Influência da desnutrição e da fragilidade na qualidade de vida e sobrevida global de pacientes com câncer de bexiga e de rim

Abstract

Despite the knowledge that cancer can simultaneously influence nutritional status and frailty, most studies focus on a specific syndrome, without considering the occurrence of both, and their interrelationships with quality of life (QoL) and mortality. This observation is even more expressive in studies of patients with urinary tract cancer. Thus, this thesis aimed to evaluate the influence of malnutrition and frailty on the quality of life and overall survival of patients with bladder or kidney cancer. A prospective cohort study was carried out with patients with bladder or kidney cancer, aged 20 years or older, whose participants were recruited and evaluated between the 1st and 2nd years of cancer diagnosis, and then reassessed after a median time of 14 months. The assessment consisted of anthropometry; Patient-Generated Subjective Global Assessment (PG-SGA); frailty phenotype (FP); and analysis of QoL using the 30-item Quality of Life Questionnaire (QLQ-C30). Socio-demographic and clinical data were also collected using a specific form or searching medical records. Survival status was determined when the study completed 5 years from its beginning. Eighty-eight patients were included in the study, among these 66 participated in the second evaluation. Most were male, with a mean age of 62.3 (±12.5) years, 37% had some degree of malnutrition by PG-SGA, between 18% and 20% were frail, and most were pre-frail. FP did not differ between young adults and older people, but was associated with nutritional status, when classified by the PG-SGA, where 80% of the robust ones had better nutritional status. The summary score of QoL was lower both among malnourished and frail individuals. The factors that most negatively impacted QoL over time between the two assessments were malnutrition (β = -7.25; p = 0.000), frailty (β= -7.85; p = 0.021) and performance status (β= -6.9; p=0.000). Regarding overall survival at 60 months, weight loss ≥ 5% (HR= 3.57; 95% CI= 1.51 – 8.46; p = 0.004), underweight or malnourished classification by body mass index ( HR= 6.95; 95% CI= 2.17 – 22.27; p = 0.001), and frailty (HR= 3.74; 95% CI= 1.32 – 10.59; p = 0.013), were independent predictors of mortality risk. These findings showed the influence of malnutrition and frailty on the worsening of QoL and reduction of overall survival, and may be the first step for future studies with nutritional intervention and physical activity as a way to prevent and/or treat these conditions, in favor of better outcomes for patients with bladder and kidney cancer