Tesis

Terapi Medik gizi Pada Pasien Lansia dengan Kanker Kepala Leher yang Menjalani Radiasi = Nutritional Management in Elderly Patients with Head and Neck Cancer Undergoing Radiation Therapy.

Latar Belakang: Penuaan merupakan salah satu faktor risiko terjadinya penyakit kanker. Seiring peningkatan harapan hidup semakin meningkat pula populasi lansia yang mengalami kanker kepala leher. Pasien lansia dengan kanker kepala dan leher berisiko tinggi mengalami gangguan nutrisi. Berdasarkan penelitian, diketahui sitokin dan hormon pro-inflamasi, terlibat dalam patogenesis malnutrisi dan kaheksia. Kehilangan kekuatan otot dan massa otot rangka sering terjadi karena proses penuaan maupun terapi kanker. Sarkopenia sering ditemui pada pasien keganasan. Pemberian nutrisi pada pasien kanker kepala leher selama menjalani radioterapi bertujuan menjaga status nutrisi, toleransi terapi, kapasitas fungsional, prognosis secara keseluruhan serta mencegah sarkopenia. Metode: Pasien kanker kepala leher (KKL) berusia 60-70 tahun. Keempat pasien berjenis kelamin laki-laki. Satu orang pasien dengan KSS sinonasal T3N0M0, dua orang dengan KSS laring T4aN0M0 dan T3N2bM0 dan satu orang dengan karsinoma nasofaring (KNF) T2N2M0. Dua orang pasien menjalani kemoradioterapi, dua orang menjalani radioterapi dengan satu orang mendapat neoadjuvant chemotherapy (NAC) sebelumnya. Dilakukan pemantauan sebelum, selama, dan 2 minggu pasca radioterapi terhadap keluhan nutrisi akibat terapi, antropometri, analisis asupan, komposisi tubuh, kekuatan genggam tangan, dan kapasitas fungsional. Pemeriksaan untuk mengetahui sarkopenia dengan memeriksa massa otot, kekuatan genggaman tangan, dan performa fisik baik dengan berjalan 6 meter, maupun chair stand test. Hasil: Asupan 2 pasien melebihi kebutuhan energi total (KET) di akhir radiasi namun 2 orang pasien masih di bawah KET. Asupan protein 2 orang pasien dapat mencapai rekomendasi ESPEN. Asupan lemak dalam rentang 18-33% dan karbohidrat 53-68%. Kebutuhan mikronutrien dapat dipenuhi keempat pasien dan semua pasien dipreskripsikan EPA. Tiga pasien dengan malnutrisi sedang, satu pasien dengan malnutrisi berat. Tiga pasien mengalami penurunan massa otot dan fat free mass index (FFMI), walaupun 2 orang pasien dengan FFMI di atas nilai normal. Skeletal mass index (SMI) menurun pada 3 orang pasien. Hasil performa fisik baik pada 3 orang pasien. Tiga orang pasien dalam kondisi pra sarkopenia sedangkan 1 pasien tidak. Tiga pasien mengalami penurunan berat badan, 1 pasien mengalami peningkatan berat badan. Kekuatan genggaman tangan keempat pasien normal dan skor ECOG menetap selama radiasi. Keluhan klinis berkurang pasca radiasi. Kesimpulan: Pemberian terapi nutrisi dapat memengaruhi status nutrisi dan kapasitas fungsional serta mencegah kondisi sarkopenia.
Kata Kunci: Kanker kepala leher, kaheksia, sarkopenia, massa otot


Backgroud: Aging is a risk factor for cancer. Along with increasing life expectancy, the elderly patients with head and neck cancer increase. Elderly patients with head and neck cancer have high risk of nutritional deficiencies. Several agents, such as cytokines and pro-inflammatory hormones, have been implicated in the pathogenesis of malnutrition and cachexia. Loss of muscle strength and skeletal muscle mass are common and develop due to aging and cancer therapy. Sarcopenia is common in malignant patients. Providing nutrition support for head and neck cancer patients undergoing radiotherapy aims to maintain nutritional status, therapy tolerance, functional capacity, overall prognosis and to prevent sarcopenia. Methods: Head and neck cancer patients aged 60-70 years. All patients are male. One patient with T3N0M0 squamous cell carcinoma sinonasal, two patients with T4aN0M0 and T3N2bM0 laryngeal carcinomas and another with nasopharynx carcinoma T2N2M0. Two patients have undergone chemoradiotherapy, two patients radiotherapy with one person with neoadjuvan chemotherapy history prior radiation. Monitoring was carried out before, during, and 2 weeks after radiotherapy for nutritional complaints due to therapy, anthropometry, analysis of intake, body composition, hand grip strength, and functional capacity. Examination to determine sarcopenia by examining muscle mass, hand grip strength, and physical performance using 6 meters walking test and chair stand test. Results: The intake of 2 patients exceeded the total energy requirement (KET) at the end of the radiation . Protein intake of 2 patients could reach the ESPEN recommendations. Fat intake in the range of 18-33% and carbohydrates 53-68%. Micronutrient requirements were met in all four patients and all patients were prescribed EPA. Three patients with moderate malnutrition, one patient with severe malnutrition. Three patients had decreased muscle mass and fat free mass index (FFMI), although 2 patients had FFMI above normal values. Skeletal mass index (SMI) decreased in 3 patients. The results of physical performance within normal range in 3 patients. Three patients were in pre-sarcopenia while 1 patient was not. Three patients experienced weight loss, 1 patient experienced weight gain. Hand grip strength of all four patients were normal and the ECOG scores remained constant during radiation. Clinical complaints are reduced after radiation. Conclusion: The provision of nutritional therapy maintains nutritional status and functional capacity and prevents sarcopenia.
Keywords:Head and neck cancer, cachexia, sarcopenia, muscle mass