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Abstrak :
Kuantitas dan kualitas asupan protein belum sepenuhnya diketahui perannya terhadap kualitas hidup. Prognostic Nutritional Index (PNI) juga belum diketahui dapat mencerminkan kualitas hidup dan apakah bisa ditingkatkan dengan asupan protein. Penelitian dengan desain potong lintang ini bertujuan untuk mengetahui korelasi antara asupan protein dengan PNI dan kualitas hidup serta korelasi PNI dengan kualitas hidup pada pasien kanker kepala leher dengan radioterapi di Departemen Radioterapi Rumah Sakit dr. Cipto Mangunkusumo, Jakarta. Sebanyak 61 subjek didapatkan dari consecutive sampling. Rerata usia subjek adalah 46,3 ± 12,4 dan 65,6% subjek berada pada kanker stadium IV dan mendapatkan terapi kemoradiasi. Sebanyak 32,8% subjek yang memiliki status gizi kurang. Median asupan protein adalah 1,42 (0,26-4,11) g/kg/hari. Nilai PNI pada subjek penelitian memiliki median 45,9 (29,4-54,2). Hasil penelitian menunjukkan adanya korelasi bermakna antara kuantitas asupan protein berdasarkan Food Frequency Questionnaire (FFQ) semikuantitatif dan beberapa aspek gejala pada kualitas hidup yaitu pada aspek pain (head and neck) (r=-0,32; p=0,01), swallowing (r=-0,37;p=0,004), social eating (r=-0,29; p=0,02), dry mouth (r=-0,41; p=0,001), sticky saliva (r=-0,32; p=0,01), fatigue (r=-0,28; p=0,03), nausea and vomiting (r=-0,26; p=0,04) dan appetite loss (r=-0,3; p=0,01). Kualitas asupan protein tidak berkorelasi bermakna dengan kualitas hidup. PNI berkorelasi bermakna terhadap 1 aspek fungsional yaitu physical function (r=0,378; p=0,003) dan 2 aspek gejala yaitu opening mouth (r=-0,325; p=0,01) dan dyspnea (r=-0,257; p=0,045). Meskipun tidak signifikan secara statistik, namun PNI memiliki arah korelasi yang positif terhadap aspek fungsional lainnya dan memiliki arah korelasi negatif terhadap aspek gejala lainnya yang berarti semakin tinggi PNI maka aspek fungsional semakin baik dan gejala semakin ringan. Studi ini tidak menemukan adanya korelasi bermakna antara asupan protein, baik kualitas maupun kuantitasnya, terhadap PNI. Hasil ini diduga berkaitan dengan penemuan bahwa sebagian besar penderita masih memiliki pola asupan yang mampu mencukupi kebutuhan kalori dan protein harian. Diperlukan studi prospektif yang menelusuri aspek prognostik kanker kepala leher dari segi kualitas hidup untuk mengetahui apakah PNI dapat memprediksi aspek kualitas hidup dengan lebih rinci. ......Quality and quantity of protein intake has not been well understood that it can affect quality of life. Moreover, Prognostic Nutritional Index (PNI) also has not been well studied upon its usage to reflect quality of life of head and neck cancer patients undergoing radiotherapy. This cross sectional study was aimed to determine the correlation between protein intake and PNI and also the correlation between PNI and quality of life in head and neck cancer patients undergoing radiotherapy at Radiotherapy Department, dr. Cipto Mangunkusumo General Hospital, Jakarta. Total of 61 subjects were recruited with consecutive sampling method with mean age of 46,3 ± 12,4 years old and 65,6% subjects were on stage IV cancer and were getting a combination of chemo and radiotherapy. Only 32,8% subjects were on low nutritional status. Median of total protein intake was 1,42 (0,26-4,11) g/kg/day. Median of PNI was 45,9 (29,4-54,2) among subjects. The result of the study showed a significant correlations between quanitity of protein intake based on semiquantitative Food Frequency Questionnaire (FFQ) with several aspects of quality of life, that were pain (head and neck) (r=-0,32; p=0,01), swallowing (r=-0,37; p=0,004), social eating (r=-0,29; p=0,02), dry mouth (r=-0,41; p=0,001), sticky saliva (r=-0,32; p=0,01), fatigue (r=-0,28; p=0,03), nausea and vomiting (r=-0,26; p=0,04) dan appetite loss (r=-0,3; p=0,01). This aspects were all symptomatics. PNI was significantly correlated with 1 functional aspect, which was Physical function (r=0.378; p=0,003) and 2 symptomp aspects, which were opening mouth (r=-0,325; p=0,01) dan dyspnea (r=-0,257; p=0,045). Although not statistically significant, but there were positive direction of correlation with other functional aspects and negative direction of correlation with other symptomps aspects. This implicates that the higher the PNI, the lower the symptoms and the better the functional status of head and neck cancer patients undergoing radiotherapy. This study did not show a significant correlation between quality and quantity of protein intake with PNI. An adequate intake of calorie and protein in most subjects were found in this study which might explain the result. More studies, preferably prospective one, may be needed to show the usage of PNI to reflect quality of life, especially involving quality of life progresivity.

Abstrak :
Penelitian ini merupakan penelitian potong lintang di Departemen Radioterapi Rumah Sakit Umum Pusat Nasional Dr. Cipto Mangunkusumo Jakarta, yang bertujuan untuk mengetahui korelasi antara kadar asam lemak omega-3 terhadap massa otot dan kekuatan genggam pada subjek kanker kepala leher yang mendapatkan radioterapi. Kaheksia kanker sering terjadi pada kanker kepala leher akibat peningkatan sitokin proinflamasi yang menyebabkan hipermetabolisme, peningkatan kebutuhan nutrisi, anoreksia, penurunan massa otot dan berat badan. Asam lemak omega-3 berperan dalam menurunkan inflamasi, meningkatkan massa otot, dan kekuatan genggam. Dari 52 subjek yang sudah mendapatkan radioterapi ge;25 kali, 57 adalah laki-laki dengan rerata usia di atas 50 tahun. Lokasi kanker paling banyak di area nasofaring, sebagian besar sudah berada pada stadium IV dan mendapatkan kombinasi radioterapi dan kemoterapi. Sebesar 38,5 dan 32,7 subjek berada pada kategori indeks massa tubuh normal dan kurang. Data yang diperoleh dari penelitian ini dapat memberikan gambaran kurangnya asupan energi, protein, lemak, dan asam lemak omega-3, serta massa otot sebagian besar subjek yang tergolong kecil 28,4 4,7 , dengan kekuatan genggam sebagian besar subjek tergolong normal, dan kadar asam lemak omega-3 plasma seluruh subjek yang tergolong rendah 2,5 0,8 . Data tersebut menunjukkan adanya masalah nutrisi pada pasien kanker kepala leher. Terdapat korelasi yang kuat antara kadar asam lemak omega-3 plasma terhadap massa otot r =0,6, p 50?60 Gy dan 50 Gy. ......This cross sectional study conducted in the Department of Radiotherapy Dr. Cipto Mangunkusumo Hospital, aimed to investigate the correlation between omega 3 fatty acids plasma levels with muscle mass and hand grip muscle strength in subjects with head and neck cancer undergoing radiotherapy. Cancer cachexia is common in head and neck cancer as a result of the increasing of proinflammatory cytokines that cause hipermetabolisme, increased nutritional needs, anorexia, decreased muscle mass and body weight. Omega 3 fatty acids play a role in reducing inflammation, as well as improving muscle mass and hand grip. There were 52 subjects who had received radiotherapy ge 25 times, 57 were male with a mean age of 50 years. Most cancer sites were at nasopharynx area, mostly in stage IV and received a combination of radiotherapy and chemotherapy. There were 38,5 of the subjects in the normal body mass index and 32,7 were in low body mass index. The data from this study showed inadequate intake of energy, protein, fat, and omega 3 fatty acids, as well as muscle mass majority was small 28,4 4,7 , with most of the hand grip classified as normal, and the plasma levels of omega 3 fatty acids all of the subjects were low 2,5 0,8 . The data showed that there were nutritional problems in patients with head and neck cancer. There was strong correlation of plasma levels of omega 3 fatty acids with muscle mass r 0,8, p 50 60 Gy and 50 Gy.