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"Kaheksia merupakan sindrom multifaktorial yang menyebabkan gangguan fungsional progresif dan tidak dapat ditangani dengan terapi nutrisi konvensional. Kaheksia dijumpai pada 45% penderita kanker dan bila tidak diatasi dapat menyebabkan kematian 22% pasien kanker. Terapi medik gizi merupakan bagian dari terapi multimodal yang direkomendasikan dalam tatalaksana kaheksia dengan tujuan menjaga atau meningkatkan asupan makan, status gizi, dan kapasitas fungsional. Serial kasus ini melaporkan empat pasien kaheksia pada kanker dengan intake sulit berusia 42-53 tahun. Tiga pasien berstatus gizi normal, sedangkan satu pasien obes berdasakan kriteria World Health Organization (WHO) Asia Pasifik. Terapi medik gizi diberikan sesuai pedoman pada kanker dengan target pemberian energi sesuai Kebutuhan Energi Total (KET) masing-masing pasien yang dihitung dari Kebutuhan Energi Basal (KEB) yang dikalikan dengan faktor stres 1,5. Protein diberikan minimal 1,2 g/kgBB/hari untuk pasien dengan fungsi ginjal normal dan 0,8 g/kgBB/hari untuk pasien dengan penyakit ginjal kronis. Nutrien spesifik asam amino rantai cabang (AARC) dipenuhi melalui pemberian bahan makanan sumber dan oral nutrition supplementation (ONS). Keempat pasien pulang dengan perbaikan asupan makan dan peningkatan kapasitas fungsional. Status gizi keempat pasien dapat dipertahankan selama perawatan. Terapi medik gizi dapat meningkatkan asupan makan, menjaga status gizi, dan meningkatkan kapasitas fungsional pasien kaheksia pada kanker dengan intake sulit.

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Cachexia is a multifactorial syndrome responsible for progressive functional impairment that cannot be overcome with conventional nutrition therapy. Cachexia was found in 45% of cancer patients and will lead to death in 22% cancer patients. Nutrition therapy is a part of multimodal therapy that was recommended in cachexia therapy to maintain or increase food intake, nutritional status, and functional capacity. This case series report four cancer cachexia patients with low intake aged 42-53 years old. Three patients have normal nutritional status, while one patient is obese based on World Health Organization (WHO) for Asia Pacific criteria. Nutrition therapies were given based on cancer guideline with energy target prescriptions according to total energy requirements for each patients. Proteins were given with minimal 1,2 g/kgBW/day for patients with normal kidney function and 0,8 g/kgBW/day for patient with chronic kidney disease.  Specific nutrient branched-chain amino acids (BCAA) requirements are fulfilled by administration of Oral Nutrition Supplementation (ONS). All four patients were discharged with improvements in food intake and functional capacity. No nutritional status were declined during hospitalization. Medical nutrition therapy could improve food intake, maintain nutritional status, and improve functional capacity in cachexia cancer with low intake patients."

"Latar belakang: Kanker sel skuamosa (KSS) lidah adalah keganasan rongga mulut tersering dengan prognosis terburuk. Insiden KSS lidah cenderung meningkat dan semakin banyak pada usia kurang dari 45 tahun. Hampir semua pasien kanker kepala leher mengalami malnutrisi saat didiagnosis kanker. Tiga puluh satu persen pasien KSS kepala leher dengan kaheksia memiliki disease-free survival lebih rendah dibandingkan pasien yang tidak kaheksia. Modalitas terapi KSS lidah seperti radioterapi, kemoterapi, pembedahan, maupun kombinasi ketiganya dapat memperburuk malnutrisi atau kaheksia yang telah terjadi jika tidak ditatalaksana dengan baik. Terapi medik gizi diperlukan pada pasien KSS lidah yang menjalani radioterapi untuk mencegah malnutrisi atau kaheksia.Metode: Pasien KSS lidah berusia 41-53 tahun. Tiga pasien berjenis kelamin perempuan dan satu orang laki-laki. Dua pasien telah menjalani pembedahan, semua pasien menjalani radioterapi bersamaan dengan kemoterapi. Satu pasien memiliki hasil skrining MST kurang lebih 5, dan selebihnya memiliki nilai 4. Pemantauan dilakukan sebelum, saat, dan sesudah radioterapi meliputi keluhan subjektif, kondisi klinis, pemeriksaan laboratorium, antropometri, komposisi tubuh, kapasitas fungsional dan analisis asupan. Keempat pasien mendapatkan edukasi nutrisi, oral nutrition support (ONS), suplementasi vitamin dan mineral serta asam lemak omega-3.Hasil: Keempat pasien dapat meningkatkan asupan makanannya. Pasien mengalami penurunan berat badan, tiga pasien mengalami kenaikan berat badan pasca radioterapi. Dua pasien menggunakan NGT serta memiliki penyulit berupa hipertiroid subklinis dan DM tipe 2. Pasien mengalami anemia, dua di antaranya mengalami perbaikan kadar Hb. Terjadi penurunan massa otot namun terdapat perbaikan kekuatan genggaman tangan dan skor EGOG.Kesimpulan: Terapi medik gizi dapat memperbaiki keluaran klinis, kapasitas fungsional, antropometri, dan laboratorium terutama pada pasien tanpa penyulit

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Background. Squamous cell carcinoma of the tongue (SCCOT) is the most common oral cavity cancer with the worst prognosis. The incidence of SCCOT tends to increase at the age of less than 45 years old. Almost all head and neck cancer patients are malnourished at the time of diagnosis. Thirty-one percent of head and neck SCC cachexia patients have a lower disease-free survival than non cachexia. Modalities of tongue SCC therapy such as radiotherapy, chemotherapy, surgery, or a combination of all three can worsen malnutrition or cachexia that has occurred if it is not managed properly. Early medical nutrition therapy is required in SCCOT patients undergoing radiotherapy to prevent cachexia or malnutrition.

Method. Four SCCOT patients 41-53 years old. Three patients were females and one patient was male. Two patients underwent surgery, and all patients underwent concurrent radio-chemotherapy. One patient had MST score more less than 5, and the rest had a score of 4. Monitoring was carried out before, during and after radiotherapy including subjective complaints, clinical conditions, laboratory examinations, anthropometry, body composition, functional capacity and food intake analysis. Four patients received nutritional education, oral nutrition support (ONS), supplementation of vitamins and minerals and omega-3 fatty acid.

Results. All patients can increase their food intake. Patients experienced weight loss, most of them experienced weight gain after radiotherapy. Two patients used tube feeding and had complications of subclinical hyperthyroidism and type 2 diabetes. Patients had anemia, two of them had improved hemoglobin level. There was a decrease in muscle mass but there was an improvement in the strength of hand grip and EGOG score, especially after radiotherapy.

Conclusion. Medical nutrition therapy can improve clinical outcomes, functional capacity, anthropometry, and laboratory especially in patients without complications."