Ketahanan Gizi sebagai Prediktor Kelelahan pada Pasien Kanker Selama Kemoterapi: Studi Kohort Prospektif
DOI:
https://doi.org/10.22437/jkuj.v10i1.48283Kata Kunci:
cancer-related fatigue, chemotherapy, nutritional resilience, food insecurity, diet qualityAbstrak
Kelelahan terkait kanker (cancer-related fatigue/CRF) merupakan salah satu gejala paling membebani selama kemoterapi, namun prediktor yang efektif terhadap trajektorinya masih terbatas. Meskipun kualitas diet dan ketidakamanan pangan telah diteliti secara terpisah, konsep terpadu resiliensi nutrisi—kemampuan untuk mempertahankan kecukupan gizi melalui akses pangan yang stabil, pola makan sehat, dan perilaku makan adaptif—belum pernah ditelaah secara sistematis.
Penelitian ini mengevaluasi apakah Nutritional Resilience Index (NRI) dapat memprediksi hasil kelelahan pada pasien kanker yang menjalani kemoterapi di Medan, Indonesia. Sebuah studi kohort prospektif dengan teknik consecutive sampling dilakukan pada 200 pasien dewasa dengan tumor solid di dua rumah sakit rujukan tersier. NRI baseline dihitung dari tiga domain: ketahanan pangan (HFIAS), kualitas diet (AHEI-2010), dan strategi manajemen makan adaptif. Kelelahan diukur pada baseline, setelah siklus kedua, dan setelah siklus keempat menggunakan skala FACIT-F. Analisis regresi linear hierarkis digunakan untuk menguji nilai prediktif NRI terhadap trajektori kelelahan dengan mengendalikan kovariat demografis dan klinis.
Hasil menunjukkan peserta (usia rata-rata 52,3 ± 11,6 tahun; 64% perempuan) memiliki kelelahan tingkat sedang pada baseline (FACIT-F 29,8 ± 8,6). Kelelahan memburuk secara signifikan sepanjang kemoterapi (24,1 ± 9,4 pada siklus 4; p<0,001). Analisis regresi menunjukkan bahwa NRI baseline yang lebih tinggi memprediksi skor kelelahan yang lebih rendah secara signifikan pada siklus 4 (β = −0,31; p<0,001), independen dari usia, jenis kelamin, stadium kanker, dan kelelahan baseline. Model menjelaskan 42% varians dalam hasil kelelahan (adjusted R² = 0,42).
Resiliensi nutrisi secara independen memprediksi CRF selama kemoterapi. Skrining dan penguatan resiliensi nutrisi dapat melengkapi manajemen kelelahan berbasis pedoman dengan secara simultan menangani kualitas diet, akses pangan, dan perilaku makan adaptif.
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