Patients with cancer experience high impact of emotional consequences of reduced ability to eat: A cross sectional survey study

Objective: Patients with cancer can experience emotional consequences of reduced ability to eat, their impact is unknown. This study assesses the impact of these emotional consequences, and patients' satisfaction with healthcare professionals' (HCPs) support. Methods: A cross-sectional survey was conducted among patients with head/neck, lung cancer and lymphoma, who experienced reduced ability to eat in the past year. Patients were recruited through patient organisations and hospitals. The questionnaire encompassed the impact of emotional consequences of reduced ability to eat (scale 1–10) and satisfaction with HCPs' support for reduced ability to eat (scale 1–10). The differences in patient characteristics between unsatisfied (Score < 6) and satisfied patients (score ≥6) were tested using independent t-tests and the chi-square or Fishers' exact tests. Results: Overall, 116 patients (48%) responded and 98 were included in the analyses. The most impactful emotional consequences were as follows: disappointment (mean ± SD: 8.31 ± 1.49), grief/sadness (7.90 ± 1.91), and anger (7.87 ± 1.41). Patients were less satisfied when more time had passed since their diagnosis (p < 0.002) and when they expected no improvements regarding their eating problems (p < 0.001). Conclusion: The impact of emotional consequences of reduced ability to eat is high. Support for emotional consequences is needed, especially for patients with reduced ability to eat, which persists in recovery and remission

Changes in body weight in patients with colorectal cancer treated with surgery and adjuvant chemotherapy: An observational study

Background and objectives Prevalence of overweight and obesity is high among colorectal cancer patients upon diagnosis. Body weight may change substantially during treatment for colorectal cancer. In this study, we describe changes in body weight in colorectal cancer patients during three periods: the period of surgery, during adjuvant chemotherapy and during oncological follow-up; in addition, we assess which clinical/personal factors were associated with weight change. Subject/Methods 485 stage II/III colorectal cancer patients diagnosed between 2007 and 2012 and treated with surgery and adjuvant chemotherapy in three hospitals in the Netherlands were identified through the Netherlands Cancer Registry. Data on changes in body weight were retrieved from medical records. Results Over the period of surgery, patients on average lost weight (mean −1.9 kg, SD 4.6 kg) (n=357). Weight increased during chemotherapy (2.9 kg, SD 5.8 kg) (n=291) and increased during oncological follow-up (2.2 kg, SD 6.6 kg) (n=242). Mean weight change over the total period was +2.0 kg (SD 6.8 kg) (n=283). Factors univariately associated with weight gain were normal BMI (vs a BMI of 25–30), open surgery (vs laparoscopic surgery) and Capecitabine monotherapy (vs Capecitabine plus Oxaliplatin). In a multivariate model, factors were no longer associated with weight gain. Conclusions Body weight generally decreased during surgery and increased during and after chemotherapy. During oncological follow-up, body weight generally was higher than upon diagnosis. Studies among other patient groups suggest that weight changes may primarily affect muscle mass, and may lead to e.g. sarcopenic obesity. Future prospective studies are needed to explore this in colorectal cancer patients

Comparison of the ‘ESPEN guidelines on nutrition in cancer patients 2016’ with the recommendations of the Dutch Dietitians in Oncology Group

Rationale: In 2016, a completely revised second version of the ‘Handbook Nutrition in Cancer’ (HNC, in Dutch) by the Dutch Dietitians Oncology Group (DDOG) was published. In this project, the DDOG evaluated similarities and potential discrepancies between DDOG recommendations and the ESPEN guidelines for the identification, prevention and treatment of reversible elements of malnutrition during and after cancer treatment. Methods: The recommendations of the DDOG, as published in the HCN, were systematically compared with the ESPEN guidelines on nutrition in cancer patients. guidelines. However, DDOG recommendations are more detailed, comprehensive, and practical. The DDOG and the ESPEN guidelines differ in that the DDOG 1) recommends the comprehensive PG-SGA and PG-SGA Short Form for screening and nutritional assessment; 2) recommends to start artificial nutrition at an earlier stage; 3) does not recommend increasing the ratio of energy from fat/energy from carbohydrates in weight-losing cancer patients with insulin resistance; 4) includes a less conservative recommendation on increasing energy intake for prevention of refeeding syndrome; and 5) supports a longer period of corticosteroid use to increase appetite (4-8 weeks vs ESPEN 1-3 weeks). Additionally Results: Overall, the DDOG recommendations are in line with the ESPEN , the DDOG does not include a specific advice for parenteral nutrition composition during intensive chemotherapy, and includes the advice to avoid fatty fish/fish oil 24 hours before and after specific chemotherapy treatment. Both guidelines recommend nutritional care to be accompanied by exercise training. Conclusion: The DDOG and ESPEN recommendations are generally in line with each other, but the DDOG recommendations are more specific and practical. DDOG and ESPEN are complementary to each other

Changes in body weight in patients with colorectal cancer treated with surgery and adjuvant chemotherapy: An observational study

Background and objectives Prevalence of overweight and obesity is high among colorectal cancer patients upon diagnosis. Body weight may change substantially during treatment for colorectal cancer. In this study, we describe changes in body weight in colorectal cancer patients during three periods: the period of surgery, during adjuvant chemotherapy and during oncological follow-up; in addition, we assess which clinical/personal factors were associated with weight change. Subject/Methods 485 stage II/III colorectal cancer patients diagnosed between 2007 and 2012 and treated with surgery and adjuvant chemotherapy in three hospitals in the Netherlands were identified through the Netherlands Cancer Registry. Data on changes in body weight were retrieved from medical records. Results Over the period of surgery, patients on average lost weight (mean −1.9 kg, SD 4.6 kg) (n=357). Weight increased during chemotherapy (2.9 kg, SD 5.8 kg) (n=291) and increased during oncological follow-up (2.2 kg, SD 6.6 kg) (n=242). Mean weight change over the total period was +2.0 kg (SD 6.8 kg) (n=283). Factors univariately associated with weight gain were normal BMI (vs a BMI of 25–30), open surgery (vs laparoscopic surgery) and Capecitabine monotherapy (vs Capecitabine plus Oxaliplatin). In a multivariate model, factors were no longer associated with weight gain. Conclusions Body weight generally decreased during surgery and increased during and after chemotherapy. During oncological follow-up, body weight generally was higher than upon diagnosis. Studies among other patient groups suggest that weight changes may primarily affect muscle mass, and may lead to e.g. sarcopenic obesity. Future prospective studies are needed to explore this in colorectal cancer patients.</p

Hemodynamic effects of leg crossing and skeletal muscle tensing during free standing in patients with vasovagal syncope

Physical maneuvers can be applied to abort or delay an impending vasovagal faint. These countermaneuvers would be more beneficial if applied as a preventive measure. We hypothesized that, in patients with recurrent vasovagal syncope, leg crossing produces a rise in cardiac output (CO) and thereby in blood pressure (BP) with an additional rise in BP by muscle tensing. We analyzed the age and gender effect on the BP response. To confirm that, during the maneuvers, Modelflow CO changes in proportion to actual CO, 10 healthy subjects performed the study protocol with CO evaluated simultaneously by Modelflow and by inert gas rebreathing. Changes in Modelflow CO were similar in direction and magnitude to inert gas rebreathing-determined CO changes. Eighty-eight patients diagnosed with vasovagal syncope applied leg crossing after a 5-min freestanding period. Fifty-four of these patients also applied tensing of leg and abdominal muscles. Leg crossing produced a significant rise in CO (+9.5%; P <0.01) and thereby in mean arterial pressure (+3.3%; P <0.01). Muscle tensing produced an additional increase in CO (+8.3%; P <0.01) and mean arterial pressure (+7.8%; P <0.01). The rise in BP during leg crossing was larger in the elderl