RESUMEN
One-third of cancer pain patients do not experience adequate pain relief using analgesic ladder by the World Health Organization. Interventional procedures, such as epidural morphine, have been considered. This study aimed to review the literature comparing the effects of epidural administration of morphine with the oral route. This systematic review included randomized controlled trials (RCTs) conducted with patients with gastrointestinal neoplasm. A search was conducted on PubMed, EMBASE, Web of Science, Scopus, Cochrane Library, and CINAHL databases to identify studies published up to May 2023. The retrieved study was evaluated using the Risk of Bias 2 (RoB 2) tool and qualitatively synthesized. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach (Prospero: CRD42021264728). Only one RCT, a crossover trial, was included in this systematic review. The study was conducted with ten participants (one withdrawal) and reported a statistically significant difference between both subcutaneous and epidural morphine solutions and oral morphine. The adverse events were not described. The included study presents some concerns of bias and low certainty of evidence on the effectiveness and security of epidural morphine administration. The available literature does not suffice to elucidate whether morphine administration via the epidural route is more effective than other routes. Further RCTs are necessary to improve the level of evidence on the effectiveness and risk-benefit of epidural morphine in the management of cancer pain in gastrointestinal neoplasm patients.
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Analgesia Epidural , Analgésicos Opioides , Dolor en Cáncer , Neoplasias Gastrointestinales , Morfina , Ensayos Clínicos Controlados Aleatorios como Asunto , Humanos , Administración Oral , Analgesia Epidural/métodos , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/efectos adversos , Analgésicos Opioides/uso terapéutico , Dolor en Cáncer/tratamiento farmacológico , Neoplasias Gastrointestinales/tratamiento farmacológico , Neoplasias Gastrointestinales/complicaciones , Morfina/administración & dosificación , Morfina/uso terapéutico , Morfina/efectos adversos , Resultado del TratamientoRESUMEN
BACKGROUND & AIMS: Obesity and non-alcoholic fatty liver disease (NAFLD) are known risk factors for gastrointestinal (GI) cancers. However, GI carcinogenesis in lean NAFLD patients remains unclear. This systematic review and meta-analysis aims to investigate the association between lean NAFLD and GI cancer risk. METHODS: PubMed, Embase and Cochrane Library databases were systematically searched (from inception date to April 2023) for cohort studies assessing GI cancers in lean (body mass index [BMI] < 25 kg/m2 or < 23 kg/m2 in Asians) and non-lean (BMI ≥25 kg/m2 or ≥ 23 kg/m2 in Asians) NAFLD individuals. Data from eligible studies were extracted, and meta-analysis was carried out using a random effects model to obtain risk ratios (RRs) with 95% confidence intervals (CIs). Subgroup analyses, meta-regressions and sensitivity analyses were also performed. This study was registered in PROSPERO (CRD42023420902). RESULTS: Eight studies with 56,745 NAFLD individuals (11% were lean) and 704 cases of incident GI cancers were included. Lean NAFLD was associated with higher risk of hepatic (RR 1.77, 95% CI 1.15-2.73), pancreatic (RR 1.97, 95% CI 1.01-3.86) and colorectal cancers (RR 1.53, 95% CI 1.12-2.09), compared to non-lean NAFLD. No significant differences were observed for oesophagus, gastric, biliary and small intestine cancers. CONCLUSIONS: This study shows that lean NAFLD patients have an increased risk of liver, pancreatic and colorectal cancers compared to non-lean NAFLD patients, emphasizing the need to explore tailored cancer prevention strategies for this specific patient group. Further research is required to explore the mechanisms underlying the association between lean NAFLD and specific GI cancers.
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Neoplasias Colorrectales , Neoplasias Gastrointestinales , Enfermedad del Hígado Graso no Alcohólico , Humanos , Enfermedad del Hígado Graso no Alcohólico/complicaciones , Enfermedad del Hígado Graso no Alcohólico/epidemiología , Factores de Riesgo , Neoplasias Gastrointestinales/epidemiología , Neoplasias Gastrointestinales/complicaciones , Neoplasias Colorrectales/complicacionesRESUMEN
OBJECTIVE: to associate the presence and grading of adverse dermatoneurological events (peripheral neuropathy and hand-foot syndrome) and the interference in the activities of daily living of patients with gastrointestinal neoplasms undergoing systemic antineoplastic treatment. METHOD: this is a longitudinal, prospective study, using instruments to assess hand-foot syndrome and peripheral neuropathy. RESULTS: there were 36 patients: 66.7% diagnosed with colon cancer and 83.2% on combination therapy. From cycle 5 onwards, all of them had hand-foot syndrome, with a majority of grade 1, unrelated to interference in activities of daily living. Regarding peripheral neuropathy, there was a moderate to strong correlation from cycle 1 of treatment. CONCLUSION: peripheral neuropathy negatively affects activities of daily living. The monitoring of dermatoneurological events by oncology nurses contributes to the clinical practice of nursing and subsidizes the development of advanced practice in the country.
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Neoplasias Gastrointestinales , Síndrome Mano-Pie , Humanos , Actividades Cotidianas , Estudios Prospectivos , Neoplasias Gastrointestinales/complicaciones , Neoplasias Gastrointestinales/tratamiento farmacológico , Terapia CombinadaRESUMEN
OBJECTIVES: This study was aimed to analyse the effect of a patient-oriented modality of physical exercise (programmed and directed physical exercise (PDPE)) on cancer-related fatigue (CRF) and quality of life (QoL). The secondary aim was to evaluate changes in body composition and skeletal muscle function during the study in patients with and without PDPE. METHODS: A prospective randomised study was conducted to analyse the impact of PDPE on CRF and QoL. Patients were selected before the development of CRF to set the intervention before its appearance. A high probability CRF population was chosen: patients with advanced gastrointestinal cancer undergoing chemotherapy with weight loss (≥5%) over the last 6 months. PDPE consisted of a programme of exercise delivered weekly and adjusted to patients' medical conditions. Four visits were planned (weeks 0, 4, 8 and 12). QoL, CRF, body composition and skeletal muscle function were evaluated in each visit. RESULTS: From 101 patients recruited, 64 were considered evaluable, with three or four visits completed (n=30 control, n=34 PDPE group). Satisfactory compliance of ≥50% to the PDPE programme was seen in 47%. A reduction in the severity of fatigue was detected in the PDPE group (p=0.019), being higher in the subgroup of satisfactory compliance (p<0.001). This latter group showed better results of QoL in comparison with the control group (p=0.0279). A significant increase in endurance was found in the PDPE group (p<0.001). CONCLUSION: PDPE reduced the severity of fatigue and improved QoL. The difference in endurance would explain the results seen in the severity of fatigue.
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Neoplasias Gastrointestinales , Calidad de Vida , Humanos , Estudios Prospectivos , Ejercicio Físico , Neoplasias Gastrointestinales/complicaciones , Neoplasias Gastrointestinales/tratamiento farmacológico , Fatiga/etiologíaRESUMEN
OBJECTIVE: To determine the factors for failure of endoscopic ureteric stenting in patients with malignant ureteric obstruction. METHODS: We performed a search strategy in the Medical Literature Analysis and Retrieval System Online (MEDLINE), the Excerpta Medica dataBASE (EMBASE), the Literatura Latino-Americana e do Caribe em Ciências da Saúde database (LILACS), and the Cochrane Central Register of Controlled Trials (CENTRAL) databases. We included patients with malignant ureteric obstruction, who had a JJ catheter insertion. The studies reported the percentage of failure and risk factors, e.g. bladder invasion or deformity of the trigone, hydronephrosis, renal failure, previous radiotherapy, age, obstruction aetiology, and patient's health status. We performed a meta-analysis using R software ('meta' and 'metafor' libraries). RESULTS: We included nine studies that met the inclusion criteria, with 761 patients and an average age of 60.5 years. The studies assessed the time to failure during the first 30 days. The reported failure rate was 32% (95% confidence interval [CI] 21-45%; I2 = 88%). Regarding risk factors for failure, bladder invasion or deformity of the trigone had a hazard ratio (HR) of 4.8 (95% CI 1.28-8.5; I2 = 97.4%); severe hydronephrosis had a HR of 3.92 (95% CI 0.32-7.52; I2 = 93.9%); and age <65 years had a HR of 0.93 (95% CI 0.8-0.9; I2 = 0%). CONCLUSIONS: We found a high probability of failure for endoscopic urinary decompression in patients with malignant ureteric obstruction. Factors such as bladder invasion or deformity of the trigone and age >65 years had an increased risk of failure.
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Neoplasias Gastrointestinales/complicaciones , Neoplasias de los Genitales Femeninos/complicaciones , Stents , Obstrucción Ureteral/cirugía , Factores de Edad , Femenino , Humanos , Invasividad Neoplásica , Calidad de Vida , Factores de Riesgo , Stents/efectos adversos , Insuficiencia del Tratamiento , Obstrucción Ureteral/etiología , Ureteroscopía , Vejiga Urinaria/patología , Derivación Urinaria/efectos adversosRESUMEN
BACKGROUND & AIMS: The evaluation of function and muscle mass in older cancer patients is essential to reduce comorbidities. We hypothesized that Simple Questionnaire to Rapidly Diagnose Sarcopenia (SARC-F) questionnaire is useful to assessment the muscle function, but not muscle mass. Thus, the purpose of this study was to evaluate the correlation and reliability between the SARC-F and skeletal muscle mass index (SMI) in older gastrointestinal cancer patients. METHODS: A cross-sectional observational study enrolled 108 (63.55 ± 8.9 y) gastrointestinal cancer patients. The patients were evaluated using the SARC-F questionnaire and the muscle mass index (SMI). SMI was calculated using Lee's equation: the appendicular muscle mass (ASM) was divided by height. Pearson's correlation was used to examine the correlation between SARC-F and SMI. The Bland-Altman plot and Cohen's kappa coefficient were used to determine the concordance and reliability between them. Statistical difference was set at p < 0.05. RESULTS: The Bland-Altman plot showed that the difference between methods were within agreement (±1.96; p = 0.001). However, SARC-F has low concordance (κ = 0.20; standard error = 0.14) and correlation (r = -0.303; p = 0.0014) with SMI. CONCLUSION: In older cancer outpatients, we found that SARC-F has low correlation and reliability with SMI.
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Neoplasias Gastrointestinales/fisiopatología , Evaluación Geriátrica/estadística & datos numéricos , Indicadores de Salud , Sarcopenia/diagnóstico , Encuestas y Cuestionarios/estadística & datos numéricos , Anciano , Correlación de Datos , Estudios Transversales , Femenino , Neoplasias Gastrointestinales/complicaciones , Evaluación Geriátrica/métodos , Humanos , Masculino , Músculo Esquelético/fisiopatología , Reproducibilidad de los Resultados , Sarcopenia/etiología , Encuestas y Cuestionarios/normasRESUMEN
INTRODUCTION: Introduction: sarcopenia is considered a risk factor for cancer patients, as it increases mortality and post-surgical complications, and reduces response to treatment and quality of life. Objective: to identify the risk of sarcopenia by SARC-CalF, as well as the factors associated with this outcome in patients with cancer of the gastrointestinal tract (GIT) and adnexal glands. Methods: this cross-sectional study included patients with cancer of the GIT and adnexal glands, without edema or ascites, of both sexes and aged ≥ 20 years. Conventional anthropometric variables and handgrip strength (HGS) were measured. The risk of sarcopenia was assessed through the SARC-CalF questionnaire, and nutritional status by the Patient-Generated Subjective Global Assessment (PG-SGA). The data analysis was performed using the SPSS® software, 22.0, with a significance of 5 %. Results: seventy patients took part in the study. Of these, 55.7 % were female, 52.9 % were aged over 60 years, and 64.3 % were non-white. PG-SGA identified 50.0 % of patients as well-nourished and 50.0 % as having some degree of malnutrition. The prevalence of risk of sarcopenia was 28.6 %. There were different correlations between the SARC-CalF score and anthropometric variables (p < 0.05) according to life stage (adults and elderly). After a linear regression analysis the measures that most influenced the SARC-CalF score were arm circumference (AC) and adductor pollicis muscle thickness in the dominant hand (DAPMT) for adults, while for the elderly current weight and DAPTM (p < 0.05) were more relevant. Conclusion: SARC-CalF identified 28.6 % of patients at risk for sarcopenia and was associated with body weight and anthropometric variables indicative of muscle reserve in adults and the elderly.
INTRODUCCIÓN: Introducción: se considera la sarcopenia un factor de riesgo, especialmente para los pacientes con cáncer, ya que aumenta la mortalidad y las complicaciones posquirúrgicas, reduciendo la respuesta al tratamiento y la calidad de vida. Objetivo: identificar el riesgo de sarcopenia por el SARC-CalF y los factores asociados en pacientes con cáncer del tracto gastrointestinal (TGI) y las glándulas anexas. Métodos: estudio transversal descriptivo. Se incluyeron pacientes con cáncer del TGI y glándulas anexas, sin edema o ascitis, de ambos sexos y de edad ≥ 20 años. Se midieron las variables antropométricas convencionales y la fuerza de presión manual (FPM). El riesgo de sarcopenia se obtuvo mediante el cuestionario SARC-CalF y el estado nutricional mediante la valoración global subjetiva generada por el propio paciente (VGS-GP). El análisis de los datos se realizó con el software SPSS®, versión 22.0, con una significancia del 5 %. Resultados: Participaron 70 pacientes. De estos, el 55,7 % eran mujeres, el 52,9 % eran mayores de 60 años y el 64,3 % eran de etnia no caucásica (64,3 %). La VGS-GP identificó un 50,0 % de pacientes bien alimentados y un 50,0 % con algún grado de desnutrición. El riesgo de sarcopenia fue del 28,6 %. Hubo diferentes correlaciones entre el puntaje SARC-CalF y las variables antropométricas (p < 0,05) según la etapa de la vida (adultos y ancianos). Después del análisis de regresión lineal, las medidas que más influyeron en el puntaje SARC-CalF fueron la circunferencia muscular del brazo (CMB) y el espesor del músculo aductor del pulgar de la mano dominante (EMAPD) en los adultos, mientras que en los ancianos fueron el peso actual y elEMAPD (p < 0,05). Conclusión: el SARC-CalF identificó al 28,6 % de los pacientes con riesgo de sarcopenia y se asoció con el peso corporal y las variables antropométricas indicativas de reserva muscular en adultos y ancianos.
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Neoplasias Gastrointestinales/complicaciones , Desnutrición/diagnóstico , Estado Nutricional , Sarcopenia/etiología , Adulto , Anciano , Anciano de 80 o más Años , Antropometría , Brazo/anatomía & histología , Brasil , Estudios Transversales , Análisis de Datos , Femenino , Fuerza de la Mano/fisiología , Humanos , Pierna/anatomía & histología , Modelos Lineales , Masculino , Persona de Mediana Edad , Músculo Esquelético/anatomía & histología , Evaluación Nutricional , Calidad de Vida , Medición de Riesgo , Factores de Riesgo , Sarcopenia/diagnóstico , Subida de Escaleras , Encuestas y Cuestionarios , Adulto JovenRESUMEN
OBJECTIVE: The aim of this study was to evaluate the association between preoperative nutritional status and health-related quality of life (HRQoL) in patients with gastrointestinal cancer who were admitted for elective surgical treatment. METHODS: This was a cross-sectional study in which patients with a diagnosis of gastrointestinal cancer were evaluated before a surgical procedure. The nutritional assessment included subjective global assessment (SGA) and measurements of weight loss percentage, bioelectrical impedance, and functional capacity. HRQoL was evaluated by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30). Statistical analyses were performed with a significance level of 5%. The sample size was calculated based on a pilot study. RESULTS: We evaluated 132 patients, the majority of whom were men. The median age of the patients was 62 y, and the most prevalent tumors were in the colon, rectum, and anus (52.3%). The SGA highlighted the high prevalence of malnutrition (69.9%), which was confirmed by the rates of weight loss (73.8%) and the low fat-free mass index (56.8%). Malnourished patients and patients with severe weight loss had worse functional, symptom, global health and quality of life scores (P < 0.05). Malnutrition, according to the SGA, decreased physical function and role performance scores by 9 and 20 points, respectively (P < 0.05). CONCLUSION: Malnutrition, assessed by various tools, was associated with poor HRQoL of surgical patients with gastrointestinal cancer.
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Neoplasias Gastrointestinales , Desnutrición , Estudios Transversales , Femenino , Neoplasias Gastrointestinales/complicaciones , Neoplasias Gastrointestinales/epidemiología , Neoplasias Gastrointestinales/cirugía , Humanos , Masculino , Desnutrición/diagnóstico , Desnutrición/epidemiología , Desnutrición/etiología , Evaluación Nutricional , Estado Nutricional , Proyectos Piloto , Calidad de VidaRESUMEN
BACKGROUND: Birt-Hogg-Dubé syndrome (BHDS) is a rare autosomal dominant genodermatosis characterized by benign growth of the hair follicles, the presence of pulmonary cysts, spontaneous pneumothorax, and bilateral renal tumors that are usually hybrid oncocytic or multifocal chromophobe renal cell carcinoma. The diagnosis is confirmed by the presence of a pathogenic variant in the tumor suppressor folliculin (FLCN) gene mapped at 17p11.2. Although the dermatological lesions typical of BHDS are benign and only cause aesthetic concerns, and the pulmonary manifestations are controllable, the greater tendency of patients with this syndrome to present benign or malignant renal tumors, often bilateral and multifocal, makes the diagnosis of this syndrome important for the prognosis of the patients. The objective was to report the case of a patient with BHDS, without pulmonary manifestations and with hyperplastic polyposis of the gastrointestinal tract, and to perform a literature review. CASE PRESENTATION: A 60-year-old man complained of abdominal pain and diarrhoea for 2 months. Physical examination was normal except for the presence of normochromic papules in the frontal region of the face associated with hyperkeratotic and hyperchromic papules in the dorsal region. The excisional biopsies of the skin lesions indicated trichodiscomas. Esophagogastroduodenoscopy, enteroscopy, and colonoscopy showed the presence of hyperplastic polyps in the stomach, duodenum, jejunum, colon, and rectum. Computed tomography (CT) and magnetic resonance imaging (MRI) of the abdomen revealed multiple expansive solid lesions in both kidneys, with necrotic and calcified areas. Renal magnetic resonance angiography also showed a solid lesion in the right kidney measuring 5 cm in diameter and another solid lesion in the left kidney measuring 8 cm in diameter, both suggestive of renal angiomyolipoma. CT scans of the skull, chest, and temporal bones were normal. The genetic study revealed the presence of a variant of FLCN in the intron 13. CONCLUSIONS: To the best of our knowledge, this is the first reported case of BHDS with the simultaneous finding of gastrointestinal hyperplastic polyposis, which may represent a possible phenotypic expression of this syndrome that has not yet been described.
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Síndrome de Birt-Hogg-Dubé/complicaciones , Neoplasias Gastrointestinales/complicaciones , Tracto Gastrointestinal/patología , Pólipos/complicaciones , Síndrome de Birt-Hogg-Dubé/diagnóstico , Síndrome de Birt-Hogg-Dubé/genética , Diagnóstico Diferencial , Neoplasias Gastrointestinales/diagnóstico , Neoplasias Gastrointestinales/genética , Humanos , Hiperplasia/complicaciones , Hiperplasia/diagnóstico , Hiperplasia/genética , Pólipos Intestinales/complicaciones , Pólipos Intestinales/diagnóstico , Pólipos Intestinales/genética , Masculino , Persona de Mediana Edad , Neoplasias Primarias Múltiples/diagnóstico , Neoplasias Primarias Múltiples/genética , Pólipos/diagnóstico , Pólipos/genética , Proteínas Proto-Oncogénicas/genética , Proteínas Supresoras de Tumor/genéticaRESUMEN
BACKGROUND: Worsening nutritional status in older adult cancer patients can lead to sarcopenia, a condition that occurs with low quantity or quality of muscle mass associated with low physical function. However, most of the studies with cancer patients have only analyzed the quantity of muscle mass for diagnostic of sarcopenia, without exploring muscle characteristics and physical function. The purpose of the present study is to explore the associations between muscle mass characteristics and physical function in older adult patients with cancer. METHODS: Gastric older cancer patients were enrolled in a cross-sectional study. Computed tomography images of the abdominal region evaluated skeletal muscle mass using the Slice-O-Matic version 5.0 Software program (Tomovision, Montreal, Canada) to determine the parameters of skeletal muscle index (SMI, muscle quantity) and skeletal muscle radiodensity (SMD). The physical function was evaluated through handgrip strength and gait speed test. Four musculature phenotypes were identified: normal SMI and SMD, only low SMI, only low SMD, and low SMI and SMD. Linear regression analyses adjusted by age and tumor stage verified the associations between SMI, SMD and physical function. A One-Way Covariance Analysis with Bonferroni post hoc test was used to compare the physical function variables among the four different phenotypes. RESULTS: In total, 167 patients were evaluated (58.1% males; mean age 69.17⯱â¯7.97â¯years). The results showed that muscle mass characteristics explains, at least partially, the variability in handgrip strength and gait speed in a direct relationship. The phenotypes with low muscular SMI and/or SMD presented worse performances in handgrip strength and gait speed tests. When stratified for sexes, the significant difference occurs only in males. CONCLUSIONS: Low SMD has negatively impacted physical function in older adults with gastrointestinal cancer, especially in males.
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Neoplasias Gastrointestinales/complicaciones , Músculo Esquelético/diagnóstico por imagen , Sarcopenia/diagnóstico por imagen , Anciano , Estudios Transversales , Femenino , Análisis de la Marcha , Neoplasias Gastrointestinales/fisiopatología , Fuerza de la Mano , Humanos , Masculino , Persona de Mediana Edad , Músculo Esquelético/fisiopatología , Sarcopenia/etiología , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: According to the Common-Sense Model of Self-Regulation, when faced with a health threat, we make cognitive and emotional assumptions about the illness. The aims of this study were to (a) examine the role of sociodemographic and disease-specific factors on illness perception and perceived stress and (b) test the association between perceived stress and illness perception in participants diagnosed with gastrointestinal cancer. METHODS: Participants completed a battery of questionnaires including a Sociodemographic and Disease-Specific Questionnaire, the Illness Perception Questionnaire, Brief Version (Brief-IPQ), and the Perceived Stress Scale (PSS-14). Descriptive statistics, Pearson correlations, analysis of variance (ANOVA), and linear regression were performed to test the hypotheses. RESULTS: Of the 627 participants, the mean age was 62 years (SD = 11); the majority were male (63.3%) and Caucasian (90.9%). Younger (F3,625 = 5.80, P < .01) and divorced or never married participants reported higher levels of perceived stress when compared with older and married participants (F4,618 = 3.52, P < .01). Younger participants (18-74 years old) reported more negative illness perceptions than older participants (75 years and older) (F3,511 = 4.08, P < .01). A weak, positive relationship between perceived stress and illness perceptions was observed (r = 0.22, P < .01), and illness perceptions predicted 36.1% of the variance of perceived stress. CONCLUSIONS: Our findings suggest that participants who negatively perceived their illness experienced greater levels of perceived stress. Interventions that aim to adjust patients' illness perceptions in order to facilitate a reduction of stress and improvement in quality of life are needed.
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Neoplasias Gastrointestinales/psicología , Conducta de Enfermedad , Cooperación del Paciente/psicología , Calidad de Vida/psicología , Estrés Psicológico/psicología , Adaptación Psicológica , Anciano , Actitud Frente a la Salud , Femenino , Neoplasias Gastrointestinales/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Estrés Psicológico/etiología , Encuestas y Cuestionarios , Adulto JovenRESUMEN
BACKGROUND AND AIMS: Due to its high peroxidizable characteristics, n-3 fatty acids, present in fish oil, could increase tumor cells sensitivity to conventional cancer treatment while non-neoplastic cells remain unaffected, this may lead to an increase in cancer treatment response with no increase on adverse effects. The aim of this study was to evaluate anti-cancer treatment response, performance status and adverse events in gastrointestinal cancer patients supplemented with fish oil. Oxidative stress parameters were investigated in blood non-neoplastic cells as an indicator of cytotoxicity. METHODS: This is a randomized, triple-blind, placebo-controlled clinical trial. Fish oil group (FOG) received two capsules of fish oil containing 1.55 g of EPA + DHA a day for nine weeks, placebo group (PG) received two capsules containing olive oil. Baseline was set right before the administration of the first chemotherapy, oxidative stress parameters, adverse events presence and grading and performance status were assessed at baseline and after nine weeks of supplementation. Tumor markers, response to treatment and survival were evaluated at baseline and after one year of study inclusion. RESULTS: 76 patients were considered eligible, 56 were randomized, and 51 remained for analysis. After nine weeks, although there were no differences between groups for treatment response and presence of adverse events, PG patients were graded with more severe diarrhea than FOG patients (p = 0.03) and with higher (worse) performance status score (p = 0.02). No differences in lipid peroxidation and activity of antioxidant enzymes were observed between groups. CONCLUSIONS: Fish oil may lead to a better performance status for gastrointestinal cancer patients undergoing chemotherapy while does not seem to increase treatment-related toxicity. Registered under ClinicalTrials.gov Identifier no. NCT02699047, www.clinicaltrials.gov.
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Antineoplásicos/efectos adversos , Aceites de Pescado/administración & dosificación , Aceites de Pescado/uso terapéutico , Neoplasias Gastrointestinales/complicaciones , Adulto , Suplementos Dietéticos , Ácidos Grasos Omega-3/administración & dosificación , Femenino , Neoplasias Gastrointestinales/tratamiento farmacológico , Humanos , Peroxidación de Lípido , Masculino , Persona de Mediana Edad , Estado Nutricional , Estrés OxidativoRESUMEN
BACKGROUND: Chemotherapy is an effective treatment with good clinical response in patients with cancer. However, it can cause exacerbated toxicities in patients and consequently change the course of treatment. Some factors may interfere with this toxicity such as body composition, especially in gastrointestinal cancer. The aim of this study was to evaluate the effects of body composition, nutritional status, and functional capacity scale in predicting the occurrence of toxicities in gastrointestinal cancer patients during chemotherapy treatment. METHODS: This is a prospective study with gastrointestinal cancer patients at the beginning of chemotherapy treatment. Sarcopenia and muscle attenuation were assessed using the skeletal muscle index from computerized tomography by measuring cross-sectional areas of the L3 tissue (cm2 /m2 ). Cachexia was graded according to involuntary weight loss associated with sarcopenia. Nutritional status was assessed by using anthropometric evaluation and Patient-Generated Subjective Global Assessment. Functional capacity was evaluated by handgrip strength and Eastern Cooperative Oncology Group (ECOG) Performance Status scale. Haematological gastrointestinal and dose-limiting toxicities (DLTs) were defined according to National Cancer Institute Common Toxicity Criteria. The associations among sarcopenia, cachexia, nutritional status, and functional capacity with DLT were assessed by univariate and multivariate Cox regression model. RESULTS: A total of 60 patients were evaluated (55% male, 60.9 ± 14.0 years) and followed up for a mean of 55 days. Most patients had normal weight (44.2%) and good ECOG Performance Status (≤1) at baseline (78%). During the chemotherapy period, the most prevalent toxicities were diarrhoea, nausea, and anorexia, but the presence of DLT was similar between cycles (P > 0.05). Cachexia was associated with a higher toxicity manifested by diarrhoea (P = 0.02), nausea (P = 0.02), and anorexia (P < 0.01 and P = 0.03 at Cycles 1 and 2, respectively). Sarcopenic and cachetic individuals experienced more toxicities and DLT during chemotherapy. The only factors associated with DLT in the multivariate Cox regression analyses including the presence of metastasis and the chemotherapy protocol were cachexia and the ECOG scale (P < 0.001 for both). CONCLUSIONS: Cachexia and ECOG score may identify patients with an increased risk for developing severe toxicity events during chemotherapy treatment for gastrointestinal cancer.
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Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Caquexia/diagnóstico , Caquexia/etiología , Neoplasias Gastrointestinales/complicaciones , Adulto , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Índice de Masa Corporal , Brasil , Terapia Combinada , Femenino , Neoplasias Gastrointestinales/diagnóstico , Neoplasias Gastrointestinales/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Músculo Esquelético/metabolismo , Músculo Esquelético/patología , Estadificación de Neoplasias , Estado Nutricional , Estudios Prospectivos , Tomografía Computarizada por Rayos XAsunto(s)
Endoscopía Capsular/métodos , Enteroscopía de Doble Balón/métodos , Hemorragia Gastrointestinal , Neoplasias Gastrointestinales , Tracto Gastrointestinal , Nevo Azul , Escleroterapia/métodos , Neoplasias Cutáneas , Coagulación con Plasma de Argón/métodos , Niño , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/prevención & control , Neoplasias Gastrointestinales/complicaciones , Neoplasias Gastrointestinales/diagnóstico , Neoplasias Gastrointestinales/fisiopatología , Neoplasias Gastrointestinales/cirugía , Tracto Gastrointestinal/irrigación sanguínea , Tracto Gastrointestinal/diagnóstico por imagen , Tracto Gastrointestinal/cirugía , Humanos , Masculino , Nevo Azul/complicaciones , Nevo Azul/diagnóstico , Nevo Azul/fisiopatología , Nevo Azul/cirugía , Neoplasias Cutáneas/complicaciones , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/fisiopatología , Neoplasias Cutáneas/cirugía , Resultado del Tratamiento , Venas/anomalíasRESUMEN
OBJECTIVE: To verify the prevalence of patients with muscle function loss (MFL) and whether it is associated with anxiety and depression scores in gastrointestinal (GI) cancer patients. METHODS: A cross-sectional study with seventy-one adult GI cancer patients was conducted. The MFL was evaluated by the SARC-F questionnaire, and participants were divided into MFL (cut-off ≥4 SARC-F) and normal muscle function (NMF) groups (cut-off <4 SARC-F). Anxiety and depression were analyzed using the Hospital Anxiety and Depression Scale (HADS). RESULTS: From 71 patients, 25.4% (n = 18) were classified as MFL and 74.6% (n = 53) as NMF. Body weight was lower in the MFL group when compared to the NMF group (MFL: 57.6 ± 11.3 vs. NMF: 64.8 ± 11.6 kg, p = 0.032). MFL showed higher anxiety (MFL: 7.5 (0-21) vs. NMF: 2 (0-17), p = 0.030) and depression scores (MFL: 6.5 (0-13) vs. NMF: 2 (0-17), p = 0.034) compared to NMF. A positive correlation between the SARC-F and the anxiety (r = 0.34, p = 0.004) and depression score (r = 0.32, p = 0.006) was found. When adjusted by sex and body weight, MFL saw an increase with the anxiety score (OR: 1.15 95%CI(1.01-1.31), p = 0.023), but not with the depression score. In addition, LMF was responsible for anxiety in 12% of the population. CONCLUSION: In our study, 25% of GI cancer patients presented LMF and an association with the anxiety score.
Asunto(s)
Ansiedad/complicaciones , Depresión , Neoplasias Gastrointestinales/complicaciones , Músculos/fisiología , Sarcopenia/etiología , Adulto , Anciano , Anciano de 80 o más Años , Peso Corporal , Brasil , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y CuestionariosRESUMEN
BACKGROUND: The aim of the study is to clarify if a classification based on the time of occurrence of associated malignancies in GIST patients can help in the understanding of the clinical controversies observed in these patients. METHODS: We retrospectively reviewed all the patients diagnosed with GIST tumors between January 1999 and October 2016. They were divided into GIST patients associated with other tumors (A-GIST) and those not associated (NA-GIST). A-GIST patients were also divided into four types according to the proposed classification. RESULTS: Of 104 GIST patients, 32 (30.7%) (A-GIST group) had at least one additional primary malignancy. The most frequent location of the associated malignancy was the GI tract (26%). Compared to NA-GIST, A-GIST were more often asymptomatic with a lower risk of recurrence. The main cause of death in NAGIST was GIST itself, being associated tumors the main cause of death in A-GIST group. No differences were found in DFS and OS between A-GIST and NA-GIST. CONCLUSIONS: The use of the proposed classification classifies GIST patients with associated malignancies in different subtypes that differ substantially in terms of incidence, type of neoplasms associated, cause of the association and prognosis.
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Neoplasias Gastrointestinales/epidemiología , Tumores del Estroma Gastrointestinal/epidemiología , Neoplasias Primarias Múltiples/epidemiología , Femenino , Estudios de Seguimiento , Neoplasias Gastrointestinales/complicaciones , Tumores del Estroma Gastrointestinal/complicaciones , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Neoplasias Primarias Múltiples/complicaciones , Pronóstico , Estudios Retrospectivos , España/epidemiología , Tasa de SupervivenciaRESUMEN
OBJECTIVE: to evaluate the association between the nutritional and the inflammatory statuses of patients with cancer of the gastrointestinal tract undergoing surgical resection and to identify predictors of mortality in these patients. METHODS: we conducted a prospective study of 41 patients with gastrointestinal tract cancer submitted to surgery between October 2012 and December 2014. We evaluated the nutritional status by subjective and objective methods. We assessed the inflammatory response and prognosis using the modified Glasgow Prognostic Score (mGPS), Neutrophil/Lymphocyte Ratio (NLR), Onodera Prognostic Nutritional Index (mPNI), Inflammatory-Nutritional Index (INI) and C-Reactive Protein/Albumin ratio (mPINI). RESULTS: half of the patients were malnourished and 27% were at nutritional risk. There was a positive association between the percentage of weight loss (%WL) and the markers NLR (p=0.047), mPINI (p=0.014) and INI (p=0.015). Serum albumin levels (p=0.015), INI (p=0.026) and mPINI (p=0.026) were significantly associated with the PG-SGA categories. On multivariate analysis, albumin was the only inflammatory marker independently related to death (p=0.004). CONCLUSION: inflammatory markers were significantly associated with malnutrition, demonstrating that the higher the inflammatory response, the worse the PG-SGA (B and C) scores and the higher the %WL in these patients. However, further studies aimed at improving surgical outcomes and determining the role of these markers as predictors of mortality are required.
Asunto(s)
Neoplasias Gastrointestinales/cirugía , Estado Nutricional , Femenino , Neoplasias Gastrointestinales/complicaciones , Neoplasias Gastrointestinales/inmunología , Neoplasias Gastrointestinales/mortalidad , Humanos , Inflamación/etiología , Masculino , Persona de Mediana Edad , Pronóstico , Estudios ProspectivosRESUMEN
OBJECTIVE: to evaluate plasma and salivary uracil (U) to dihydrouracil (UH2) ratios as tools for predicting 5-fluorouracil systemic exposure and drug-related severe toxicity, and clinically validate the use of dried saliva spots (DSS) as an alternative sampling strategy for dihydropyrimidine dehydrogenase (DPD) deficiency assessment. METHODS: Pre-chemotherapy plasma, fresh saliva and DSS samples were obtained from gastrointestinal patients (Nâ¯=â¯40) for measurement of endogenous U and UH2 concentrations by LC-MS/MS. A second plasma sample collected during 5FU infusion was used for 5FU area under the curve (AUC) determination by HPLC-DAD. Data on toxicity was reported according to CTCAE. RESULTS: 15% of the patients developed severe 5FU-related toxicity, with neutropenia accounting for 67% of the cases. U, UH2 and [UH2,]/[U] were highly correlated between fresh and dried saliva samples (rsâ¯=â¯0.960; rsâ¯=â¯0.828; rsâ¯=â¯0.910, respectively). 5FU AUC ranged from 11.3 to 37.31â¯mgâ¯hâ¯L-1, with 46.2% of under-dosed and 10.3% over-dosed patients. The [UH2]/[U] ratios in plasma, fresh saliva and dried saliva samples were moderately correlated with 5FU AUC and adverse events grade, indicating a partial contribution of the variables to drug exposure (râ¯=â¯-0.412, rsâ¯=â¯-0.373, rsâ¯=â¯0.377) and toxicity (râ¯=â¯-0.363, rsâ¯=â¯-0.523, rsâ¯=â¯0.542). Metabolic ratios were lower in patients with severe toxicity (Pâ¯<â¯.01 salivary ratios, and Pâ¯<â¯.5 plasma ratios), and 5FU AUC were in average 47% higher in this group than in moderate toxicity. The diagnostic performance of [UH2]/[U] ratios in fresh saliva and DSS for the identification of patients with severe toxicity were comparable. CONCLUSIONS: The [UH2]/[U] metabolic ratios in plasma, fresh saliva and DSS were significantly associated with 5FU systemic exposure and toxicity degree. This study also demonstrated the applicability of DSS as alternative sampling for evaluating DPD activity.