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      Frequência de queixas de deglutição e alimentação durante consulta compartilhada em cuidados paliativos oncológicos Translated title: Frequency of swallowing and food complaints during shared consultation in oncological palliative care

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          Abstract

          RESUMO Objetivo identificar a frequência de queixas de deglutição e alimentação em pacientes oncológicos em cuidados paliativos e associá-las com os dados clínicos e funcionais. Métodos estudo transversal e descritivo, realizado com pacientes oncológicos atendidos durante consulta compartilhada em ambulatório de cuidados paliativos, por meio de triagem fonoaudiológica, protocolos e escalas, com análise estatística dos dados obtidos. Resultados amostra constituída de 52 indivíduos, atendidos durante 8 meses, com média de idade de 66,7 anos, Palliative Performance Scale (PPS) média de 57,5. A topografia da neoplasia mais frequente foi trato gastrointestinal e o tratamento foi cirurgia, quimioterapia e radioterapia associadas. As queixas da triagem foram categorizadas em deglutição e alimentação. Dessa forma, as de deglutição foram as mais frequentes e grande parte da amostra necessitou de avaliação funcional da deglutição. Apenas a associação entre queixas de deglutição e a topografia de trato gastrointestinal apresentou relação estatisticamente significativa. As queixas de deglutição foram mais frequentes nos pacientes submetidos à radioterapia e com menores porcentagens na escala PPS. Conclusão as queixas de deglutição foram as mais frequentes e as associações permitiram relacioná-las à localização do tumor e identificar sua frequência, conforme o tratamento oncológico e declínio funcional da terminalidade.

          Translated abstract

          ABSTRACT Purpose to identify the frequency of swallowing and feeding complaints in cancer patients in palliative care, and to associate them with clinical and functional data. Methods cross-sectional and descriptive study, carried out with cancer patients treated during shared consultation in a palliative care outpatient clinic, through speech-language pathology screening, protocols and scales, with statistical analysis of the obtained data. Results Sample consisted of 52 subjects, seen during 8 months, with a mean age of 66.7 years, PSS (Palliative Performance Scale) a mean of 57.5. The topography of the most frequent neoplasm was the gastrointestinal tract and the treatment was surgery and associated chemotherapy and radiotherapy . Complaints identified at screening were categorized into swallowing and feeding. Thus, swallowing was the most frequent and a large part of the sample required a functional assessment of swallowing. Only the association between swallowing complaints and the topography of the gastrointestinal tract showed a significant statistical relationship. Swallowing complaints were more frequent in those undergoing radiotherapy and with lower percentages on the PPS scale. Conclusion swallowing complaints were the most frequent and the associations made it possible to relate them to the location of the tumor, and to identify their frequency according to cancer treatment and terminal functional decline.

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          Most cited references23

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          Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients.

          To report on the development and psychometric evaluation of a clinical scale to document change in functional oral intake of food and liquid in stroke patients. Validity and reliability study. Tertiary care, academic medical center, metropolitan stroke unit. Acute stroke patients (N=302). Not applicable. Interrater reliability, validity, and sensitivity to change assessments were completed on a 7-point ordinal scale-the Functional Oral Intake Scale (FOIS)-developed to document the functional level of oral intake of food and liquid in stroke patients. Interrater reliability was drawn from FOIS ratings applied to dietary information from patient medical charts. Consensual validity was estimated by rankings from judges against predefined scale scores. Criterion validity was evaluated by comparison to the Modified Rankin Scale, the Modified Barthel Index, and Mann Assessment of Swallowing Ability. Cross-validation was assessed via comparison to 2 physiologic measures of swallowing function. Change in functional oral intake over time was assessed descriptively by applying the scale to dietary information from a cohort of 302 acute stroke patients followed up for 6 months. Interrater reliability was high, with perfect agreement on 85% of ratings. Kappa statistics ranged from .86 to .91. Consensual validity was high (.90). Criterion validity was high at onset and 1 month poststroke. Significant associations were identified between the FOIS and stroke handicap scales. The FOIS was significantly associated with 2 physiologic measures of swallowing. Scores on the FOIS from the cohort of stroke patients showed a shift toward increased oral intake over a 6-month period. The FOIS had adequate reliability, validity, and sensitivity to change in functional oral intake. These findings suggest that the FOIS may be appropriate for estimating and documenting change in the functional eating abilities of stroke patients over time.
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            The Spectrum of Malnutrition/Cachexia/Sarcopenia in Oncology According to Different Cancer Types and Settings: A Narrative Review

            Nutritional status in oncological patients may differ according to several modifiable and non-modifiable factors. Knowledge of the epidemiology of malnutrition/cachexia/sarcopenia may help to manage these complications early in the course of treatment, potentially impacting patient quality of life, treatment intensity, and disease outcome. Therefore, this narrative review aimed to critically evaluate the current evidence on the combined impact of tumor- and treatment-related factors on nutritional status and to draw some practical conclusions to support the multidisciplinary management of malnutrition in cancer patients. A comprehensive literature search was performed from January 2010 to December 2020 using different combinations of pertinent keywords and a critical evaluation of retrieved literature papers was conducted. The results show that the prevalence of weight loss and associated symptoms is quite heterogeneous and needs to be assessed with recognized criteria, thus allowing a clear classification and standardization of therapeutic interventions. There is a large range of variability influenced by age and social factors, comorbidities, and setting of cures (community-dwelling versus hospitalized patients). Tumor subsite is one of the major determinants of malnutrition, with pancreatic, esophageal, and other gastroenteric cancers, head and neck, and lung cancers having the highest prevalence. The advanced stage is also linked to a higher risk of developing malnutrition, as an expression of the relationship between tumor burden, inflammatory status, reduced caloric intake, and malabsorption. Finally, treatment type influences the risk of nutritional issues, both for locoregional approaches (surgery and radiotherapy) and for systemic treatment. Interestingly, personalized approaches based on the selection of the most predictive malnutrition definitions for postoperative complications according to cancer type and knowledge of specific nutritional problems associated with some new agents may positively impact disease course. Sharing common knowledge between oncologists and nutritionists may help to better address and treat malnutrition in this population.
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              Palliative performance scale (PPS): a new tool.

              The Palliative Performance Scale (PPS), a modification of the Karnofsky Performance Scale, is presented as a new tool for measurement of physical status in palliative care. Its initial uses in Victoria include communication, analysis of home nursing care workload, profiling admissions and discharges to the hospice unit, and, possibly, prognostication. We assessed 119 patients at home, of whom 87 (73%) had a PPS rating between 40% and 70%. Of 213 patients admitted to the hospice unit, 175 (83%) were PPS 20%-50% on admission. The average period until death for 129 patients who died on the unit was 1.88 days at 10% PPS upon admission, 2.62 days at 20%, 6.70 days at 30%, 10.30 days at 40%, 13.87 days at 50%. Only two patients at 60% or higher died in the unit. The PPS may become a basis for comparing drug costs at home and for studying the effects of treatments (e.g. hypodermoclysis) at various levels of physical performance. Validity and reliability testing are currently being undertaken.
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                Author and article information

                Journal
                acr
                Audiology - Communication Research
                Audiol., Commun. Res.
                Academia Brasileira de Audiologia (São Paulo, SP, Brazil )
                2317-6431
                2022
                : 27
                : e2607
                Affiliations
                [01] Brasília Distrito Federal orgnameUniversidade de Brasília orgdiv1Fonoaudiologia, Faculdade de Ceilândia Brazil
                [02] Goiânia GO orgnameFaculdade CEAFI (Centro de Estudos Avançados e Formação Integrada) orgdiv1Programa de Pós-Graduação em Disfagia com Enfoque Hospitalar Brasil
                Article
                S2317-64312022000100324 S2317-6431(22)02700000324
                10.1590/2317-6431-2021-2607pt
                0ff694bd-3e4c-47f8-b461-d00a37ba9f1a

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 07 December 2021
                : 05 July 2022
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 24, Pages: 0
                Product

                SciELO Brazil

                Categories
                Artigos Originais

                Deglutição,Alimentação,Consultas médicas compartilhadas,Palliative care,Neoplasm,Swallowing,Feeding,Shared medical consultations,Cuidados paliativos,Neoplasia

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