Author : Haroen H. Rotty L*, Lasut P, Hendratta C, Balansa E, Harlinda Harun
BACKGROUND : Carcinoma is a malignant disease caused by uncontrolled cell proliferation and the loss of normal apoptosis of the cells cycle. The most common nutritional problems in patients with carcinoma is cancer anorexia-cachexia syndrome (CACS), characterized by weight loss, and asthenia. Etiology of this syndrome remains unclear but probably multifactorial. This study was aimed to determine the incidence of CACS in carcinoma patients before and after they underwent chemotherapy. METHODS: A retrospective cohort study design with descriptive analytic method. 206 carcinoma patients undergoing chemotherapy at Prof. dr. R. D. Kandou hospital from February to August 2016 as subject of this research and met the inclusion criteria, namely carcinoma patients who had completed chemotherapy cycle for 6 months was included in this study. Cancer anorexia cachexia syndrome was assessed using Scored Patient-Generated Subjective Global Assessment (PG-SGA) questionnaire and anthropometry examination and then grouped into A (good nutritional status), B (pre cachexia) and C (cachexia). All patients included in this study were assessed when undergoing chemotherapy for the first time and 6 months after. RESULTS: A total of 206 patients were included in this study. Most were breast (39,30%), ovarium (18,44%) and cervix (15,53%) carcinomas. The most common stages before they underwent chemotherapy were stage IIb (breast carcinoma), IIIa (ovarian carcinoma) and IIIa (cervical carcinoma). The most common comorbidities were type 2 DM, lung disease and kidney disease from each of the three groups. The incidence of CACS was as follows: breast carcinoma before chemotherapy; A (n = 51, 62.96%), B (n = 30, 37.04%) and after chemotherapy; A (n = 73, 90 , 12%) and B (n = 8, 9.88%). Ovarian carcinoma before chemotherapy; A (n = 14, 36,84%), B (n = 20, 52,63%), C (n = 4, 10.53%) and after chemotherapy; A (n = 16, 42,11%), B (n = 22, 57,89%). Cervical carcinoma before chemotherapy; A (n = 14,43,75%), B (n = 10, 31,25%), C (n = 8,25,00%) and after chemotherapy; A ( n = 18, 56.25%), B (n = 12, 37.50%) and C (n = 2, 6.25%). In the breast carcinoma group prior to chemotherapy there was a very significant relationship between CACS events with stage (p <0.000) and with coexisting disease (p <0.000). In the ovarian carcinoma group prior to chemotherapy there was a significant relationship between CACS events with stage (p = 0.028) and with coexisting disease (p = 0.038). In the cervical carcinoma group prior to chemotherapy there was no correlation between CACS events with stage (p = 0.143) and also with coexisting disease (p = 0.094). CONCLUSION: In this study, visible improvements in nutritional status of carcinoma patients after underwent chemotherapy for 6 months. There is a significant association between the occurrence of CACS with the stage and the presence of comorbidities in breast and ovarian carcinoma group prior to chemotherapy. In cervical carcinoma group there was not a statistically significant relationship of CACS with stages, but the incidence was more common in patients with advanced stage and comorbidities. Key words: Cancer Anorexia Cachexia Syndrome, Carcinoma.
Dr. Arend L Mapanawang, Sp.PD, FINASIM, PhD