Malnutrition in patients treated for colorectal cancer – a multidimensional clinical, nursing, and ethical-legal problem

Introduction:
Malnutrition in patients treated for colorectal cancer promotes complications and worsens prognosis. It represents a significant (and highly complex) clinical and nursing problem, and in the context of the need to ensure an adequate quality of life for the patient – also an ethical and legal one. Therefore, early and appropriate identification of patients with malnutrition and implementation of appropriate treatment methods is very important. Assessment of the degree of malnutrition in patients with colorectal cancer at the generalised stage treated at the St. John of Dukla Oncology Centre of Lublin to verify the hypothesis that the presence of cancer and the application of specific oncological treatment methods may be factors increasing the risk of developing malnutrition with the clinical, nursing, and ethical-legal consequences indicated in the article.

Material and methods:
The study included 101 patients with metastatic colorectal cancer treated in the Department of Clinical Oncology at the St. John of Dukla Oncology Centre in Lublin. It was retrospective in nature. A survey method was used, carried out using a questionnaire technique and the following tools: the subjective global assessment (SGA) scale, the numerical rating scale 2002, anthropometric examinations, skinfold measurement with a fold gauge, the Eastern Cooperative Oncology Group-World Health Organisation form, and medical records.

Results:
The nutritional status of the patients studied was not directly related to gender or their clinical status, while the risk of malnutrition was higher in elderly patients (> 67 years). In patients with metastatic colorectal cancer, body weight and body mass index (BMI) correlate negatively with SGA classification – i.e. the lower the body weight and BMI, the higher the SGA grade. Those with normal nutritional status were also less likely to have adverse gastrointestinal symptoms and abnormalities related to fluid intake and regular food intake. In the last 3 months of the disease, weight loss and BMI were found in 51.5% of patients. It appears that weight loss and BMI decrease may be dependent on the initial tumour location – a decrease in their values was most frequently observed in patients with colon and rectal cancer. In contrast, the results of the study did not confirm a correlation between increased tumour weight and increased cachexia.

Conclusions:
The presence of cancer and the use of certain oncological treatments may be factors that increase the risk of developing malnutrition. Because of the increased risk of malnutrition, the nutritional status of patients should be the basis for comprehensive medical care and, if features of malnutrition are found, the implementation of appropriate nutritional therapy – nutritional treatment. The objectives indicated in the documents defining the oncology patient’s guarantees for dignified and qualitatively best possible functioning, both physical and psychological, should also be met to the fullest extent possible.