Habilidade de deglutição, estado nutricional e funcionalidade de adultos com câncer avançado exceto cabeça, pescoço e trato gastrointestinal superior: um estudo transversal em um ambulatório de cuidados paliativos
Swallowing ability, nutritional status, and functioning in adults with advanced cancer excluding head, neck, and upper gastrointestinal tract: a cross-sectional study in an outpatient palliative care setting
Danielle Nunes Moura Silva; Yohane Cristina Guimarães Jardim; Laélia Cristina Caseiro Vicente; Amélia Augusta de Lima Friche
Resumo
Objetivo: Analisar a função de deglutição de pacientes oncológicos em cuidados paliativos segundo a funcionalidade e o estado nutricional. Método: Estudo observacional, do tipo transversal, com pacientes com câncer avançado excluindo cabeça, pescoço e trato gastrointestinal superior, em cuidados paliativos ambulatorial de um centro oncológico brasileiro, realizado entre março de 2022 e agosto de 2023. Foram obtidos dados sociodemográficos, clínicos, funcionais e nutricionais. A avaliação fonoaudiológica classificou a habilidade de deglutição e a via de alimentação por meio dos protocolos PARD e FOIS, respectivamente. Foram realizadas análise descritiva, uni e multivariada por meio de regressão logística. Resultados: 39 indivíduos participaram do estudo, a maioria do sexo feminino, performance funcional entre regular a boa e moderadamente desnutridos. Na avaliação das habilidades de deglutição, os pacientes, majoritariamente, foram classificados com deglutição plenamente funcional, seguida de deglutição funcional com necessidades raras de mínimas pistas, tempo adicional ou evitar alimentos específicos. Quanto à classificação da deglutição, a maioria dos participantes apresentou deglutição normal ou deglutição funcional e apenas um paciente apresentou disfagia orofaríngea leve. A análise multivariada revelou associação significativa entre pior habilidade de deglutição e desempenho funcional e estado nutricional inferiores. Conclusão: Habilidade de deglutição prejudicada em pacientes com câncer avançado que não abarcam a região de cabeça, pescoço e trato gastrointestinal superior foi associada a uma funcionalidade global e estado nutricional inferiores.
Palavras-chave
Abstract
Purpose: This study sought to analyze the swallowing function of cancer patients undergoing palliative care according to the degree of functionality and nutritional status. Methods: observational, cross-sectional study, conducted with advanced cancer patients outside the head and neck and upper gastrointestinal tract, in an outpatient palliative care setting at a Brazilian oncology center, conducted between March 2022 and August 2023. In the first stage, sociodemographic, clinical, functional, and nutritional data were collected. Subsequently, a speech therapy assessment was performed to classify swallowing disorders and feeding route associated with swallowing ability. Descriptive, univariate, and multivariate analyses were conducted using logistic regression. Results: 39 individuals participated in the study, the majority were female, with functional performance between fair and good, moderately undernourished. Regarding the assessment of swallowing abilities, the sample mostly exhibited fully functional swallowing, followed by functional swallowing with occasional minimal cues, additional time, or avoidance of specific foods. As for the classification of swallowing, most participants had either normal swallowing or functional swallowing, with only one patient presenting mild oropharyngeal dysphagia. Multivariate analysis revealed a significant association between a decline in swallowing ability and poorer functional performance and nutritional status. Conclusion: Poorer swallowing ability in patients with advanced cancer, excluding those with head, neck, and upper gastrointestinal tract cancers, was associated with lower global functionality and nutritional status.
Keywords
Referências
- 1Wright M, Wood J, Lynch T, Clark D. Mapping levels of palliative care development: a global view. J Pain Symptom Manage. 2008;35(5):469-85. http://doi.org/10.1016/j.jpainsymman.2007.06.006 PMid:18243637.
» http://doi.org/10.1016/j.jpainsymman.2007.06.006 - 2WHPCA: Worldwide Hospice Palliative Care Alliance [Internet]. London: WHPCA; 2015 [citado em 2021 Ago 24]. Disponível em: https://www.thewhpca.org/
» https://www.thewhpca.org/ - 3WHO: World Health Organization. WHO definition of palliative care. Geneva: WHO; 2019.
- 4Frowen J. Dysphagia in patients with non-head and neck cancer. Curr Opin Otolaryngol Head Neck Surg. 2019;27(3):162-7. http://doi.org/10.1097/MOO.0000000000000541 PMid:30946062.
» http://doi.org/10.1097/MOO.0000000000000541 - 5Rivelsrud MC, Hartelius L, Bergström L, Løvstad M, Speyer R. Prevalence of oropharyngeal dysphagia in adults in different healthcare settings: a systematic review and meta-analyses. Dysphagia. 2023;38(1):76-121. http://doi.org/10.1007/s00455-022-10465-x PMid:35639156.
» http://doi.org/10.1007/s00455-022-10465-x - 6Kenny C, Gilheaney Ó, Walsh D, Regan J. Oropharyngeal dysphagia evaluation tools in adults with solid malignancies outside the head and neck and upper GI tract: a systematic review. Dysphagia. 2018;33(3):303-20. http://doi.org/10.1007/s00455-018-9892-9 PMid:29607447.
» http://doi.org/10.1007/s00455-018-9892-9 - 7Frowen J, Hughes R, Skeat J. The prevalence of patient-reported dysphagia and oral complications in cancer patients. Support Care Cancer. 2020;28(3):1141-50. http://doi.org/10.1007/s00520-019-04921-y PMid:31203510.
» http://doi.org/10.1007/s00520-019-04921-y - 8Wakabayashi H, Matsushima M, Uwano R, Watanabe N, Oritsu H, Shimizu Y. Skeletal muscle mass is associated with severe dysphagia in cancer patients. J Cachexia Sarcopenia Muscle. 2015;6(4):351-7. http://doi.org/10.1002/jcsm.12052 PMid:26673551.
» http://doi.org/10.1002/jcsm.12052 - 9Menezes TT, Furia CLB, Soares GXS. Frequency of swallowing and food complaints during shared consultation in oncological palliative care. Audiol Commun Res. 2022;27:e2607. http://doi.org/10.1590/2317-6431-2021-2607en
» http://doi.org/10.1590/2317-6431-2021-2607en - 10Bogaardt H, Veerbeek L, Kelly K, van der Heide A, van Zuylen L, Speyer R. Swallowing problems at the end of the palliative phase: incidence and severity in 164 unsedated patients. Dysphagia. 2015;30(2):145-51. http://doi.org/10.1007/s00455-014-9590-1 PMid:25533181.
» http://doi.org/10.1007/s00455-014-9590-1 - 11Okuni I, Otsubo Y, Ebihara S. Molecular and neural mechanism of dysphagia due to cancer. Int J Mol Sci. 2021;22(13):7033. http://doi.org/10.3390/ijms22137033 PMid:34210012.
» http://doi.org/10.3390/ijms22137033 - 12Monteiro DR, Almeida MA, Kruse MHL. Tradução e adaptação transcultural do instrumento Edmonton Symptom Assessment System para uso em cuidados paliativos. Rev Gaúcha Enferm. 2013;34(2):163-71. http://doi.org/10.1590/S1983-14472013000200021 PMid:24015476.
» http://doi.org/10.1590/S1983-14472013000200021 - 13Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982;5(6):649-55. http://doi.org/10.1097/00000421-198212000-00014 PMid:7165009.
» http://doi.org/10.1097/00000421-198212000-00014 - 14Morita T, Tsunoda J, Inoue S, Chihara S. The Palliative Prognostic Index: a scoring system for survival prediction of terminally ill cancer patients. Support Care Cancer. 1999;7(3):128-33. http://doi.org/10.1007/s005200050242 PMid:10335930.
» http://doi.org/10.1007/s005200050242 - 15Morita T, Tsunoda J, Inoue S, Chihara S. Validity of the palliative performance scale from a survival perspective. J Pain Symptom Manage. 1999;18(1):2-3. PMid:10439564.
- 16Murad M Jr. Avaliação de escore preditor de mortalidade em pacientes com tumor sólido avançado [dissertação]. Belo Horizonte: Universidade Federal de Minas Gerais; 2011.
- 17Stone CA, Tiernan E, Dooley BA. Prospective validation of the palliative prognostic index in patients with cancer. J Pain Symptom Manage. 2008;35(6):617-22. http://doi.org/10.1016/j.jpainsymman.2007.07.006 PMid:18261876.
» http://doi.org/10.1016/j.jpainsymman.2007.07.006 - 18VHS: Victoria Hospice Society. A Escala de Desempenho em Cuidados Paliativos versão 2 (EDCP v2) [Internet]. Victoria: VHS; 2009 [citado em 2019 Maio 27]. Disponível em: https://victoriahospice.org/wp-content/uploads/2019/07/pps_-_portuguese_brazilian_-_sample.pdf
» https://victoriahospice.org/wp-content/uploads/2019/07/pps_-_portuguese_brazilian_-_sample.pdf - 19Fielding RA, Vellas B, Evans WJ, Bhasin S, Morley JE, Newman AB, et al. Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International Working Group on Sarcopenia. J Am Med Dir Assoc. 2011;12(4):249-56. http://doi.org/10.1016/j.jamda.2011.01.003 PMid:21527165.
» http://doi.org/10.1016/j.jamda.2011.01.003 - 20Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16-31. http://doi.org/10.1093/ageing/afy169 PMid:30312372.
» http://doi.org/10.1093/ageing/afy169 - 21Roberts HC, Denison HJ, Martin HJ, Patel HP, Syddall H, Cooper C, et al. A review of the measurement of grip strength in clinical and epidemiological studies: towards a standardised approach. Age Ageing. 2011;40(4):423-9. http://doi.org/10.1093/ageing/afr051 PMid:21624928.
» http://doi.org/10.1093/ageing/afr051 - 22Gonzalez MC, Borges LR, Silveira DH, Assunção MCF, Orlandi SP. Validation of a Portuguese version of patient-generated subjective global assessment. Rev Bras Nutr Clin. 2010;25(2):102-8.
- 23Campos JADB, Prado CD. Cross-cultural adaptation of the Portuguese version of the Patient-Generated Subjective Global Assessment. Nutr Hosp. 2012;27(2):583-9. http://doi.org/10.1590/S0212-16112012000200035. PMid:22732987.
- 24ABEP: Associação Brasileira de Empresas de Pesquisa. Critério de Classificação Econômica Brasil – CCEB 2021 [Internet]. São Paulo: ABEP; 2021 [citado em 2021 Out 2]. Disponível em: http://www.abep.org/criterio-brasil
» http://www.abep.org/criterio-brasil - 25Padovani AR, Moraes DP, Mangili LD, Andrade CRF. Dysphagia risk evaluation protocol. Rev Soc Bras Fonoaudiol. 2007;12(3):199-205. http://doi.org/10.1590/S1516-80342007000300007
» http://doi.org/10.1590/S1516-80342007000300007 - 26Cichero JA, Lam P, Steele CM, Hanson B, Chen J, Dantas RO, et al. Development of international terminology and definitions for texture-modified foods and thickened fluids used in dysphagia management: the IDDSI framework. Dysphagia. 2017;32(2):293-314. http://doi.org/10.1007/s00455-016-9758-y PMid:27913916.
» http://doi.org/10.1007/s00455-016-9758-y - 27Crary MA, Mann GD, Groher ME. Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Arch Phys Med Rehabil. 2005;86(8):1516-20. http://doi.org/10.1016/j.apmr.2004.11.049 PMid:16084801.
» http://doi.org/10.1016/j.apmr.2004.11.049 - 28Turra GS, Schwartz IVD, Almeida ST, Martinez CC, Bridi M, Barreto SSM. Efficacy of speech therapy in post-intubation patients with oropharyngeal dysphagia: a randomized controlled trial. CoDAS. 2021;33(2):e20190246. http://doi.org/10.1590/2317-1782/20202019246 PMid:33909759.
» http://doi.org/10.1590/2317-1782/20202019246 - 29Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159-74. http://doi.org/10.2307/2529310 PMid:843571.
» http://doi.org/10.2307/2529310 - 30Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377-81. http://doi.org/10.1016/j.jbi.2008.08.010 PMid:18929686.
» http://doi.org/10.1016/j.jbi.2008.08.010 - 31Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O’Neal L, et al. Building an international community of software platform partners. J Biomed Inform. 2019;95:103208. http://doi.org/10.1016/j.jbi.2019.103208 PMid:31078660.
» http://doi.org/10.1016/j.jbi.2019.103208 - 32Matsuda Y, Karino M, Kanno T. Relationship between the Functional Oral Intake Scale (FOIS) and the self-efficacy scale among cancer patients: a cross-sectional study. Healthcare. 2020;8(3):269. http://doi.org/10.3390/healthcare8030269 PMid:32823778.
» http://doi.org/10.3390/healthcare8030269 - 33Mercadante S, Aielli F, Adile C, Ferrera P, Valle A, Fusco F, et al. Prevalence of oral mucositis, dry mouth, and dysphagia in advanced cancer patients. Support Care Cancer. 2015;23(11):3249-55. http://doi.org/10.1007/s00520-015-2720-y PMid:25832897.
» http://doi.org/10.1007/s00520-015-2720-y - 34Cocks H, Ah-See K, Capel M, Taylor P. Palliative and supportive care in head and neck cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol. 2016;130(S2):S198-207. http://doi.org/10.1017/S0022215116000633 PMid:27841131.
» http://doi.org/10.1017/S0022215116000633 - 35Hui D, Santos R, Chisholm GB, Bruera E. Symptom expression in the last seven days of life among cancer patients admitted to acute palliative care units. J Pain Symptom Manage. 2015;50(4):488-94. http://doi.org/10.1016/j.jpainsymman.2014.09.003 PMid:25242021.
» http://doi.org/10.1016/j.jpainsymman.2014.09.003 - 36Paiva CE, Faria CB, Nascimento MS, Dos Santos R, Scapulatempo HH, Costa E, et al. Effectiveness of a palliative care outpatient programme in improving cancer-related symptoms among ambulatory Brazilian patients. Eur J Cancer Care. 2012;21(1):124-30. http://doi.org/10.1111/j.1365-2354.2011.01298.x PMid:22044405.
» http://doi.org/10.1111/j.1365-2354.2011.01298.x - 37Oliveira LC, Abreu GT, Lima LC, Aredes MA, Wiegert EVM. Quality of life and its relation with nutritional status in patients with incurable cancer in palliative care. Support Care Cancer. 2020;28(10):4971-8. http://doi.org/10.1007/s00520-020-05339-7 PMid:32034514.
» http://doi.org/10.1007/s00520-020-05339-7 - 38INCA: Instituto Nacional de Câncer José Alencar Gomes da Silva. Consenso nacional de nutrição oncológica. 2. ed. Rio de Janeiro: INCA; 2015.
- 39SBNO: Sociedade Brasileira de Nutrição Oncológica. Consenso brasileiro de nutrição oncológica da SBNO. Rio de Janeiro: Edite; 2021.
- 40Matsuo H, Sakuma K. Pathophysiology of cachexia and characteristics of dysphagia in chronic diseases. Asia Pac J Oncol Nurs. 2022;9(10):100120. http://doi.org/10.1016/j.apjon.2022.100120 PMid:36118624.
» http://doi.org/10.1016/j.apjon.2022.100120 - 41Grant M, de Graaf E, Teunissen S. A systematic review of classifications systems to determine complexity of patient care needs in palliative care. Palliat Med. 2021;35(4):636-50. http://doi.org/10.1177/0269216321996983 PMid:33706600.
» http://doi.org/10.1177/0269216321996983 - 42O’Reilly AC, Walshe M. Perspectives on the role of the speech and language therapist in palliative care: an international survey. Palliat Med. 2015;29(8):756-61. http://doi.org/10.1177/0269216315575678 PMid:25762581.
» http://doi.org/10.1177/0269216315575678 - 43Tohara H, Saitoh E, Mays KA, Kuhlemeier K, Palmer JB. Three tests for predicting aspiration without videofluorography. Dysphagia. 2003;18(2):126-34. http://doi.org/10.1007/s00455-002-0095-y PMid:12825906.
» http://doi.org/10.1007/s00455-002-0095-y - 44Ling J, Rees E, Hardy J. What influences participation in clinical trials in palliative care in a cancer centre? Eur J Cancer. 2000;36(5):621-6. http://doi.org/10.1016/S0959-8049(99)00330-5 PMid:10738127.
» http://doi.org/10.1016/S0959-8049(99)00330-5 - 45Chvetzoff G, Girodet M, Despax J, Baudry V, Duranti J, Mastroianni B, et al. Reasons for acceptance and refusal of early palliative care in patients included in early-phase clinical trials in a regional comprehensive cancer centre in France: protocol for a qualitative study. BMJ Open. 2022;12(4):e060317. http://doi.org/10.1136/bmjopen-2021-060317 PMid:35459679.
» http://doi.org/10.1136/bmjopen-2021-060317
Submetido em:
07/07/2024
Aceito em:
22/11/2024
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email