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Povezanost med prehranskim stanjem in kakovostjo življenja pri bolnikih z razsejanim na kastracijo odpornim rakom prostate
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Čavka, Luka
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),
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Šeruga, Boštjan
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Rotovnik Kozjek, Nada
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Abstract
UVOD: Poleg podaljšanja celokupnega preživetja je glavni cilj zdravljenja razsejanega raka prostate ohranitev ali izboljšanje z zdravjem povezane kakovosti življenj. Eden od dejavnikov, ki bi lahko vplival na posameznikovo doživljanje z zdravjem povezane kakovosti življenja, je prehransko stanje. Znano je, da ima rak negativen presnovni učinek, dodatno pa je prehransko stanje lahko prizadeto še z zdravljenjem. Pri bolnikih z razsejanim na kastracijo odpornim rakom prostate povezanost med prehranskim stanjem in z zdravjem povezano kakovostjo življenja do sedaj še ni bila poglobljeno raziskana. METODE: V raziskavo smo vključili bolnike z novougotovljenim razsejanim na kastracijo odpornim rakom prostate. Za oceno z zdravjem povezane kakovosti življenja smo uporabili standardiziran vprašalnik FACT-P (Functional Assessement of Cancer Therapy - Prostate). Prehransko stanje smo opredelili s tremi različnimi meritvami: (i) z indeksom telesne mase (ITM), (ii) z diagnozo prehranskega stanja, določenega na podlagi kliničnih in laboratorijskih parametrov ter validiranega vprašalnika za oceno prehranske ogroženosti, in (iii) s faznim kotom (FK), določenim z bioimpedančno meritvijo. Fazni kot in indeks telesne mase sta zvezni spremenljivki, diagnoza prehranskega stanja pa opisna. Ta je na podlagi strokovno dogovorjenih kriterijev zavzemala štiri različne vrednosti: normalno prehransko stanje (nPS), prehransko tveganje brez sarkopenije/kaheksije (PT), sarkopenija in kaheksija. Povezanost smo proučevali z univariatnimi in multivariatnimi regresijskimi modeli. V multivariatne modele smo vključevali še kovariate, ki bi lahko imele vpliv na z zdravjem povezano kakovost življenja pri bolnikih z napredovalim rakom prostate. Za značilne rezultate povezanosti smo šteli tiste s p-vrednostjo pod 0,05, ob tem nismo opravili prilagoditev za večkratna testiranja. REZULTATI: V raziskavo smo vključili 141 bolnikov. Njihova povprečna starost je bila 74,2 leta (standardni odklon: 7,1), 18 (12,4 %) jih je imelo visceralne metastaze. Ob vključitvi je 58 (41,6 %) imelo normalno prehransko stanje, 24 (16,8 %) je bilo prehransko ogroženih brez sarkopenije/kaheksije, pri 43 (30,8 %) bolnikih je bila ugotovljena sarkopenija in pri 16 (11,8 %) kaheksija. Izhodiščno so bile vse opredelitve prehranskega stanja povezane z izhodiščno z zdravjem povezano kakovostjo življenja, največ variabilnosti so pojasnjevale diagnoze prehranskega stanja. V multivariatnem modelu, v katerega so bile poleg drugih pojasnjevalnih spremenljivk vključene vse tri spremenljivke prehranskega stanja, so bile diagnize prehranskega stanja statistično značilno povezane z z zdravjem povezano kakovostjo življenja (PT vs. nPS: ß = –13,31, p = 0,015; sarkopenija vs. nPS: ß = –11,23, p = 0,02; kaheksija vs. nPS: ß = –21,49; p = 0,005), ne pa tudi ITM in fazni kot (ß = 0,48, p = 0,28 in ß = –1,06, p = 0,66). Izhodiščni ITM ni napovedoval boljše z zdravjem povezane kakovosti življenja po 6 mesecih (OR = 1,04, p = 0,39), so pa imeli napovedno vrednost diagnoze prehranskega stanja in fazni kot (PT vs. nPS: OR = 0,29, p = 0,02; sarkopenija vs. nPS: ß = 0,71, p = 0,44; kaheksija vs. nPS: ß = 0,22; p = 0,02; in OR za FK = 1,82, p = 0,01). ITM po 6 mesecih prav tako ni kazal povezanosti z z zdravjem povezano kakovostjo življenja, ponovno pa so jo imele diagnoze prehranskega stanja po 6 mesecih in fazni kot po 6 mesecih. Prav slednja spremenljivka je pojasnila največ variabilnosti (R2 = 22,5 %). V multivariatnih modelih je obremenitev z bolečino konsistentno kazala značilno negativno napovedno vrednost za z zdravjem povezano kakovost življenja. UGOTOVITVE: Pri bolnikih z razsejanim na kastracijo odpornim rakom prostate je boljše prehransko stanje neodvisno povezano z boljšo z zdravjem povezano kakovostjo življenja. Za opredelitev prehranskega stanja je potreben klinično naravnan proces prehranske obravnave, saj ocena prehranskega stanja z ITM ne izključuje prehranske ogroženosti. Pri bolnikih z napredovalim rakom prostate bi morala prehranska obravnava predstavljati del njihovega zdravljenja.
Language:
Slovenian
Keywords:
Prehransko stanje
,
prehranska ogroženost
,
sarkopenija
,
kaheksija
,
kakovost življenja
,
rak prostate
Work type:
Doctoral dissertation
Organization:
MF - Faculty of Medicine
Year:
2021
PID:
20.500.12556/RUL-128330
COBISS.SI-ID:
68133379
Publication date in RUL:
09.07.2021
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2176
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117
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Language:
English
Title:
Association between nutritional Status and Quality of Life in Patients with Metastatic Castration-Resistant Prostatic Cancer
Abstract:
BACKGROUND: Health-related quality of life (HRQoL) is of paramount importance in men with metastatic castrate-resistant prostate cancer (mCRPC) beyond survival gain. The disease itself, as well as treatment, could impair nutritional status (NS). It is unknown yet whether there is an association between NS and HRQoL in the population of patients with mCRPC. METHODS: We prospectively enrolled men with early mCRPC into this study. HRQoL was assessed by the validated questionnaire Functional Assessment of Cancer Treatment (FACT-P). NS was described as one of three nutritional variables: (i) body mass index (BMI), (ii) diagnosis of NS (based on clinical/laboratory criteria and the score of validated nutritional risk questionnaire four NS categories were defined: normal NS (nNS), nutritional risk without cachexia/sarcopenia (NR), sarcopenia and cachexia), and (iii) phase angle (PA) -delivered from bioimpedance analysis. BMI and PA are continuous variables, in contrast to discrete NS diagnoses. Associations between NS and HRQoL were estimated using univariate and multiple regression models – those were established by inclusion of covariables with possible impact on the HRQoL in mCRPC patients. The threshold for statistical significance was settled at the p-value of 0.05, which was not adjusted for the multiple testing. RESULTS: One hundred forty-one patients were enrolled in our study. At presentation, their mean age was 74.2 years (SD 7.1), and 18 (12.4 %) had visceral metastases. Fifty-eight (41.6%) had nNS; 24 (16.8 %) NR, 43 (30.8 %) had sarcopenia; and 16 (11.8 %) had cachexia. At baseline, all three NS variables showed a significant association with HRQoL. In the multiple model, established by all NS variables and covariates, NS categories only were significantly associated with HRQoL (NR vs. nNS: β=-13.31, p=0.015; sarcopenia vs. nNS: β=-11.23, p=0.02; cachexia vs. nNS: β=- 21.49; p=0.005), in contrast to BMI and PA (β=0.48, p=0.28 in β=-1.06, p=0.66). Baseline BMI did not predict HRQoL after 6 months (OR=1.04, p=0.39). However, NS diagnoses and PA had some prognostic value (NR vs. nNS: OR=0.29, p=0.02; sarcopenia vs. nNS: β=0.71, p=0.44; cachexia vs. nNS: β=0.22; p=0.02; and OR for PA = 1.82, p= 0.01). Consistently, BMI after 6 months did not appear as significantly associated with HRQoL after 6 months, contrasting to NS categories and PA. PA explained the most proportion of variability (R²= 22.5 %). In all multiple models pain was consistently negatively associated with HRQoL. Conclusion: Better NS is independently associated with HRQoL in patients with mCRPC. Relying solely on BMI does not exclude nutritional risk, so there is a need to perform a more detailed nutritional examination. Nutritional care should be part of the comprehensive assessment of patients with mCRPC.
Keywords:
Nutritional Status
,
Nutritional Risk
,
Sarcopenia
,
Cachexia
,
Quality of Life
,
Prostate Cancer
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