of body weight, omega-3 fatty acids, and vitamins A, D, and E. Vitamin E plasmatic levels were significantly higher in the group on ONS, as was the case with RANKL; finally, a lower rate of vitamin D deficiency was also found. Conclusions: ONS were used by patients with worse respiratory and nutritional statuses and their use was associated with a higher intake of macro- and micronutrients and with better plasmatic levels of fat-soluble vitamins.     

Feasibility,Safety, and Beneficial Effects of MCT-Based Ketogenic Diet for Breast Cancer Treatment: A Randomized Controlled Trial Study

Abstract

The present study was aimed to evaluate the safety, tolerability, and beneficial effects of a ketogenic diet (KD) on body composition and blood parameters and survival in patients with breast cancer. In this randomized, controlled trial, 60 patients with locally advanced or metastatic breast cancer and planned chemotherapy, were randomly assigned to a group receiving KDs (n?=?30) or to a control group with standard diet (n?=?30) for 3 months. Serum biochemical parameters and body composition were analyzed at baseline, every 3 weeks and end of each arm. Compliance and safety of KD were also checked weekly. Fasting blood sugar (FBS) was significantly decreased in intervention group compared to the baseline (84.5?±?11.3 vs. 100.4?±?11.8, P?=?0.001). A significant inter-group difference was also observed for FBS level at end of intervention. There was an increasing trend in serum levels of ketone bodies in intervention group (0.007–0.92, P?<?0.001). Compared to the control group, BMI, body weight, and fat% were significantly decreased in intervention group in last visit (P?<?0.001). No severe adverse side effect was found regarding lipid profile and kidney or liver marker. Overall survival was higher in KD group compared to the control group in neoadjuvant patients (P?=?0.04). Our results suggested that chemotherapy combined with KDs can improve the biochemical parameters, body composition, and overall survival with no substantial side effects in patients with breast cancer.     

Effects of a Low-Volume,Nutrient- and Energy-Dense Oral Nutritional Supplement on Nutritional and Functional Status: A Randomized,Controlled Trial in Nursing Home Residents

ObjectivesAlthough oral nutritional supplements (ONS) are known to be effective to treat malnutrition in the elderly, evidence from nursing home populations, including individuals with dementia, is rare, especially with regard to functionality and well-being. A known barrier for ONS use among elderly is the volume that needs to be consumed, resulting in low compliance and thus reduced effectiveness. This study aimed to investigate the effects of a low-volume, energy- and nutrient-dense ONS on nutritional status, functionality, and quality of life (QoL) of nursing home residents.DesignRandomized controlled intervention trial.SettingSix nursing homes in Nürnberg and Fuerth, Germany.ParticipantsNursing home residents affected by malnutrition or at risk of malnutrition.InterventionRandom assignment to intervention (IG) and control group (CG), receiving 2 × 125 mL ONS (600 kcal, 24 g protein) per day and routine care, respectively, for 12 weeks.MeasurementsNutritional (weight, body mass index [BMI], upper arm and calf circumferences, MNA-SF) and functional parameters (handgrip strength, gait speed, depressive mood [GDS], cognition [MMSE], activities of daily living [Barthel ADL]) as well as QoL (QUALIDEM) were assessed at baseline (T1) and after 12 weeks (T2). ONS intake was registered daily and compliance calculated.ResultsA total of 77 residents (87 ± 6 y, 91% female) completed the study; 78% had dementia (MMSE <17) and 55% were fully dependent (ADL ≤30). Median compliance was 73% (IQR 23.5%–86.5%) with median intake of 438 (141–519) kcal per day. Body weight, BMI, and arm and calf circumferences increased in the IG (n = 42) and did not change in the CG (n = 35). Changes of all nutritional parameters except MNA-SF significantly differed between groups in favor of the IG (P < .05). GDS, handgrip strength, and gait speed could not be assessed in 46%, 38%, and 49% of participants at T1 and/or T2, because of immobility and cognitive impairment. In residents able to perform the test at both times, functionality remained stable in IG and CG, except for ADLs, deteriorating in both groups. From 10 QoL categories, “positive self-perception” increased in IG (78 [33–100] to 83 [56–100]; P < .05) and tended to decrease in CG (100 [78–100] to 89 [56–100]; P = .06), “being busy” significantly dropped in CG (33 [0–50] to 0 [0–50]; P < .05).ConclusionLow-volume, nutrient- and energy-dense ONS were well accepted among elderly nursing home residents with high functional impairment and resulted in significant improvements of nutritional status and, thus, were effective to support treatment of malnutrition. Assessment of function was hampered by dementia and immobility, limiting the assessment of functionality, and highlighting the need for better tools for elderly with functional impairments. ONS may positively affect QoL but this requires further research.     

Effect of Sit-to-Stand Exercises Combined With Protein-Rich Oral Supplementation in Older Persons: The Older Person's Exercise and Nutrition Study

ObjectivesNursing home (NH) residents are often undernourished and physically inactive, which contributes to sarcopenia and frailty. The Older Person's Exercise and Nutrition Study aimed to investigate the effects of sit-to-stand exercises (STS) integrated into daily care, combined with a protein-rich oral nutritional supplement (ONS), on physical function, nutritional status, body composition, health-related quality of life, and resource use.DesignResidents in 8 NHs were randomized by NH units into an intervention group (IG) or a control group (CG) (n = 60/group). The IG was a combination of STS (4 times/day) and ONS (2 bottles/day providing 600 kcal and 36 g protein) for 12 weeks.Setting and ParticipantsThe participants resided in NH units (dementia and somatic care), were ≥75 years of age, and able to rise from a seated position.MethodsThe 30-second Chair Stand Test was the primary outcome. Secondary outcomes were balance, walking speed, dependence in activities of daily living, nutritional status and body composition, health-related quality of life, and resource use.ResultsAltogether, 102 residents (age 86 ± 5 years, 62% female) completed the study. No improvement in the physical function assessments was observed in the IG, whereas body weight increased significantly (2.05 ± 3.5 kg, P = .013) vs the CG. Twenty-one (of 52) participants with high adherence to the intervention (ie, at least 40% compliance to the combined intervention) increased their fat free mass (2.12 kg (0.13, 4.26 interquartile range), P = .007 vs CG). Logistic regression analyses indicated that the odds ratio for maintained/improved 30-second Chair Stand Test was 3.5 (confidence interval 1.1, 10.9, P = .034) among the participants with high adherence compared with the CG.Conclusions/ImplicationsTwelve-week intervention of daily STS combined with ONS in NH residents did not improve physical function, but increased body weight. Subgroup analyses indicated that high adherence to the combined intervention was associated with maintained or improved physical function and a gain of fat free mass.     

Nutrition intervention program for the management of iron‐deficiency anemia in a group of pregnant women in Jordan

The impact of a nutrition education intervention program on the prevention of iron deficiency anemia in a group of pregnant Jordanian women was evaluated. The program was based on planned meals from local food sources in combination with nutritional counseling as an alternative approach to more costly iron supplementation.

Data on dietary intake, anthropometric measures, iron status indices and nutrition knowledge were used in evaluation of program effectiveness.

The treatment group showed increased nutrition knowledge, more adequate nutrient intake, normal weight gain and better iron status than the control group, which received only usual care including limited nutrition counseling.

Results of the study indicate the feasibility of the nutrition intervention program in the management of iron‐deficiency and prevention of anemia in women from communities of low socio‐economic status.     

Nutritional status among patients with hip fracture in relation to pressure ulcers

BACKGROUND & AIMS: Patients with a hip fracture often have a poor nutritional status that is associated with increased risk of complications, morbidity and mortality. The aim of this study was to investigate the effects of an improved care intervention in relation to nutritional status and pressure ulcers. An intervention of best practices for patients with hip fracture was introduced, using the available resources effectively and efficiently with a not too complicated or expensive intervention. METHODS: A quasi-experimental study of 478 patients consecutively included between April 1, 2003 and March 31, 2004. A new evidence-based clinical pathway was introduced on October 1, 2003. The results from the first 210 patients in the control group and the last 210 patients in the intervention group are presented in this article. RESULTS: The total number of patients with a hospital-acquired pressure ulcer was in the intervention group, 19 patients, and in the control group, 39 patients (p = 0.007). No patient younger than 65 years developed a pressure ulcer. There were no statistical significant differences between the groups with respect to blood biochemical variables at inclusion. Patients in the control group had higher arm muscle circumference (AMC) (p = 0.05), calf circumference (CC) (p = 0.038) and body mass index (BMI) (p = 0.043) values. Abnormal anthropometrical tests of BMI, triceps skin fold (TSF) <10th percentile and AMC <10th percentile were found in 12 patients in the control group and in 4 patients in the intervention group. None of the 4 patients in the intervention group developed pressure ulcers. However, 2 of the 12 patients in the control group were affected. CONCLUSIONS: It is possible to reduce the development of hospital-acquired pressure ulcers among elderly patients with a hip fracture even though they have poor prefracture nutritional status. Results in this study indicate the value of the new clinical pathway, as number of patients who have developed pressure ulcers during their stay in hospital has been reduced by 50%.     

Effect on an Oral Nutritional Supplement with β-Hydroxy-β-methylbutyrate and Vitamin D on Morphofunctional Aspects,Body Composition,and Phase Angle in Malnourished Patients

This is a retrospective study of data from clinical practice to observe the effect of a high-calorie, high-protein oral nutritional supplement (ONS) with β-hydroxy-β-methylbutyrate (HMB) on nutritional status, body weight, and muscle-related parameters in 283 adult patients with or at risk of malnutrition under standard of care, 63% being cancer patients. They were recommended to increase physical activity and energy and protein intake from regular diet plus two servings per day of a specialized ONS enriched with HMB or standard ONS for up to 6 months. Dietary records, adherence and tolerance to ONS, nutritional status, body composition, handgrip strength, and blood analysis at the beginning and the end of the intervention were recorded. This program improved nutritional status from 100% malnourished or at risk of malnutrition at baseline to 80% well-nourished at final visit. It also increased body weight by 3.6–3.8 kg, fat-free mass by 0.9 to 1.3 kg, and handgrip strength by 4.7 to 6.2 kg. In a subgroup of patients (n = 43), phase angle (PhA), and body cell mass (BCM) increased only in the patients receiving the ONS enriched with HMB (0.95 (0.13) vs. −0.36 (0.4), and 2.98 (0.5) vs. −0.6 (1.5) kg, mean difference (SE) from baseline for PhA and BCM, respectively), suggesting the potential efficacy of this supplement on muscle health.     

The Impact of Human Papillomavirus (HPV) Associated Oropharyngeal Squamous Cell Carcinoma (OPSCC) on Nutritional Outcomes

Background: Patients undergoing (chemo) radiotherapy for oropharyngeal squamous cell carcinoma (OPSCC) are at high risk of malnutrition during and after treatment. Malnutrition can lead to poor tolerance to treatment, treatment interruptions, poor quality of life (QOL) and potentially reduced survival rate. Human papillomavirus (HPV) is now known as the major cause of OPSCC. However, research regarding its effect on nutritional outcomes is limited. The aim of this study was to examine the relationship between HPV status and nutritional outcomes, including malnutrition and weight loss during and after patients’ (chemo) radiotherapy treatment for OPSCC. Methods: This was a longitudinal cohort study comparing the nutritional outcomes of HPV-positive and negative OPSCC patients undergoing (chemo) radiotherapy. The primary outcome was nutritional status as measured using the Patient Generated-Subjective Global Assessment (PG-SGA). Secondary outcomes included loss of weight, depression, QOL and adverse events. Results: Although HPV-positive were less likely to be malnourished according to PG-SGA at the beginning of treatment, we found that the difference between malnutrition rates in response to treatment was not significantly different over the course of radiotherapy and 3 months post treatment. HPV-positive participants had significantly higher odds of experiencing >10% weight loss at three months post-treatment than HPV-negative participants (OR = 49.68, 95% CI (2.7, 912.86) p ≤ 0.01). Conclusions: The nutritional status of HPV positive and negative patients were both negatively affected by treatment and require similarly intense nutritional intervention. In acute recovery, HPV positive patients may require more intense intervention. At 3- months post treatment, both groups still showed nutritional symptoms that require nutritional intervention so ongoing nutritional support is essential.     

Disparities in women’s cancer-related quality of life by Southern Appalachian residence

Purpose

The purpose was to determine whether Appalachian residence alone or in combination with violence was linked to poorer quality of life (QOL).

Methods

Women recently diagnosed and included in either the Kentucky or North Carolina Cancer Registries were interviewed by phone between 2009 and 2015 (n?=?3320; mean age?=?56.74). Response rates were similar by state (40.1 in Kentucky and 40.9% in North Carolina). Appalachian (N?=?990) versus non-Appalachian residents (N?=?2330) were hypothesized to have poorer QOL defined as (a) lower Functional Assessment of Cancer Therapy—General (FACT-G) scores and (b) more symptoms of depression, stress, or comorbid physical conditions. Lifetime intimate partner or sexual violence was first investigated as a moderator then mediator of regional differences. Multiple analyses of covariance (MANCOVA) models were used.

Results

Violence modified the effect of Appalachian residence on poorer QOL outcomes; FACT-G total scores (p?=?.02) were lowest for women living in Appalachia who had additionally experienced violence. Socioeconomic indicators appeared to mediate or explain differences in QOL outcomes by Appalachian residence such that when adjusting for income, education and insurance, Appalachian residence remained associated only with poorer physical QOL outcomes (p?<?.05).

Conclusions

While violence rates did not differ by residence, the combined effect of living in Appalachia and experiencing violence resulted in significantly greater impact on poorer QOL among women recently diagnosed with cancer. Clinical consideration of patients’ residence, socioeconomic status and violence experienced may help identify and mitigate the longer-term impact of these identifiable factors associated with poorer QOL.

     

Nutritional Status and Osteoporotic Fracture Rehabilitation Outcomes in Older Adults

Abstract

To determine the impact of nutritional status and risk factors for undernutrition based on the changes in functional outcomes and rehabilitation success, defined as the ability of older adults to return as close as possible to their original functional state. Retrospective cohort study among 107 rehabilitation patients, aged ≥65 y. Data included demographics, Functional Independence Measure (FIM), Short Nutritional Assessment Questionnaire (SNAQ), reported weight, Mini-Mental Status Examination (MMSE), and Cumulative Illness Rating-Scale for Geriatrics (CIRS-G). Rehabilitation success was determined by delta-FIM. Higher vs. lower functioning patients were younger, had shorter hospitalization, and lower CIRS-G score with higher mean MMSE. Delta-FIM was significantly higher in patients with low malnutrition risk (SNAQ): 14.2?±?10.5 vs. 6.9?±?13.9 in undernourished patients, those who did not lose weight 14.5?±?10.5 vs. 5.6?±?12.8 in patients who lost weight with normal dietary intake, normal albumin, and lower CIES-G. Patients who achieved functional independence, FIM_DC ≥90, ate normally and experienced less “appetite loss” [40.5% vs. 68.4%; P?=?0.048]. Weight loss was the strongest negative predictor of delta-FIM (B?=?–9.094; P?=?0.007). To conclude, nutritional status, mainly weight change, is an independent negative predictor for rehabilitation success.     

Comprehensive Care Improves Physical Recovery of Hip-Fractured Elderly Taiwanese Patients With Poor Nutritional Status

ObjectivesThe effects of nutritional management among other intervention components have not been examined for hip-fractured elderly persons with poor nutritional status. Accordingly, this study explored the intervention effects of an in-home program using a comprehensive care model that included a nutrition-management component on recovery of hip-fractured older persons with poor nutritional status at hospital discharge.DesignA secondary analysis of data from a randomized controlled trial with 24-month follow-up.SettingA 3000-bed medical center in northern Taiwan.ParticipantsSubjects were included only if they had “poor nutritional status” at hospital discharge, including those at risk for malnutrition or malnourished. The subsample included 80 subjects with poor nutritional status in the comprehensive care group, 87 in the interdisciplinary care group, and 85 in the usual care group.InterventionsThe 3 care models were usual care, interdisciplinary care, and comprehensive care. Usual care provided no in-home care, interdisciplinary care provided 4 months of in-home rehabilitation, and comprehensive care included management of depressive symptoms, falls, and nutrition as well as 1 year of in-home rehabilitation.MeasurementsData were collected on nutritional status and physical functions, including range of motion, muscle power, proprioception, balance and functional independence, and analyzed using a generalized estimating equation approach. We also compared patients' baseline characteristics: demographic characteristics, type of surgery, comorbidities, length of hospital stay, cognitive function, and depression.ResultsPatients with poor nutritional status who received comprehensive care were 1.67 times (95% confidence interval 1.06–2.61) more likely to recover their nutritional status than those who received interdisciplinary and usual care. Furthermore, the comprehensive care model improved the functional independence and balance of patients who recovered their nutritional status over the first year following discharge, but not of those who had not yet recovered.ConclusionsAn in-home program using the comprehensive care model with a nutritional component effectively improved the nutritional status of hip-fractured patients with poor nutrition. This comprehensive care intervention more effectively improved recovery of functional independence and balance for patients with recovered nutritional status.