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- 연제번호 : P-276 북마크
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제목 The Role of Energy Balance Index during Chemotherapy in Hematologic Cancer Patients 소속 Seoul National University Hospital, Department of Rehabilitation Medicine1 저자 Hyun Jeong Lee1*, Hyun Sung Lee1, Kwan-Sik Seo1† Background
In hematologic cancer patients receiving chemotherapy, the negative energy balance is known to occur due to a combination of reduced food intake, physical activities and metabolic derangements which is tumor or chemotherapy derived. This study monitored energy balance indexes in hematologic cancer patients receiving chemotherapy and analyzed the relationships between them.
Methods
This retrospective cohort study included 50 hematologic cancer patients admitted for chemotherapy from 2018 to 2019 (Table 1). The energy balance indexes including body weight, oral intake, basal metabolic rates and physical functions were measured every week for 4 weeks. The basal metabolic rate was calculated through Harris-Benedict, Ireton-Jones energy expenditure, Mifflin–St. Jeor and Penn State equation. The physical functions were measured through the de Morton Mobility Index (DEMMI) score. Patient Generated Subjective Global Assessment (PG-SGA) and the outcome variables for QoL including European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and EuroQol-5D(EQ5D) were reported before chemotherapy and at 3rd week after chemotherapy.
For group analysis, reduced oral intake was considered to be present if the estimated energy intake is less than 60% of requirement for more than 1 week. Weight loss was defined as a loss of more than 5% of the body weight. Impaired physical function was defined as a decrease in DEMMI scores more than 2 points during chemotherapy.
Results
The oral intake calories showed no significant difference during chemotherapy. However, the body weight and basal metabolic rate calculated by Harris-Benedict equation decreased significantly during chemotherapy. The DEMMI score showed an overall decrease during chemotherapy. There was no significant difference of PG-SGA, EORTC QLQ_C30 and EQ5D between baseline and third week of chemotherapy.
In group analysis, impaired physical function group, body weight decreased less than the control group after chemotherapy. The DEMMI scores in impaired physical function group showed a maximal decrease at 1st week of chemotherapy and did not recover until 3rd week of chemotherapy (Figure 1, Table 2).
Conclusion
The impaired physical function group showed a maximal decrease in DEMMI scores at 1st week of chemotherapy. Monitoring physical function in the early period of chemotherapy is important to make an early intervention in these patients.
In this study, patients maintained their oral intake but showed a decrease in body weight, basal metabolic rates and DEMMI scores during chemotherapy. The DEMMI score measures physical capacity not physical activities and basal metabolic rates are calculated by equations which were dependent on body weight. Therefore, it will be necessary to measure actual physical activities and basal metabolic rates in the future studies.File.1: Table 1.JPGTable 1. Demographics and clinical characteristics of study population. Abbreviation: ALL, Acute lymphocytic leukemia; AML, Acute myelocytic leukemia; MPAL, Mixed phenotype acute leukemia ** Type of drugs means types of drugs at 3rd week of chemotherapy. ** Type of antiemetic drugs means types of antiemetic drugs at 3rd week of chemotherapy. ** Pre-admission date means the days after diagnosis and before admission.File.2: Figure 1.JPGFigure 1. DEMMI scores as a measure of physical function after chemotherapy. The impaired physical function group showed significantly decreased DEMMI score after first week of chemotherapy (p<0.05) and did not recover until third week of chemotherapy. ** Impaired physical function group was defined as a decrease in DEMMI score more than 2 points during chemotherapyFile.3: Table 2.JPGTable 2. DEMMI scores as a measure of physical function after chemotherapy. The impaired physical function group showed significantly decreased DEMMI score after first week of chemotherapy (p<0.05) and did not recover until third week of chemotherapy. +Paired T test for the intragroup data (each time-point vs. baseline). *Wilcoxon signed rank test for the intragroup data (each time-point vs. baseline).