RESUMEN

Malnutrition among colorectal cancer patients can impair quality of life and decrease survival. This study evaluated the nutritional status of colorectal cancer patients and its association with quality of life among Filipino colorectal cancer patients seen in a tertiary hospital. A cross-sectional study was conducted among colorectal cancer patients seen at the Philippine General Hospital between December 1, 2019 and February 28, 2020. Nutritional status was evaluated using the Subjective Global Assessment, while quality of life was assessed using the EORTC QLQ-C30. Descriptive statistics, ANOVA and logistic regression were employed for analysis. Among 292 patients, malnutrition was noted in 76.4%. Stage III cancer had a higher odds for malnutrition (OR (odds ratio) = 6.22, 95% confidence interval (CI): 1.59, 24.42). Patients who received or were currently receiving chemotherapy were less likely to develop malnutrition (OR = 0.35, 95% CI: 0.18-0.69). Global health status and all functional subscale scores for the severely malnourished group were lower while the scores for symptom scales increased with the degree of malnutrition. There was a high prevalence of malnutrition among colorectal cancer patients and this was associated with poor quality of life. Future directions emphasizing early nutritional screening and assessment are recommended.

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Small bowel cancers are rare tumors with an incidence 50-100-fold less than colorectal cancer. These tumors carry a poor prognosis. Owing to its rarity, treatment of this disease, particularly in its advanced stages, has not been optimized and is derived mainly from treatment regimens for colorectal cancer. Based on recent studies bevacizumab, an antibody directed against vascular endothelial growth factor and used in the management of metastatic CRC, has been added to treatment guidelines for metastatic small bowel adenocarcinoma. We investigate in this review the evidence behind other targeted treatments that may be beneficial in the treatment of metastatic small bowel adenocarcinoma. These are agents against EGFR, VEGFR-2, HER2, and NTRK as well as immune checkpoint inhibitors. The last class of drugs appears to hold the greatest promise based on the preponderance of evidence supporting its use. However, overall data remains sparse. Results of studies currently underway will be valuable in shedding more light on the management of this aggressive cancer.

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Taking care of patients with chronic, terminal diseases presents unique challenges to the mental health of medical oncologists. The current coronavirus disease 2019 (COVID-19) pandemic has exacerbated these mental health risks brought about by isolation and exhaustion. Delegated to be a national COVID-19 referral centre, the University of the Philippines-Philippine General Hospital faced many challenges, including the increased workload in a perilous and anxiety-inducing national crisis which placed the entire healthcare team in an unprecedented situation. To adapt to these challenges, the Division of Medical Oncology employed the following measures to safeguard the mental health of its faculty and fellows: 1) use of psychological support materials; 2) initiation of a psychological intervention programme and 3) establishment of peer support programmes. Caring for the carers through evidence-based interventions ensures the delivery of quality care to our cancer patients despite the challenges during these trying times.