A novel model with nutrition-related parameters for predicting overall survival of cancer patients

Improve the quality of end-of-life in cancer patients using social representations of nutrition

Introduction

The problems related to nutrition generate great concern in palliative cancer patients and their caregivers. Literature has analyzed the psychological and social problems that nutrition causes. From patient-centered orientation, there are protocols for nutritional care. This psycho-health information is a source of discomfort among patients and families and its absence generates many problems related to nutrition with negative clinical repercussions. Thus, this study aims to analyze the concept of nutrition in advanced cancer patients with palliative care and their caregivers. Furthermore, given that food has an important cultural component as important as it is nutrition, the sociocultural influence on the social representation of nutrition will also be analyzed.

Methods

The study design was qualitative and cross-sectional with a recruitment period lasting 18 months. After the informed consent, a sample of advanced cancer patients (N=57) and their caregivers (N=57) were interviewed individually. The data was analyzed using content analysis and descriptive analysis. The existence of statistical differences between groups (patients and caregivers) was tested by Chi-Square statistics.

Results

Results showed that the perception of nutrition was structured in five categories: health/survival/life (e.g. "healthy"), social relationship (e.g. "intimate relationship"), care (e.g. "care role"), foodstuff (e.g. "vegetables"), and others ("anything"). There were significant differences (p-Value>0.05) in the uses of nutrition between patients and their caregivers and caregivers had higher scores. Then, nutrition was perceived as an act of care and, therefore, patients were expected to strive to eat despite the loss of appetite.

Discussion

This study is one of the first to explore the perception of nutrition emphasize the insufficient consideration of patients' and caregivers' needs and perceptions regarding food, as well as the significance of this knowledge in patient-centered care approaches. In this way, it could intervene by first understanding the behavior concerning food and, secondly, redirecting the behavior if it is harmful to the patient or family relationships regarding the health care and well-being of patients with advanced cancer with palliative care.

Creation and Validation of a Survival Nomogram Based on Immune-Nutritional Indexes for Colorectal Cancer Patients

Nutritional and inflammatory status was associated with prognosis in various types of malignant cancer, including colorectal cancer (CRC). This clinical research was performed to estimate the prognostic role of immune-nutritional indexes CRC in patients and to set up a survival nomogram based on the significant immune-nutritional indexes. 1024 CRC patients underwent surgical resection from Wuhan Union Hospital were enrolled and divided into the test cohort (n = 717) and validation cohort (n = 307). A total of 19 immune-nutritional indexes were included into our analysis. The Cox regression analysis was utilized to identify the informative immune-nutritional indexes which were closely associated with overall survival (OS) and disease-free survival (DFS). Survival nomograms were created in the test set and further verified in the validation set. Td-ROC was curved to estimate the predictive performance of survival nomograms for CRC patients. Body mass index (BMI), chemotherapy, TNM stage, T stage, lactate dehydrogenase (LDH)/prealbumin (PA), monocytes (MON)/albumin (ALB), and prognostic nutritional index (PNI) were seven potent prognostic biomarkers of CRC patients. We created an OS-nomogram based on the seven risk indexes, and the predictive accuracy expressed with area under curve (AUC) was 0.826 for 1-year, 0.809 for 3-year, and 0.80 for 5-year OS rates in the test set and 0.795 for 1-year, 0.749 for 3-year, and 0.647 for 5-year OS rates in the validation set. TNM stage, T stage, LDH/ALB, and MON/ALB were risk factors for unfavorable DFS in CRC patients. We further built a DFS-nomogram based on the four risk factors, and the predictive performance presented with AUC was 0.806 for 1-year, 0.763 for 3-year, and 0.82 for 5-year DFS rates in the test set, and 0.704 for 1-year, 0.692 for 3-year, and 0.692 for 5-year DFS rates in the validation set. Our survival nomogram based on immune-nutritional indexes is a useful and potential prognostic tool in CRC patients.