Malnutrition is one of the most common disorders observed in patients who are being treated for various diseases. In cancer patients with a palliative profile, compared with patients without malignant neoplasms, anemia, lymphopenia, decreased glomerular filtration rate were significantly more often detected, and a tendency to lower albumin levels was revealed. There was a significant decrease in PNI, BMI, shoulder circumference, thickness of the skin‑fat fold of the scapula and shoulder, and a tendency to reduce lean body weight in patients with palliative malignancies. The logistic regression analysis revealed the relationship between the presence of a malignant tumor in palliative patients and the presence of trophic status disorders: PNI (β = –0.37, p = 0.021), weight (β = –0.41, p = 0.001), BMI (β = –0.36, p = 0.001), shoulder circumference (β =–0.65, p = 0.001), thickness of the scapular skin‑fat fold (β = –0.66, p = 0.001).
Introduction. Nutritional status disorders are common among cancer patients. These disorders significantly reduce the quality of life and worsen the prognosis. Objective: to assess the prevalence of trophic insufficiency in palliative care cancer patients.Materials and methods. An observational, analytical, single-stage (crosssectional) study was conducted, which included 106 cancer patients of a palliative profile. The patients underwent laboratory and instrumental examination, a comprehensive assessment of the trophic status. Results. 77 (72.6%) of the examined patients showed signs of nutritional deficiency. Signs of hypotrophy were found in 19 patients. Hypotrophy of the III degree was not detected in any of the cases, of the II degree — in 4 patients, of the I degree — in 15 patients. Normal or elevated body mass index in some cases is associated with a violation of the nutritional status. A detailed study of the trophic status in cancer patients with palliative profile showed a different significance of each criterion studied. The study of the level of total protein (χ²=1.07, p=0.348), albumin (χ² =7.42, p=0.006), the number of peripheral blood lymphocytes (χ²=12.61, p=0.0004) allowed more often to diagnose a violation of the nutritional status in comparison with somatometric indicators (χ² =2.07, p=0.153) and the value of transferin (χ² =1.07, p=0.348). The study of variants of the combination of reduced indicators of nutritional status in the examined group of patients showed that the use of one criterion in isolation from other clinical and laboratory indicators will lead to underdiagnosis and underestimation of the severity of trophic disorders.Conclusion. In cancer patients with a palliative profile, nutritional disorders are detected with a high frequency. Somatometric indicators of nutritional status do not fully reflect the presence of trophic disorders. A decrease in the level of albumin, total protein, and the number of peripheral blood lymphocytes makes it possible to more often diagnose a violation of the nutritional status in the studied group of patients. However, none of the criteria for nutritional insufficiency can be used in isolation.
Aim. To study the relationship between the symptoms of nutritional insufficiency and systemic inflammation in cancer palliative patients. Methods. 106 palliative cancer patients were examined at Chelyabinsk Regional Clinical Center of Oncology and Nuclear Medicine: 54 (50.9%) men and 52 (49.1%) women aged 61 [54; 67] years. All patients underwent laboratory and instrumental examination within the approved standards of specialized medical care. Systemic inflammation was assessed by the levels of acute phase proteins (C-reactive protein, fibrinogen). The study of integrated clinical and laboratory, somatometric parameters was carried out. The nutritional risk index was assessed. Results. Palliative cancer patients showed a statistically significant decrease in the concentration of hemoglobin, lymphocytes, and albumin. The activation of systemic inflammation that manifested by hyperfibrinogenemia and an increase in the level of C-reactive protein was revealed. The study of somatometric parameters revealed a statistically significant decrease in body mass index, shoulder circumference, subscapular skinfold thickness, and a tendency to reduce lean body mass. The nutritional risk index assessment showed mild nutritional insufficiency in 22 (20.8%) of the examined patients and severe nutritional insufficiency in 28 (26.4%) patients. The maximum diagnostic significance of the level of C-reactive protein for prediction the nutritional insufficiency was achieved at 80.4% sensitivity and 52.7% specificity (AUC=0.671, 95% confidence interval [0.573; 0.759], p=0.001), which corresponded to a C-reactive protein threshold of 31 mg/l. Conclusion. 50 (47.2%) of the examined patients showed signs of nutritional insufficiency, a statistically significant decrease in hemoglobin and albumin concentration, as well as lymphocyte count, activation of systemic inflammation, manifested by hyperfibrinogenemia, and an increase in the level of C-reactive protein; it was revealed a statistically significant relationship between C-reactive protein level and malnutrition.
Introduction. Palliative care is aimed at maintaining and improving the quality of life of the patient. Without taking into account the psychosocial aspects, psychological rehabilitation is impossible in the conditions of a psychotraumatic situation of the disease.The aim of the study was to assess the psychoemotional state of polymorbid palliative cancer patients.Materials and methods. An observational, analytical, single-stage (cross-sectional) study was conducted, which included 74 cancer patients of a palliative profile. The patients underwent laboratory and instrumental examination. The following tests were evaluated: resilience (S. Maddy's method, D. A. Leontiev's adaptation), life-sense orientations, the level of subjective control, C. D. Spielberger, the severity of chronic pain syndrome; the value of the Charlson comorbidity index, the Karnovsky index (ECOG) was calculated.Results. The level of the comorbidity index was 3 [2; 5] points, the intensity of chronic pain syndrome-2 [2; 3] points, ECOG-2 [2; 3] points. In polymorbid cancer palliative patients, the presence of a belief in the impact of the struggle on the outcome of what is happening was revealed, however, patients are not always ready to act in a difficult situation. In the examined group, signs of dissatisfaction with their life in the present prevailed, the lack of sufficient freedom of choice, the existence of hope for recovery as a result of the actions of others, primarily doctors. The average (and in some cases high) level of situational and personal anxiety was noted. The association of the comorbidity index and the indicators of the life-meaning orientations test; the indicator of the general internality scale and the ECOG value; the glomerular filtration rate and the indicator of resilience, risk acceptance was revealed. A number of correlations between the indicators of the psychoemotional state and laboratory parameters (the level of hemoglobin, albumin, iron, C-reactive protein) were noted.Conclusion. In cancer patients with a palliative profile, signs of mental maladaptation were revealed. The average (and in some cases high) level of situational and personal anxiety was noted. The revealed number of correlations focuses on the role of chronic non-communicable diseases in aggravating the psychoemotional status of chronic polymorbid cancer palliative patients.
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