Nutritional Status And Its Influencing Factors In Patients With Lung Cancer During Radiotherapy

Objective1. To investigate the nutritional status, the food intake, psychological status, inflammatory status, pain and treatment-induced adverse effect of patient with lung cancer during radiotherapy.2. To analysis the demographic data, clinical data, food intake, psychological status, inflammatory status, pain and adverse effect, identify the associated factors of nutritional status and find early predictors of malnutrition for lung cancer patients during RT and to provide the basis to propose early malnutrition risk screening model and nutrition intervention program.MethodsWe evaluated patients diagnosed with lung cancer received radiotherapy by convenience sampling method between February2011and Janurary2013at Tian Jin Cancer Hospital. At the baseline visit before radiotherapy, a general questionnaire designed by the investigators was administrated to evaluate the patients’ demographic characteristics and clincal data. The questionnaire included age, gender, resident location, cigarette smoking, alcohol drinking, baseline weight, half year weight loss, Karnofsky performance score (KPS), history of diabetes and high blood pressure, the clinical TNM stage, pathology classification, the history of chemotherapy and operation, radiation dose, and the use of CRT and nutritional support, prealbumin, albumin, lymphocyte. From the beginning of radiotherapy to the end, we assessed the nutritional status of patients weekly by patient-generated subject global assessment (PG-SGA), and we evaluated the24-hour dietary recalls, self-rating anxiety scale (SAS), self-rating depression scale (SDS), inflammatory status, pain numerical rating scale (NRS) and adverse effect weekly. The variables were examined for their association with nutritional status by univariate analysis with X2test. A multivariate logistic regression analysis was performed to identify the potential factors leading to malnutrition.ResultsA total of182patients with lung cancer were enrolled.93(51.1%) patients suffered from malnutrition,72(39.6%) patients in moderate malnutrition and21(11.5%) in severe malnutrition. The incidence of malnutrition was increasing during radiotherapy. According to univariate analysis, the significant variables for malnutrition were weight loss in half year, KPS, TNM stage, use of CRT, prealbumin. There were no significant differences in history of diabetes and high blood pressure, pathology classification, the history of chemotherapy and surgery, radiation dose, nutritional support, and so on. Patients with lower energy intake suffered more malnutrition. Depression, anxiety, NLR and pain were significantly associated with nutritional status of patients. Besides, the adverse effect including fever, constipation, appetite loss, nausea, vomit, and radition-induced esophagitis were significantly associated with nutritional stuats of patients. According to logistic regression analysis, depression (odds ratio,2.375; P=0.012), loss of appetite (odds ratio,2.231; P=0.041), nausea (odds ratio,2.585; P=0.005), vomit (odds ratio,2.283; P=0.025), TNM staging (odds ratio,2.147; P=0.050), total energy intake (odds ratio,2.444; P=0.010), CRT (odds ratio,2.328; P=0.022), retained as significant risk factors that contribute independently to nutritional status of patients with lung cancer during radiotherapy.ConclusionThe incidence of malnutrtion was high in patients with lung cancer during radiotherapy. So clincal medical staff should pay attention to them. Patients who had depression, advanced TNM stage,1-3grade digestive toxicities, low total energy intake, or CCRT should be given early malnutrition screening and monitoring. Meanwhile, the result of this study was benifit to propose a predictive model of malnutrition. Medical staff can provide early nutrition guidance and appropriate nutrition intervention to reduce the incidence of malnutrition.