Abstract 1238P
Background
50-85% of patients with UGI cancer suffer from severe malnutrition, which has a negative impact on morbidity and mortality.
Methods
Nutritional status, body composition (BIA, CT scan), quality of life (QoL) and morbidity was evaluated in 69 pat. with locally advanced esophageal or gastric cancer at initial diagnosis (V1), 1-4 w after termination of neo-adjuvant radio-chemotherapy (V2) and at follow up after 10-14 m (V3). Depending on their nutritional risk screening (NRS 2002), patients received nutritional intervention starting at V1 with caloric enriched normal food (n=42), oral supplements (n=8), enteral tube feeding (n=13), or parenteral nutrition (n=6).
Results
At V1 patients had a mean weight loss (WL) of 9% (-9.3 ± 5.7 kg) as compared to 3-6 months earlier with a mean energy and protein-deficit of 42% (1001 ± 912 kcal) and 54% (39 ± 40 g/d), respectively. 78.3% (n=54) were at risk for malnutrition (NRS ≥ 3). Sarcopenia was found in 33 patients and was correlated with a higher complication rate (p=0.006), a longer hospital- and ICU-stay (p=0.029) and a higher risk for ICU readmission (p=0.041). A shorter mOS was observed in pat. with a phase angle <5° (p < 0.01), an ECM/BCM-index ≥ 1 (p=0.007), a pathological skeletal muscle index (smi; p=0.05), a weight loss of ≥ 9 kg (p=0.018) or > 10% of BW (p=0.034) and an energy- or protein-deficit >1.000 kcal/day (p=0.05) or > 40 g protein/day (p=0.03). Initiation of nutritional support significantly reduced further WL between V1 and V2 to a mean of only 1% (-1.25 ± 5.5 kg) of BW and an attenuated mean energy deficit of -205 kcal (6% daily need) and positive protein energy balance (+9.67%) with stabilisation of the smi (49.05 vs 47.72 cm2/m2). QoL significantly improved from 51.5 to 62.38 (p<0.01). In patients in whom malnutrition and sarcopenia did not further deteriorate during nutritional intervention, a significantly lower morbidity and mortality was observed (p=0.05).
Conclusions
This study demonstrates that standardized nutritional intervention in patients with advanced UGI cancer is associated with an improved QoL, a lower complication rate and a better OS.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
Universitätsmedizin der Johannes Gutenberg Universität Mainz.
Funding
This study was financially supported by a scientific grant of Fresenius Kabi Deutschland GmbH.
Disclosure
C. Fottner: Financial Interests, Institutional, Research Grant: Fresenius Kabi Deutschland GmbH. M. Silber: Financial Interests, Institutional, Research Grant: Fresenius Kabi Deutschland GmbH. M.M. Weber: Financial Interests, Institutional, Research Grant: Fresenius Kabi Deutschland GmbH. All other authors have declared no conflicts of interest.