État nutritionnel et alimentation de patientes atteintes de cancer non digestif

Abstract

Cancer is the second leading cause of death in the world. In Algeria, cancer is the subject of a national control plan (2015 - 2019). The cancer has negative effects on the nutritional state of the patient, effects caused by the disease itself, treatments, the conditions of the patient journey (interval of access to care and diagnosis) and the reduction of food intake. The result is risk of occurrence of malnutrition. The objective of the study was to evaluate the nutritional status and diet of patients with no-digestive cancer during anti-cancer treatment. This was a descriptive cross-sectional survey carried out during the period from August 2015 to February 2016 at the level of the medical oncology and radiotherapy departments of the AntiCancer-Center of the Wilaya of Batna (Algeria). It targeted patients aged from 25 to 65 years with no-digestive cancer in this case that of the breast, ovary and cervix during their treatments (chemotherapy and / or radiotherapy). The patient journey was quantified by calculating the time (in days) of access to care and diagnosis: from the occurrence of the first clinical signs to access to treatment. The disease was classified into three stages: tumor, invasive (presence of nodules) and metastatic. The evaluation of the nutritional status was carried out according to three methods: Buzby index, Objective evaluation of the nutritional status (BMI, weight loss and albuminemia) and the Calculation of the score “Patients Generated- Subjective Global Assessment” (PG-SGA). Food consumption was assessed by the repetitive 24h recall questionnaire (3 times) and the frequency of consumption. Food intake per day was quantified using household units and a photo manual and then converted to weight using previously established equivalences. Food quantities were converted to nutrients using a compiled table. Nutrients intakes and food consumption frequencies were calculated and compared to the recommendations. 315 patients with breast cancer (85%), ovarian (8%) and cervix (7%) were included in our study. The duration of the disease (from the first clinical signs at the time of the survey) was greater than one year (351 days) for 50% of the women surveyed. The duration of the course between the first signs and the access to the first treatment was greater than 4.5 months for 50% of the women surveyed. According to the Buzby index, 54.5% of the patients were undernourished. According to the objective method of assessing nutritional status, 53.9% of the patients suffered from severe or moderate malnutrition. By contrast, according to the PG-SGA Score, 60% of these patients were at high risk of malnutrition requiring symptom management and / or nutritional intervention. Patients had inadequate energy intake (73%), macronutrients, vitamins and minerals. The deterioration in the nutritional status of cancer patients is mainly determined by the type of treatment (p = 0.004) and energy intake (p = 0.012). The high prevalence of malnutrition (between 53% and 60%) was partly due to late access to care and the nature of care. In order to detect early malnutrition and situations at risk of malnutrition, the assessment of nutritional status should be an integral part of the overall management of cancer patients at CAC Batna (Algeria).