Assessments of well-being in caring of patients undergoing surgery for gastrointestinal cancer. Studies of nutrition, activities of daily living and health related quality of life

Detta är en avhandling från Department of Surgery, Lund University Hospital, S-221 85 Lund, Sweden

Sammanfattning: The aim was to study some aspects of patients´ well-being, related to nutrition, activities of daily living and health related quality of life, when undergoing major gastrointestinal cancer surgery. Chart documentations (N=45) of patients undergoing subtotal pancreatectomy were studied, and showed the patients' well-being to be affected, although it was not possible to fully evaluate the results of the assessments and the care given. A Subjective Global Assessment of nutritional status (SGA), was therefore modified and translated into Swedish, its validity and reliability were tested, and found to be acceptable. Patients with colorectal cancer (N=90) were prospectively assessed by the modified SGA, six nutritional criteria, the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire-C30, version 1.0 (EORTC QLQ-C30) and the Activities of Daily Living (ADL) Staircase preoperatively, and at follow up (median 6.7 months). During hospital stay the patients’ energy intake were recorded and compared with their estimated basal energy expenditure. The results showed the well-being of the patients to be affected preoperatively by gastrointestinal symptoms, weight loss and fatigue, with 8 % classified as suspected of being malnourished. An association was found between tumour burden, diabetes, treatment factors, and postoperative nutrition-associated complications. The patients were found to be semistarved postoperatively. At follow up evaluations the patients had improved emotionally, had better appetite, and had higher scores on quality of life, compared to preoperatively, although an increase in dependence in activities of daily living and persistent scores of fatigue were found. In conclusion, well-being of patients undergoing major gastrointestinal cancer surgery is affected, and requires systematic assessment and documentation. Nutritional treatment and care is suggested to be improved by multiprofessional cooperation.

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