Nutrition in advanced cancer care : a clinical perspective
Notice bibliographique
Résumé
Adequate nutrition is an essential part in all stages of cancer care. By optimizing the nutrition care the benefits include increased tolerance to treatment as well as decreased mortality. Understanding how aspects of nutrition care in patients diagnosed with cancer, such as appetite, protein, albumin, and C-Reactive Protein (CRP), as well as body image, are intertwined are potentially important factors in clinical practice. All studies in the thesis were performed among patients diagnosed with advanced cancer admitted to Advanced Medical Home Care in Stockholm, Sweden. \n \n \n \nIn men diagnosed with advanced cancer, who had lost weight since diagnosis, we found an inverse association between weight loss and “physical functioning”, as measured by the RAND-36 domain, β = -1.34 (95%CI: -2.44,- 0.24 (study I). In women, we found that weight loss was associated with improvement in the RAND-36 domain role “limitations due to physical health”; β = 2.02 (95%CI:0.63,3.41). Women reported a more distressed body image than men (p = 0.02), which remained significant when only women that had lost weight after diagnosis were included. Further, we found an association between weight loss in men and body image distress, β = 0.22 (95%CI:0.07,0.37). \n \n \n \nThe aim of study II was to compare how high-protein parenteral nutrition (PN) affects the liver compared to standard PN. We found no significant difference in the proportion of patients with elevated liver enzymes in the high-protein PN group; OR 0.20 (95%CI:0.02,1.86). Patients that have received high-protein PN had a significantly higher weight at follow-up when compared to patients administered a PN containing standard amount of protein (p < 0.05). \n \n \n \nIn study III we found a significant correlation in men between low appetite, measured by the Edmonton Symptom Assessment System (ESAS), and low albumin (r = 0.27, p < 0.001). In men, lower appetite was also correlated with a higher CRP (r = 0.27, p < 0.001). In regression analysis, adjusted for confounding factors, the results remained similar. In women, there was no correlation between appetite and albumin or CRP. \n \n \n \nIn a cohort analysis (study IV) moderate and poor appetite were significantly associated with a higher mortality rate when compared to participants reporting a good appetite; HR 1.44 (95%CI:1.16,1.79) and HR 1.78 (95%CI:1.39,2.29), respectively (study IV). We also found that participants with low albumin levels (< 25 g/L), and participants in the highest tertile of CRP/albumin ratio, had higher mortality rates, HR 5.35 (95%CI:3.75,7.63) and HR 2.66 (95%CI:2.12,3.35), when compared to participants with high albumin levels (>36 g/L) and participants in the lowest tertile of CRP/albumin ratio. The associations were more pronounced in men than in women.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».