Effects of the PRE- and post-operative nutritional support on inflammation symptoms and quality of life in LUNG cancer patients

Lung cancer is the most common type of cancer that causes death. In a randomized controlled intervention study, the effects of glutamine, arginine and hydroxymethylbutyrate on nutritional status, inflammation indicators and quality of life in patients with lung cancer. After a healthy diet program was applied to 70 patients aged between 27-77 years who were diagnosed with non-small cell lung cancer and planned for surgery, they were randomly divided into two groups, and the intervention (n=35) group (IG) was given 2 sachet per day, 10 days before the operation and 5 days after the operation. Nutritional supplement containing glutamine (7.4 g/sachet), arginine (7.4 g/sachet) and hydroxymethyl butyrate (1.3 g/sachet) was given. No nutritional support was given to the control group (CG) (n=35). The participants were monitored three times: at the beginning, before the operation (10th day of the nutritional support) and after the operation (the 15th day of the nutritional support). Nutritional status was monitored with patient-generated subjective global assessment (PG-SGA), and physical performance status was monitored with the eastern cooperative oncology group performance status scale (ECOG-PS). Anthropometric measurements, bioelectrical impedance analysis (BIA) results and biochemical findings were recorded. CRP/albumin ratio (CAR), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and prognostic nutrition index (PNI) were calculated with the biochemical parameters. TNF-α, IL-6 parameters were analyzed by ELISA in blood samples taken from patients. In addition, three-day food consumption records were taken from the patients in the pre-op and post-op period, and their energy and nutrient intakes were evaluated. As a result of the study, PG-SGA and ECOG-PS scores were lower in the IG in the post-op period than in the CG (p<0,05). In the post-op period, no difference between the IG and CG in terms of hemoglobin, hematocrit, total protein, albumin, lymphocyte, neutrophil and leukocyte counts, and PNI levels (p>0,05). The levels of inflammatory markers such as CRP, CAR, NLR, PLR, TNF-α, IL-6 increased in both groups in the postop period compared to the preop period (p<0.001) and there was no difference between the groups (p>0.05). The postop quality of life and physical function scores were higher in the group using nutritional support (p<0.05). In the post-op period, the pain, fatigue and insomnia scores were higher in the control group (p<0.05). In the post-op period, calf circumference in male individuals in the CG and hand grip strength in female individuals were lower than in the IG (p<0.05). There was no difference in body composition in both groups in the pre-op and post-op period (p>0.05). Wound healing time was 18 days in the IG and 20 days in the CG (p=0.015). In the postop period, energy, macro and micro nutrient consumptions of individuals in both groups decreased (p<0.05), and no significant difference was obtained between the groups. These findings show that immunonutritional support can have positive effects on nutritional and physical performance status, anthropometric measurements, quality of life and wound healing process in the postop period. Key words: lung cancer surgery, glutamine, arginine, hydroxymethylbutyrate, quality of life