1613P - The BreakThrough cancer malnutrition

Background

The BreakThrough Cancer Pain (BTCP) is a symptom that affects different aspects of the daily life of the patient. The aim of this research was to assess the impact of BTCP on the nutritional status of cancer patients initiating a palliative care program in home and hospital setting.

Methods

In this Italian observational, multicentre study “NO PAIN”, cancer patients, affected by BTCP, were included. ECOG PS, MNA, BMI, EORTC QLQ-C15-PAL, PSQI, ESAS, PGIC, HADS, BRASS were assessed. Cancer Malnutrition is defined as patient who experienced weight loss >5% of their usual weight over 3 months, combined with BMI <20 kg/m2 if <70 years old, or < 22 kg/m2 if >70 years old (ESPEN guidelines).

Results

In total, 61 patients (57.6%) male, median age (range) 70 (42-92) were accrued. The majority [40 (65%)] of them had metastatic primaries of the lung and liver, PS of 2 [39 (64%)]. Patients reported 2.4 ± 0.9 BTCP episodes/day with a mean intensity of 6.96 ± 1 NRS; 45 patients (73.7%) had incident BTCP, and 44 patients (72.1%) reported rapid onset pain (<10 min).

We observed a short “time lag” (median 30 days) between the onset of pain and the diagnosis of BTCP and severe malnutrition. We proposed the term BreakThrough Cancer Malnutrition (BTCM) as the exacerbation of rapidly progressive malnutrition that occurs in cancer patients with uncontrolled BTCP. Weight loss was reported by 88% and BMI <21 by 62%. There was a decrease in food intake in 66% of patients. BTCP was statistically significant associated with anorexia, weight loss and MNA.

Conclusions

BTCP, if left untreated, can lead to weight loss and severe malnutrition. The BTCM is the new concept of cancer malnutrition defined as the exacerbation of rapidly progressive malnutrition that occurs in cancer patients with uncontrolled BTCP. The prospective study “NO PAIN” confirmed that BTCP has deleterious consequences for the nutritional status, this information may have important significance in early palliative care.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.