Vol 4, No 4 (2023)

BACKGROUND: Individuals over the age of 70 comprise over half of operable patients with stage 0–IIIA lung cancer. In the early postoperative period of this cohort, pain, fatigue, insomnia, and/or mood disturbances are the four most common symptoms, which can significantly diminish quality of life and functional status. Perioperative nutritional support in such patients, which enhances exercise tolerance, can have a positive impact on their quality of life and socialization.

AIM: To assess the effect of perioperative nutritional support using high-protein oral nutrition supplements on the general health and quality of life of non-small cell lung cancer patients during the postoperative period.

MATERIALS AND METHODS: Patients with primary non-small cell lung cancer (n=112, 69 males), aged 57.2±8.2, who were awaiting lung surgery and at risk of malnutrition (Nutritional Risk Screening Assessment 2002 score ≥3) were randomly assigned into two groups. Oral nutritional support (Nutridrink Compact Protein, Nutricia LLC) was administered to the study group (n=55) at a rate of 250 ml/d (36 g of protein, 612 kcal) for 14 days prior to and 14 days following the surgery, in addition to the standard diet. Control group patients (n=57) were provided a standard diet. The quality of life was assessed using the Quality of Life Questionnaire Core-30. Results are presented as mean ± standard deviation. Differences were considered significant at p ≤0.05.

RESULTS: Throughout the entire observation period, the study group exhibited superior growth indicators in terms of general health status, physical, and role functioning than the control group (p <0.05). The study group patients exhibited a propensity toward improved emotional functioning, and by the end of the study, weakness and insomnia were less pronounced (p <0.05). Other indicators did not exhibit any significant variations.

CONCLUSION: Нigh-protein perioperative oral nutrition supplements exert a positive impact on the quality of life of non-small cell lung cancer patients.

BACKGROUND: Hematopoietic stem cell transplantation frequently necessitates nutritional support. However, the safety and tolerance of parenteral nutrition have not been adequately examined, except for its association with infectious complications.

AIM: To evaluate the impact of parenteral nutrition on nutritional status and its correlation with complications during the early period following hematopoietic stem cell transplantation.

MATERIALS AND METHODS: From 2019–2020, 125 recipients of autologous (n=38) and allogeneic (n=87) hematopoietic stem cell transplantation were included in the study with a median age of 20 years (2–65). The chosen cohort included patients with leukemia (n=67), solid tumors (n=32), dysplasia (n=15) and lymphoproliferation (n=11). The control group (n=55) was composed of patients who did not depend on nutritional support. Parenteral nutrition was administered to the primary group (n=70) using second-generation (n=22) and third-generation (n=24) fat emulsions. In the event of contraindications, parenteral nutrition was administered without fat emulsions (n=24). To mitigate the risk of side effects, the initial dose of parenteral nutrition was 50%, with the achievement of the complete dose by the third day of therapy.

RESULTS: In 95.7% of cases, mucositis was the indication for parenteral nutrition. The duration of parenteral nutrition was 2–31 days (median, 11 days). In 58.6% of cases, parenteral nutrition was initiated against the background of nausea and vomiting. During the escalation of the parenteral nutrition dose, increased nausea was observed in 7.1% of patients. Side effects were noted in 22.9% of cases: hyperglycemia (n=7), vomiting (n=6) and hypertriglyceridemia (n=3). Four patients developed complications associated with parenteral nutrition, and nutritional therapy was discontinued in 20% of cases (n=14). After hematopoietic stem cell transplantation, the primary clinical efficacy criterion, body mass index, was observed to decline in each observation group. However, it recovered by day 28 and did not differ between the comparison groups as follows: the control group — from 22.7±6.4 to 21.7±6.1 kg/m², (p=0.42); group “2 in 1” — from 23.4±6.1 to 21.6±4 kg/m², (p=0.56); group provided with parenteral nutrition employing second-generation fat emulsions — from 18,8±4,9 to 18.7±4.4 kg/m², (p=0.72); group administered parenteral nutrition with third-generation fat emulsions — from 18.6±4.2 to 18.3±3.5 kg/m², (p=0.84). The febrile neutropenia rate was 75.2% and did not vary in the control and comparison groups (p=0.54). The incidence of sepsis was 24.8% and was not influenced by the use of parenteral nutrition (p=0.07). Furthermore, sepsis risk was higher when administering parenteral nutrition “2 in 1” compared to fat emulsions-containing parenteral nutrition (p=0.002). The overall frequency of acute graft versus host disease was 16.1% and was similar in the comparison groups (p=0.65).

CONCLUSION: In the cohort of patients treated with hematopoietic stem cell transplantation, parenteral nutrition regimens supplemented with second- and third-generation fat emulsions with a stepwise dose increase varied in acceptable tolerance, infection-related complications, and immunological safety, as well as effectively maintained nutritional status parameters.

An analysis of publications in the medical databases e-Library, PubMed, and Medline (2005–2024) was conducted to evaluate the impact of nutritional support on the tolerability of antitumor chemoradiotherapy. Based on the data collected, it was revealed that chemoradiotherapy is linked to a high risk of developing protein-energy malnutrition. Consequently, the initial nutritional deficiency and sarcopenia result in either a refusal to administer chemotherapy in favor of radiation treatment alone, a forced reduction in the dose of a cytostatic medication, or the disruption of the chemoradiotherapy course. Patients with malignancies of the head and neck who have received chemoradiotherapy with previous induction chemotherapy are in the “red zone” for the risk of developing protein-energy malnutrition. Nutritional support is one of the instruments that enhances the likelihood of treatment implementation and mitigates the risk of drug and radiation toxicity.

The fundamental principles of nutritional support during chemoradiotherapy include timely prescription, adequacy, composition of a specialized mixture, and the choice of the most physiological way of its implementation. Supplementing nutritional support with feasible strength physical exercise triggers protein synthesis in skeletal muscles, increases muscular sensitivity to the anabolic properties of amino acids, and mitigates insulin resistance.

BACKGROUND: Although the critical role of vitamin D in mineral homeostasis regulation is widely recognized, the global prevalence of vitamin D deficiency is exceedingly high. The substantial number of population-based studies that examine the correlation between the concentration of circulating vitamin D levels and the risk of developing cancer may be attributed to the growing interest of researchers in this vitamin as a suppressor of proliferating epithelial cells. However, the data collected are contradictory.

AIM: To ascertain the necessity of diagnosing and rectifying vitamin D deficiency in cancer patients.

MATERIALS AND METHODS: The keywords “vitamin D,” “vitamin D deficiency,” “cancer,” and “survival” were employed to identify publications in the e-Library, PubMed, and ScienceDirect databases from January 2014 to January 2024. Based on the data obtained, an analytical review of the literature was conducted.

RESULTS: The global prevalence of vitamin D deficiency, including among cancer patients, is exceedingly high and does not vary by sex, age, or ethnicity. Decreased serum vitamin D levels are linked to an elevated incidence of colorectal cancer, breast cancer, melanoma, prostate, and pancreatic cancer. Addressing vitamin D deficiency helped mitigate the risk of developing breast cancer. Data on the effect of vitamin D deficiency and its correction on patient survival are inconsistent.

CONCLUSION: Currently, there is no consensus regarding the impact of vitamin D supplementation on the incidence of diverse malignancies, as well as tumor-specific and overall survival. Additional research is required to address the necessity of diagnosing and correcting vitamin D deficiency.