1683 - Malnutrition in cancer patients: is a late diagnosis a missed opportunity to improve care?

Background

Malnutrition (MN) related metabolic defects, through the tumor or its treatment, can negatively impact on cancer patients’ outcomes. Yet, MN is often undiagnosed and untreated. This study investigated diagnoses of MN and hospital resource use in patients with gastro-intestinal (GI) system cancers.

Methods

The study used the French Hospital database PMSI MCO. We identified 644,720 GI cancer patients (colon-rectal-anal, liver/biliary tract, pancreas, stomach, esophagus) with a first related hospital stay (no stay 2 years pre-index) between 2013 and 2016. Patients were grouped into: no MN diagnosis, MN diagnosis at first hospitalization and MN diagnosis after first hospitalization. Resource use (number and duration of hospitalizations) was analyzed by patient group, GI cancer category and by presence/absence of metastases. Propensity score matching for key characteristics, such as age, gender and comorbidities was used to adjust for differences between groups.

Results

MN diagnoses at first hospitalization occurred in 10% of patients, 13% were diagnosed after first hospitalization and 77% had no diagnosis of MN during the study period. Patients without MN had on average 5.2 hospitalizations of 13 days. Compared to MN diagnosed at first hospitalization, hospital stays were twice as frequent and longer when MN was diagnosed after 1^st cancer hospitalization (6.8 vs. 13.9 stays and 38 vs. 53 days, respectively). After propensity score matching, a significantly higher frequency of hospitalizations in those with a late compared to early diagnosis of MN remained. Differences in frequency and duration of hospitalizations increased linearly with a later MN diagnosis (1, 3, 6 months after first hospitalization), with the strongest association in patients without metastases.

Conclusions

The data suggests that an earlier diagnosis of MN should help to reduce frequency and length of hospitalizations, particularly in patients without metastases, potentially improving patients’ clinical outcomes and reducing health economic costs. Further research is warranted to understand the potential of early nutritional therapy in improving cancer patients’ outcomes and in reducing resource use.

Clinical trial identification

Legal entity responsible for the study

Baxter Healthcare SA, Zurich, Switzerland.

Funding

Baxter Healthcare SA, Zürich, Switzerland. This work is supported by a public grant overseen by the French National Research Agency (ANR) as part of the “Investissements d’Avenir” program (reference: ANR-10-EQPX-17 - Centre d’accès sécurisé aux données – CASD).

Editorial Acknowledgement

Medical writing support for this abstract was provided by Anne-Kathrin Fett, IQVIA, Frankfurt, Germany.

Disclosure

G. Zalcman: Consultant and/or on advisory panel: Baxter Healthcare Corporation; Personal fees: BMS, MSD, AstraZeneca for advisory board; Investigator in clinical trials: BMS, Roche, Takeda, Boerhinger, AstraZeneca, Pfizer; Reimbursement for congress attendance: Pfizer (ASCO 2015), Roche (ASCO 2017), Abbvie (ASCO 2018), AstraZeneca (ESMO 2017, WCLC 2018). R. Bernard, A. Zerouali: Employee, holds stock: Baxter Healthcare Corporation. F. Goldwasser: Consultant and/or on advisory panel: Baxter Healthcare Corporation, Fresenius Kabi. All other authors have declared no conflicts of interest.