ESPEN expert group recommendations for action against cancer-related malnutrition

Effects of integrative telehealth-based nutrition care with and without oral nutritional supplements in patients with liver and colorectal cancer: A randomized controlled trial

OBJECTIVES

This study investigated the effects of post-discharge integrative telehealth-based nutritional care alone versus post-discharge integrative telehealth-based nutritional care combined with high-calorie/high-protein oral nutritional supplements (HCHP-ONS) on the nutritional status and quality of life in patients with hepatocellular carcinoma (HCC) or colorectal cancer (CRC) at risk of malnutrition.

METHODS

We recruited HCC or CRC patients who were at moderate to high risk of malnutrition, defined as a score of 4-9 on the abridged Patient-Generated Subjective Global Assessment (aPG-SGA), and randomly assigned them to either a telehealth nutritional care-control group (C group) or a telehealth nutritional care combined with HCHP-ONS group (C+O group) for a 3-month intervention. In group C, a dietitian provided monthly telehealth-based nutritional assessments and guidance through a mobile application (LINE) or phone calls. In the C+O group, in addition to telehealth-based nutritional assessments and guidance, patients received a daily can of HCHP-ONS, which provided 425 kcal and 19.1 g of protein per serving. Blood tests, anthropometric indicators, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and a nutritional status assessment were conducted monthly.

RESULTS

Results showed that the C+O group had significantly reduced malnutrition risk scores at the 1st, 2nd, and 3rd months. By the 3rd month, the C+O group showed significant improvement in the Prognostic Nutritional Index (PNI), and notable improvements in diarrhea and respiratory distress scores.

CONCLUSIONS

In patients with HCC and CRC who were at risk of malnutrition, integrative telehealth-based nutritional care via LINE or phone calls effectively reduced malnutrition risk, maintained PNI, and supported quality of life (QOL). The addition of HCHP-ONS further enhanced nutritional outcomes, leading to greater improvements in PNI, diarrhea, and dyspnea by the 3rd month.

Dissecting the global leadership initiative on malnutrition criteria in advanced cancer: Reduced intake vs. inflammation

BACKGROUND & AIMS

The Global Leadership Initiative on Malnutrition (GLIM) criteria have been recommended for the diagnosis of malnutrition. It requires that the patient meets at least one phenotypic criterion and at least one aetiological criterion. For the latter, the patient must either demonstrate reduced food intake or have evidence of systemic inflammation. As both are common in advanced cancer, the aim of the present study was to determine, in patients who met the GLIM phenotypical criteria, which GLIM aetiological criteria (reduced food intake or systemic inflammation) is most useful in predicting overall survival (OS).

METHODS

Data from two cancer biobanks were combined. Inclusion criteria were: ≥18 years, advanced cancer (stage III or IV) and ability to provide written consent. Weight loss (WL) was selected as the phenotypic criterion of choice, as preliminary analysis demonstrated it to be a superior predictor of OS compared to body mass index. Malnutrition type 1 was defined as >5 % WL over 6 months and a C reactive protein (CRP) ≥3 mg/l. Further analysis was performed with a CRP >10 mg/l cut-off. Malnutrition type 2 was defined as >5 % WL over 6 months and reduced food intake, as reported in the Patient Generated Subjective Global Assessment. Survival was assessed using Kaplan-Meier methodology, log-rank tests and Cox proportional hazards models, with hazard ratios (HR) and confidence intervals (CI) reported.

RESULTS

In total, 176 patients were studied, with 147 events observed. The 3-month mortality rate was 32.4 % (CI: 25.1 to 39.0) and the 1-year mortality rate was 71.8 % (CI: 63.8 to 78.0). Malnutrition type 1 and malnutrition type 2 were observed in 37.8 % (HR: 2.27 [CI: 1.54 to 3.33], p < 0.001) and 26.3 % (HR: 1.74 [CI: 1.19 to 2.54], p = 0.005) of patients respectively, with both significantly increasing the risk of death. Following adjustment for relevant confounders both malnutrition type 1 (HR: 1.92 [CI: 1.25 to 2.94], p = 0.003) and malnutrition type 2 (HR: 1.61 [CI: 1.09 to 2.38], p = 0.019) remained significant predictors of OS. Median survival for patients with malnutrition type 1 was 2.14 (CI: 1.74 to 4.90) months compared to 9.5 (6.94-13.64) months for those without (p < 0.001). For malnutrition type 2, this was 2.37 (CI: 1.64 to 5.46) vs. 7.40 months (CI: 6.08 to 10.16), p = 0.004. When the CRP threshold was increased to >10 mg/l, malnutrition type 1 was observed in fewer patients (30.4%), median survival was shorter (1.91 [CI: 1.25 to 2.99] vs. 9.86 months [CI: 7.27 to 14.7], p < 0.001) and in both univariable (HR: 2.91 [CI: 1.94 to 4.63], p < 0.001) and multivariable (HR: 2.32 [CI: 1.50 to 3.60], p < 0.001) analyses, the risk of death increased.

CONCLUSION

The results suggest that the inflammatory component of GLIM appears superior compared to reduced intake in predicting OS and notably, a higher CRP threshold correlates with shorter OS. Therefore, whilst GLIM has multiple potential combinations, all treated with equal regard, these data suggest that the inflammatory aetiological component should be hierarchical to others.

Malnutrition risk in older adults with cancer: A prospective cross-sectional study in one setting

BACKGROUND

This descriptive and cross-sectional study evaluated the nutrition status of geriatric patients with cancer undergoing chemotherapy.

METHODS

Data were collected by researchers in the Medical Oncology Unit of a university hospital between January and September 2024 to assess the nutrition status of 100 geriatric patients with cancer undergoing chemotherapy. Malnutrition risk was evaluated using the Mini Nutritional Assessment (MNA).

RESULTS

The mean ± SD age of the study participants was 72.03 ± 5.40 years. The study found that 21% of the patients were undergoing treatment for colon cancer, 20% for lung cancer, and 16% for pancreatic cancer. Most patients were diagnosed at advanced stages, with 28% at stage III and 65% at stage IV. The nutrition risk assessment of the patients found that 34% had a normal MNA score (24-30 points), 30% were at risk of malnutrition (17-23.5 points), and 36% were malnourished (<17 points). The following symptoms affecting nutrition were observed: nausea and vomiting (39%), taste changes (24%), weakness and fatigue (73%), pain (5%), and weight loss (27%). The most commonly used type of chemotherapy was FOLFOX (folinic acid, 5-fluorouracil and oxaliplatin, 18%).

CONCLUSION

Malnutrition was very common in geriatric patients with cancer undergoing chemotherapy. Therefore, it is crucial for healthcare professionals, particularly dietitians and nutritionists, to diagnose and manage malnutrition risk early and effectively.

Impact of Body Composition on Dose Modifications and Prognosis in Locally Advanced Gastric Cancer Patients Undergoing Neoadjuvant Chemotherapy

BACKGROUND

Despite advances in treatment, locally advanced GC continues to be associated with poor prognosis. Body composition, specifically the distribution of skeletal muscle and adipose tissue, has emerged as a key factor influencing cancer prognosis, yet its impact on neoadjuvant chemotherapy (NACT) dose modifications and long-term survival in GC remains unclear. The primary aim of this study was to assess the relationship between body composition and dose delay/reduction during preoperative NACT in locally advanced gastric cancer patients. The secondary aim was to evaluate the impact of body composition on overall and disease-free survival.

METHODS

This retrospective study included 97 patients with locally advanced gastric adenocarcinoma treated with NACT at Liv Bona Dea Hospital, Baku, Azerbaijan, between 2018 and 2024. Body composition parameters-skeletal muscle index (SMI), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT)-were analyzed using pre- and post-NACT CT imaging. Dose delay and reduction were defined as treatment delays of ≥5 days and dose reductions of ≥10% due to chemotherapy-related side effects. Survival outcomes were assessed using Kaplan-Meier analysis.

RESULTS

Of the 97 patients (mean age: 63), 33% experienced dose delays and 15% had dose reductions. Multivariate analysis revealed that lower pre-NACT VAT measurements were associated with both dose delay (p=0.01, OR=7.31) and dose reduction (p=0.01, OR=8.87). No significant correlation was found between body composition parameters and overall survival (OS) or disease-free survival (DFS). However, neural (p=0.013, HR=1.88) and venous invasion (p=0.03, HR=1.43) were independent predictors of poor OS, while poor histological grade (p=0.008, HR=2.01) and neural invasion (p=0.039, HR=1.61) independently predicted poor DFS. In addition, VAT loss during the NACT period increased the length of stay after operation in this cohort (p=0.004).

CONCLUSION

This study is the first to demonstrate that lower pre-NACT VAT is a significant predictor of dose reduction and delay in locally advanced gastric cancer patients. While body composition did not predict survival outcomes, tumor histological grade and invasion factors were significant for prognosis. These findings suggest that monitoring body composition, particularly VAT, could aid in optimizing chemotherapy dosing and improving treatment outcomes for GC patients undergoing NACT. Further prospective studies are needed to validate these results.

The role of radiotherapy planning images in monitoring malnutrition and predicting prognosis in head and neck cancer patients: a pilot study

BACKGROUND

Adaptive treatment planning can be made in radiotherapy of head and neck cancer patients for reasons such as changes in tumor volume or weight loss. This study aims to find the role of treatment planning images in monitoring radiotherapy-induced malnutrition and predicting the malnutrition-induced prognosis in head and neck cancer patients.

METHODS

For this study, we analyzed 30 patients who received radiotherapy in our clinic between September 2018 and September 2021. Those patients, both regular and completed weekly dietitian counseling notes during radiotherapy and available adaptive radiotherapy planning images, were included in the analysis. All patients had weekly nutritional interventions, including nutritional and anthropometric changes in weight, height, body mass index (BMI), and lean body mass (LBM). Skeletal muscle volume, called cervical muscle gauge (CMG), was measured from the simulation images of beginning and adaptive radiotherapy. Inflammatory parameters, including the neutrophil-lymphocyte ratio (NLR), the platelet-lymphocyte ratio (PLR), and the systemic inflammatory index (SII), were also calculated from weekly total blood counts. For the analysis, anthropometric measurements were compared at the beginning and adaptive treatment time. Progression-free (PFS) and overall (OS) survival were calculated according to weight and CMG changes.

RESULTS

The median weight loss percentage was 4.8% (0 to 24%). The mean percentage of weight changes, LBM, and CMG were 6.33%, 3.47%, and 9.28%, respectively. Results indicated that BMI (p = 006), weight (p < 0.001), LBM (p < 0.001), and CMG (p = 0.057) decreased during radiotherapy. Hemoglobin levels decreased (p = 0.005), and inflammatory markers increased. There were significant correlations between weight and LBM (p < 0.0001) and CMG (p = 0.005) loss. The median follow-up was 26 months. Loss of weight (PFS; 65.5% vs. 35.7%, p = 0.09, OS; 73.7% vs. 32.1%, p = 0.09), LBM (PFS; 75% vs. 41.1%, p = 0.118, OS; 65.6% vs. 52%, p = 0.221) and CMG (PFS; 56.3% vs. 47.1%, p = 0.516, OS;76.9% vs. 32.4%, p = 0.059) negatively affected three-year survival.

CONCLUSIONS

Cervical muscle volume measurement may help predict malnutrition in patients receiving radiotherapy for head and neck cancer. Our study shows adaptive planning images may be used for this approach. In addition, this method may help to predict prognosis due to malnutrition in patients undergoing radiotherapy.

"One Size Doesn't Fit All": Nutrition Care Needs in Esophageal and Gastric Cancer Survivors-A Qualitative Study

Background/Objectives: Nutritional complications are highly prevalent in esophageal and gastric cancer survivors and can negatively impact their quality of life. Gaining insight into survivors' experiences with nutrition care can inform the development of tailored nutrition care programs for this population. The present study investigated esophageal and gastric cancer survivors' nutritional challenges and complications. It also explored survivors' and their carers' perceived unmet nutrition care needs. Methods: Esophageal and gastric cancer survivors and their caregivers were invited to participate in a semi-structured interview. Participants were asked about their nutritional challenges and experiences with existing dietetic services in meeting their nutrition care needs. Data were analyzed using Braun and Clarke's six-stage approach to thematic analysis. Results: Twelve individual interviews were completed and analyzed, and three themes emerged: nutrition-related challenges and complications, experiences with dietetic services, and coping strategies. Persistent gastrointestinal symptoms were reported as the main nutritional challenges impacting survivors' daily and social lives. While participants reported good access to dietetic services, they emphasized the need for additional support during early post-surgery stages and long-term survivorship. Key unmet needs included access to personalized dietary advice for symptom management and timely information on nutritional challenges and post-treatment complications. Conclusions: The present study underscores the need for increased dietitian support throughout the esophageal and gastric cancer journey to provide timely, personalized, and practical dietary information for survivors and their caregivers. These insights should be considered for developing tailored nutrition care programs for esophageal and gastric cancer survivors.

Associations of socioeconomic status and malnutrition with survival in adults with cancer in the UK Biobank: A prospective cohort study

OBJECTIVES

Socioeconomic disparities and malnutrition are significant contributors to global health challenges, yet the relationship between socioeconomic status (SES) and malnutrition, and the subsequent risk of mortality in cancer patients remains underexplored. This study aimed to investigate the complex relationships between SES, nutritional status, and both all-cause and cancer-specific mortality in cancer patients.

STUDY DESIGN

Prospective cohort study.

METHODS

Participants from the UK Biobank with a cancer diagnosis within two years prior to baseline assessment were included (n = 4216, 47.3 % male). Latent class analysis (LCA) and the Global Leadership Initiative on Malnutrition (GLIM) criteria were employed to evaluate patients' SES and nutritional status. Logistic regression was applied to assess the associations between SES and nutritional status. Cox-proportional hazards models, along with mediation, joint association, and interaction analyses, were done to establish the relationship between SES, nutritional status, and both all-cause and cancer-specific mortality.

RESULTS

During a median follow-up of 15.14 (IQR: 15.09-15.20) years, 1039 participants died, of which 788 deaths were cancer-specific. Participants with low SES (vs high) had an increased risk of malnutrition (OR 1.60, 95 % CI 1.08-2.39) and all-cause mortality (HR 1.22, 95 % CI 1.03-1.44). Malnutrition accounted for 6.8 % of the association between low SES and all-cause mortality. Compared to well-nourished patients with high SES, those with malnutrition and low SES had the highest risk of all-cause mortality (3.12, 2.26-4.29), while those with malnutrition and high SES faced the highest risk of cancer-specific mortality (2.88, 1.97-4.21).

CONCLUSIONS

While addressing malnutrition alone may not significantly reduce mortality disparities arising from socioeconomic differences, it remains a crucial strategy for alleviating cancer burden, especially among patients with low SES.

Impact of body composition parameters, age, and tumor staging on gastric cancer prognosis

BACKGROUND

Research studies on gastric cancer have not investigated the combined impact of body composition, age, and tumor staging on gastric cancer prognosis. To address this gap, we used machine learning methods to develop reliable prediction models for gastric cancer.

METHODS

This study included 1,132 gastric cancer patients, with preoperative body composition and clinical parameters recorded, analyzed using Cox regression and machine learning models.

RESULTS

The multivariate analysis revealed that several factors were associated with recurrence-free survival (RFS) and overall survival (OS) in gastric cancer. These factors included age (≥65 years), tumor-node-metastasis (TNM) staging, low muscle attenuation (MA), low skeletal muscle index (SMI), and low visceral to subcutaneous adipose tissue area ratios (VSR). The decision tree analysis for RFS identified six subgroups, with the TNM staging I, II combined with high MA subgroup showing the most favorable prognosis and the TNM staging III combined with low MA subgroup exhibiting the poorest prognosis. For OS, the decision tree analysis identified seven subgroups, with the subgroup featuring high MA combined with TNM staging I, II showing the best prognosis and the subgroup with low MA, TNM staging II, III, low SMI, and age ≥65 years associated with the worst prognosis.

CONCLUSION

Cox regression identified key factors associated with gastric cancer prognosis, and decision tree analysis determined prognoses across different risk factor subgroups. Our study highlights that the combined use of these methods can enhance intervention planning and clinical decision-making in gastric cancer.

Inflammatory marker cut-off points and prognosis in incurable cancer: validation study

OBJECTIVES

The study aimed to determine and validate cut-off points for selected inflammatory markers to predict 30-day, 60-day and 90-day survival in patients with incurable cancer exclusively receiving palliative care.

METHODS

Prospective cohort study with patients referred to the palliative care unit of a national reference centre for cancer in Brazil. The sample (n=2098) was randomised into development (n=1049) and validation (n=1049) groups. C-reactive protein (CRP), CRP/albumin ratio (CAR), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), lymphocyte/monocyte ratio (LMR), prognostic nutritional index (PNI) and systemic immune-inflammation index (SII) were evaluated. Time-dependent receiver operating characteristic curves were used to define the optimal cut-off points. Kaplan-Meier curves, Cox proportional hazards models and concordance statistic (C-statistic) were used to evaluate their predictive ability.

RESULTS

The optimal cut-off points related to 30-day, 60-day and 90-day mortality were, respectively, as follows: CRP ≥6.0 mg/L, ≥4.8 mg/L and ≥4.7 mg/L; CAR ≥2.0, ≥1.7 and ≥1.5; NLR ≥6.5, ≥5.8 and ≥5.7; PLR ≥298.0, ≥286.7 and ≥281.2; LMR ≥1.9, ≥2.2 and ≥2.0; PNI ≥35.5, ≥46.8 and ≥30.5; and SII ≥2254.4, ≥1983.0 and ≥1844.1. The inflammatory markers that showed discriminatory accuracy (CRP, CAR, NLR, PLR and SII) were selected for validation. These markers demonstrated predictive ability, with good discriminatory power (C-statistic ≥0.75).

CONCLUSIONS

Optimal cut-off points were validated for CRP, CAR, NLR, PLR and SII for use in the prognostic assessment of patients with incurable cancer exclusively receiving palliative care.

Optimizing Nutritional Care with Machine Learning: Identifying Sarcopenia Risk Through Body Composition Parameters in Cancer Patients-Insights from the NUTritional and Sarcopenia RIsk SCREENing Project (NUTRISCREEN)

Background/Objectives: Cancer and related treatments can impair body composition (BC), increasing the risk of malnutrition and sarcopenia, poor prognosis, and Health-Related Quality of Life (HRQoL). To enhance BC parameter interpretation through Bioelectrical Impedance Analysis (BIA), we developed a predictive model based on unsupervised approaches including Principal Component Analysis (PCA) and k-means clustering for sarcopenia risk in cancer patients at the Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale" (Naples). Methods: Sarcopenia and malnutrition risks were assessed using the NRS-2002 and SARC-F questionnaires, anthropometric measurements, and BIA. HRQoL was evaluated with the EORTC QLQ-C30 questionnaire. PCA and clustering analysis were performed to identify different BC profiles. Results: Data from 879 cancer patients (mean age: 63 ± 12.5 years) were collected: 117 patients (13%) and 128 (15%) were at risk of malnutrition and sarcopenia, respectively. PCA analysis identified three main components, and k-means determined three clusters, namely HMP (High Muscle Profile), MMP (Moderate Muscle Profile), and LMP (Low Muscle Profile). Patients in LMP were older, with a higher prevalence of comorbidities, malnutrition, and sarcopenia. In the multivariable analysis, age, lung cancer site, diabetes, and malnutrition risk were significantly associated with an increased risk of sarcopenia; among the clusters, patients in LMP had an increased risk of sarcopenia (+62%, p = 0.006). Conclusions: The NUTRISCREEN project, part of the ONCOCAMP study (ClinicalTrials.gov ID: NCT06270602), provides a personalized nutritional pathway for early screening of malnutrition and sarcopenia. Using an unsupervised approach, we provide distinct BC profiles and valuable insights into the factors associated with sarcopenia risk. This approach in clinical practice could help define risk categories, ensure the most appropriate nutritional strategies, and improve patient outcomes by providing data-driven care.

SARCOPENIA AND GASTROINTESTINAL CANCER: NUTRITIONAL APPROACH FOCUSING ON CURCUMIN SUPPLEMENTATION

BACKGROUND

Sarcopenia is a syndrome characterized by decreased strength, quantity and/or quality of skeletal muscle mass. When associated with cancer, it correlates with poorer clinical outcomes. Cancers of the gastrointestinal tract, prevalent globally and in Brazil, are associated with a greater nutritional risk. Early detection and intervention for nutritional risks are critical in this population. Recent studies on turmeric/curcumin have demonstrated beneficial effects in cancer patients. Specifically, curcumin have shown promise in reducing muscle depletion, oxidative stress, and improving strength and fatigue, factors related to sarcopenia. This review aims to elucidate sarcopenia and sarcopenia secondary to cancer, emphasizing nutritional management and the role of curcumin supplementation. Effective cancer management, whether with or without sarcopenia, demands comprehensive public health strategies and multimodal interventions within healthcare institutions. Nutrition is pivotal across the cancer care journey, encompassing screening, guidance, and provision of nutrients that support maintaining or recovering body composition. Curcumin supplementation emerges as a potential adjuvant to the standard cancer treatment and sarcopenia management. Nevertheless, further clinical studies are warranted to substantiate these findings.

BACKGROUND

• Sarcopenia is a syndrome characterized by decreased strength, quantity and/or quality of skeletal muscle mass.

BACKGROUND

• Sarcopenia when associated with cancer, it correlates with poorer clinical outcomes.

BACKGROUND

• Curcumin has shown promise in reducing muscle depletion, oxidative stress, and improving strength and fatigue, factors related to sarcopenia.

BACKGROUND

• Curcumin supplementation emerges as a potential adjuvant to the standard cancer treatment and sarcopenia management.

Poor nutrition status associated with low patient satisfaction six months into treatment for head and neck/esophageal cancer treatment: A prospective multicenter cohort study

BACKGROUND

Patient-reported outcome measures have been associated with survival in oncology patients. Altered intake and malnutrition are common symptoms for patients treated for head and neck cancer and esophageal cancer (HNC/EC). The purpose of this study was to examine the relationship between patient-reported satisfaction with medical care and nutrition status.

METHODS

This prospective cohort study collected data from 11 international cancer care sites.

RESULTS

One hundred and sixtythree adult patients (n = 115 HNC; n = 48 EC) completed a patient satisfaction questionnaire (the Canadian Health Care Evaluation Project Lite) and were included. HNC/EC patient global satisfaction with medical care was 88.3/100 ± 15.3 at baseline and remained high at 86.6/100 ± 16.8 by 6 months (100 max satisfaction score). Poor nutrition status, as defined by the Patient-Generated Subjective Global Assessment Short Form, was associated with lower patient satisfaction with overall medical care, relationship with doctors, illness management, communication, and decision-making 6 months into treatment (P < 0.01). There was no difference in global satisfaction between patients who did and did not report swallowing difficulty (P = 0.99) and patients with and without feeding tube placement (P = 0.36). Patients who were seen by a dietitian for at least one nutrition assessment had global satisfaction with care that was 16.7 percentage points higher than those with no nutrition assessment (89.3 ± 13.8 vs 72.6 ± 23.6; P = 0.005) CONCLUSION: In HNC/EC patient-centered oncology care, decreasing malnutrition risk and providing access to dietitian-led nutrition assessments should be prioritized and supported to improve patient satisfaction and standard of care. Feeding tube placement did not decrease patient satisfaction with medical care.

Malnutrition in patients with advanced head and neck cancer: Exploring the Global Leadership Initiative on Malnutrition (GLIM) criteria, energy balance and health-related quality of life

BACKGROUND & AIMS

Head and neck cancer (HNC) involves several tumor locations, the most common of which are the oropharynx and oral cavity. Patients with HNC are at high risk of developing malnutrition. Together with treatment, the tumor location contributes to difficulties in eating and swallowing, which can lead to a negative energy balance and weight loss. This study aimed to examine malnutrition via the Global Leadership Initiative on Malnutrition (GLIM) criteria, explore the different combinations of the GLIM criteria, study changes in body composition and body energy content and evaluate health-related quality of life (HRQoL) in patients with locally advanced HNC.

METHODS

Malnutrition was diagnosed via the GLIM criteria. Body weight, muscle mass, body fat, C-reactive protein (CRP) levels, energy intake, use of enteral feeding tubes or parenteral nutrition were assessed, and HRQoL scales from the European Organization for Research and Treatment of Cancer (EORTC), including the Quality of Life Questionnaire-Core 30 (QLQ-C30) and the Quality of Life Questionnaire-Head and Neck 35 (QLQ-HN35), and the M.D. Anderson Dysphagia Inventory (MDADI) were completed at baseline, 6 weeks and at 3, 6 and 12 months after the start of treatment. Body composition was measured via dual-energy X-ray absorptiometry, and body energy content was calculated.

RESULTS

Eighty patients were included. The prevalence of malnutrition varied over time and peaked at the end of treatment at 71 %, and at this time, the most common combination of the GLIM criteria was weight loss + reduced food intake + inflammation (31 %), followed by weight loss + reduced muscle mass + reduced food intake + inflammation (20 %). At the end of treatment patients were in a negative energy balance, and compared to baseline, body weight, body fat, and muscle mass had decreased with 6.0 % (p<0.0001), 5.9 % (p<0.0001), and 8.0 % (p<0.0001) respectively. At the 3-month follow-up, the reduction in muscle mass had ceased, despite a negative energy balance, and patients started to regain muscle mass. At 12 months body weight had decreased with 7.4 % (p<0.0001), body fat with 18.9 % (p<0.0001), and muscle mass with 2.4 % (p<0.0001) compared to baseline. Patients with malnutrition reported significantly worse HRQoL on a majority of the 16 quality of life scales at all time points, except at the end of treatment, when no significant differences were found between malnourished and nonmalnourished patients.

CONCLUSIONS

Patients with advanced HNC receiving combined treatment experience major nutritional problems, and malnutrition is common at the end of treatment. Inflammation-driven muscle depletion during treatment is challenging, but it seems possible to recover muscle mass after treatment. Patients with malnutrition reported worse HRQoL at all time points, except at the end of treatment, when all patients' quality of life was very negatively affected.

The use of preoperative enteral immunonutrition in patients undergoing elective colorectal cancer surgery: A systematic review and meta-analysis

AIM

The present systematic review and meta-analysis aims to compare adult patients receiving enteral immunonutrition prior to elective colorectal surgery with those receiving conventional preoperative nutrition.

METHODS

MEDLINE, Embase and the Cochrane Central Register of Controlled Trials were searched from database inception to March 2024. Articles were included if they were randomized controlled trials or cohort studies evaluating adult patients undergoing elective colorectal surgery comparing preoperative enteral immunonutrition with conventional preoperative nutrition protocols. Main outcomes of interest included surgical site infection, anastomotic leak, overall postoperative morbidity and postoperative length of stay. An inverse variance random effects meta-analysis was performed. Risk of bias was assessed with Cochrane risk of bias assessment tools. The GRADE approach was conducted to assess quality of evidence.

RESULTS

After reviewing 2508 relevant citations, 10 studies met inclusion criteria. Overall, 1521 patients (mean age 64.9 ± 10.0 years, 49.4% women) received preoperative immunonutrition and 1816 patients (mean age 64.1 ± 11.0 years, 52.1% women) received conventional preoperative nutrition. Across seven studies, there was a non-significant 30% relative risk reduction of surgical site infection (risk ratio 0.70, 95% CI 0.44-1.11, P = 0.13, I2 = 33%) and a non-significant 44% relative risk reduction of anastomotic leak (risk ratio 0.56, 95% CI 0.28-1.10, P = 0.09, I2 = 0%) in the immunonutrition group. Across eight studies, postoperative length of stay was 0.48 days shorter in the immunonutrition group (mean difference -0.48, 95% CI -0.84 to -0.12, P = 0.01, I2 = 53%). GRADE certainty of evidence was low or very low for all outcomes.

CONCLUSION

While point estimates suggest a likely benefit associated with preoperative enteral immunonutrition, wide corresponding 95% CIs suggest uncertainty remains. Further prospective study is warranted.

Impact of adherence to oral nutritional supplements on nutrition status and muscle strength in patients with gastrointestinal cancer: A prospective observational longitudinal study

BACKGROUND

Given the lack of evidence regarding the effects of adherence to oral nutritional supplements (ONS) and the types of formulas used in clinical practice, we aimed to assess the impact of adherence to ONS and the high-protein formula on the nutrition status and muscle strength in patients with gastrointestinal cancer.

METHODS

This study evaluated newly diagnosed outpatients with esophageal, gastric, pancreatic, and colorectal cancer prescribed ONS. Nutrition status was assessed using the Patient-Generated Subjective Global Assessment (PG-SGA), and muscle strength was assessed using handgrip strength (HGS) dynamometry. ONS adherence was calculated as the ratio of self-reported intake to the prescribed amount and categorized as ≥80% or <80%.

RESULTS

A total of 54 patients were included. Most patients were ≥60 years of age (63%), were diagnosed with colorectal cancer (63%), were classified as stage III and IV (83%), and exhibited nutrition risk or malnutrition according to PG-SGA (89%). Patients with adherence ≥80% to ONS exhibited less weight loss and HGS reduction compared with patients with adherence <80% (P < 0.05). Although patients consuming a high-protein formula maintained HGS and those on a standard formula experienced a reduction, formula type did not predict HGS change in the multivariate analysis. ONS protein intake, adjusted for adherence, was a predictor of weight change (β: 0.09; 95% CI: 0.02-0.2; P = 0.011).

CONCLUSION

Patients with adherence ≥80% to ONS experienced less reduction in both weight and HGS, whereas those consuming a high-protein formula maintained HGS. Notably, ONS protein intake, adjusted for adherence, was an independent predictor of weight change.

Many ways, one destination: a comprehensive review of screening and assessment tools to detect malnutrition in patients with ovarian cancer

Malnutrition is a condition of deficiency, imbalance, or excess in a person's intake of energy and/or nutrients. Despite being common in patients with cancer, it is rarely diagnosed and managed by oncologists. Weight loss or changes in body mass index may fail to capture nutritional risk in patients with ovarian cancer due to masking ascites. The European Society for Clinical Nutrition and Metabolism and American Society for Parenteral and Enteral Nutrition guidelines recommend that patients with cancer undergo formal malnutrition screening and a full specialist assessment for those identified as high risk, and this recommendation is endorsed by European Society of Gynecologic Oncology and National Comprehensive Cancer Network for patients with ovarian cancer. The goal of this review was to describe the most common screening and assessment tools, studied in patients with ovarian cancer, as they relate to patient outcomes (complications, toxicity, and survival). Several tools have been tested in research and clinical settings, including serum markers, algorithms, scores, and clinical screening and assessment methods. These include but are not limited to pre-operative albumin, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, the Glasgow prognostic score, the prognostic nutritional index, and several clinical questionnaires. There are benefits and limitations to any individual tool as described in the review. Emerging technologies may also prove useful for malnutrition detection. We advocate that gynecologic oncology practices adopt a universal standardized method of screening and assessment for malnutrition in patients with ovarian cancer. Malnutrition can dramatically impact oncologic outcomes and patient well-being. Patients with malnutrition should be offered a nutritional care plan. These patients might also benefit from pre-habilitation, an emerging concept in gynecologic oncology, but evidence on its real impact is still limited. It is imperative that future research focus on strategies to reduce nutritional risk, improve patient overall health, and support resilience to cancer and anticancer treatment.

Practical cancer nutrition, from guidelines to clinical practice: a digital solution to patient-centred care

BACKGROUND

Malnutrition affects 20%-70% of cancer patients, depending on tumour type, disease stage, and clinical setting. While nutritional care is essential for improving patients' quality of life and clinical outcomes, it is not systematically integrated into routine cancer care. MyPath is a European Union project aiming to implement patient-centred care (PCC) at nine European cancer centres using implementation science. Multidisciplinary teams have developed standardised digitally supported PCC pathways based on patient-reported outcomes (PROs) with linked evidence-based management options. Through systematic assessment and management of common symptoms and psychosocial problems in cancer patients, MyPath aims to facilitate changes in clinical practice to improve PCC for all. As part of this, the MyPath Nutrition Care Pathway (NCP) aims to facilitate necessary clinical changes to routinely assess and address nutrition in all patients.

MATERIALS AND METHODS

Between September 2022 and August 2024, an international multidisciplinary team reviewed evidence-based nutrition guidelines to select relevant PROs and other variables necessary to systematically assess patients, allowing for tailored nutritional care.

RESULTS

The MyPath NCP assessment relies on nutritional status (Malnutrition Screening Tool for malnutrition risk, modified Global Leadership Initiative on Malnutrition criteria for malnutrition, and body mass index/weight change for obesity/unintentional weight gain), health status (functional status, cancer diagnosis and prognosis, and prehabilitation needs), and inflammatory status (C-reactive protein levels). Based on this assessment, the digital solution suggests tailored, evidence-based nutritional interventions. Continuous monitoring through PROs and clinical consultations will customise care to patients' dynamic nutritional needs. The first version of this digital solution will be piloted in 2025.

CONCLUSIONS

Inconsistent implementation of nutrition guidelines is a key challenge in cancer care. The MyPath NCP offers an accessible, patient-centred assessment and management system that integrates nutritional care into routine cancer care, providing a versatile solution that can be implemented across diverse health care settings.

An Overview of Sarcopenia: Focusing on Nutritional Treatment Approaches

Sarcopenia is a syndrome characterized by the progressive and generalized loss of skeletal muscle mass and strength. This condition is associated with physical disability, decreased quality of life, and increased mortality. Therefore, reducing the prevalence of sarcopenia could significantly lower healthcare costs. Sarcopenia can be classified into primary and secondary sarcopenia. The former is related to aging and begins after the fourth decade of life; after that, there is a muscle loss of around 8% per decade until age 70 years, which subsequently increases to 15% per decade. On the other hand, secondary sarcopenia can affect all individuals and may result from various factors including physical inactivity, malnutrition, endocrine disorders, neurodegenerative diseases, inflammation, and cachexia. Understanding the multiple mechanisms involved in the onset and progression of sarcopenia allows for us to develop strategies that can prevent, treat, or at least mitigate muscle loss caused by increased protein breakdown. One potential treatment of sarcopenia is based on nutritional interventions, including adequate caloric and protein intake and specific nutrients that support muscle health. Such nutrients include natural food rich in whey protein and omega-3 fatty acids as well as nutritional supplements like branched-chain amino acids, β-hydroxy-β-methylbutyrate, and vitamin D along with food for special medical purposes. It is important to emphasize that physical exercises, especially resistance training, not only promote muscle protein synthesis on their own but also work synergistically with nutritional strategies to enhance their effectiveness.

Compliance analysis of oral nutritional supplements in hospitalized postsurgical patients with colorectal cancer: A prospective study

PURPOSE

There are few reports on compliance with oral nutritional supplements (ONS) after surgery in hospitalized patients. This study aimed to investigate the compliance with ONS and its influencing factors after surgery in colorectal cancer patients.

METHODS

STROBE checklist was used during the preparation of this paper. A total of 103 postoperative colorectal cancer patients were selected from November 2020 to April 2021 from the Department of Anorectal Surgery in our institution, which is a tertiary hospital in Hangzhou, China. The compliance with ONS was recorded by a self-record sheet, and sociodemographic and disease-related information of these patients was gathered through a self-designed questionnaire.

RESULTS

The overall ONS compliance rate of patients with colorectal cancer was 57.6%. Results of univariate analysis revealed that ONS compliance rate was related to sex, admission body mass index, abdominal distension, attitude towards ONS, and satisfaction with ONS. Multi-factor analysis showed that age, sex, and perceived benefits of nutrition therapy independently influenced the ONS compliance rate.

CONCLUSIONS

The postoperative ONS compliance rate of colorectal cancer patients needs to be further improved. Healthcare professionals should pay more attention to the postoperative ONS compliance and acknowledging the influence of age, gender, and attitudes towards ONS on ONS compliance. Notably, patients' perspectives towards ONS play a crucial and modifiable role in determining ONS compliance. Nurses ought to assist patients in cultivating a positive attitude towards ONS.

RELEVANCE TO CLINICAL PRACTICE

Dosage form and delivery method are also influence factors that deserves further exploration in the future. Future research endeavours should endeavour to craft tailored, meticulous nutritional intervention strategies tailored to the diverse factors that influence ONS compliance, ultimately leading to enhanced ONS adherence. Our findings could serve as valuable evidence for the development of strategies aimed at enhancing ONS usage practices.

Core elements and principles of nutrition models of care for people with cancer: A scoping review

BACKGROUND AND AIMS

The development and implementation of evidence-based cancer nutrition models of care into clinical practice is challenging and pragmatic guidance is lacking. This scoping review aimed to identify the core elements and principles of nutrition models of care for people with cancer.

METHODS

MEDLINE Complete, CINAHL and Embase were systematically searched between 1 January 2003-8 November 2023. Studies were eligible for inclusion and data extraction if they reported on the implementation or evaluation of a nutrition model of care for adults with any cancer diagnosis. The protocol was prospectively registered on Open Science Framework (https://doi.org/10.17605/OSF.IO/RQVHJ) on 7 November 2023.

RESULTS

The search identified 4599 papers, 28 studies met inclusion criteria. Studies were primarily conducted in Australia (71.4 %), within a hospital (96.4 %), metropolitan setting (89.3 %) and with various cancer diagnoses. Most studies described a nutrition screening process and 50 % used a valid and reliable assessment tool. Studies described provision of direct care by the dietitian (n = 26), primarily conducted in the outpatient setting (n = 26) and lesser in the inpatient setting (n = 12), and frequently face-to-face (n = 25) [phone (n = 14), telehealth (n = 3)]. Ten core elements were identified that underpinned the models of care including: timely care driven by a care pathway, protocol or clinic (100.0 %); nutrition expertise and leadership (100.0 %); flexible and integrated (100.0 %); with multi-directional communication (96.4 %); accessible (92.9 %); stratified by risk (89.3 %); multidisciplinary engagement (85.7 %); across different care time-points and settings (85.7 %); supported by training/education (50.0 %) and data integration (25.0 %).

CONCLUSIONS

Nutrition expert-led cancer nutrition models of care literature was primarily limited to metropolitan, hospital settings and many lacked valid nutrition assessment tools. Ten core elements were identified that underpinned nutrition care, with the most utilised being: timely care driven by a care pathway, protocol or clinic; nutrition expert-led; flexible and integrated; with multi-directional communication; accessible; and stratified by risk. There is great potential for an evidence-based model of nutrition care to improve the implementation and embedding of high-quality nutrition elements into the cancer pathway.

The Impact of Oral Nutrition Supplementation and Dietary Education on Nutritional Status, Knowledge, Attitudes, and Behaviour in Cancer Patients: A Randomized Clinical Trial

Cancer patients often experience significant weight loss due to metabolic changes, increased resting energy expenditure (REE), and poor nutrient intake, particularly exacerbated by treatments like chemotherapy and radiation. This study aimed to determine whether combining Oral Nutrition Supplements (ONS) with dietary education is more effective than dietary education alone in improving nutritional outcomes for cancer patients. An open-label randomized clinical trial at Persahabatan Hospital in Jakarta, Indonesia, involved 108 patients with lung or gynecological cancer, with 87 completing the study. Participants were assigned to receive either dietary education plus ONS (intervention group) or dietary education alone (control group). Results indicated that while both groups improved their nutrition knowledge, the intervention group experienced significant increases in body weight (1.68 ± 3.96 kg) and body mass index (BMI) (0.86 ± 1.96 kg/m2), whereas the control group lost weight. Additionally, the intervention group had a lower rate of anemia (60% vs. 80.9%), though no significant differences were found in albumin levels or inflammation status. These findings suggest that ONS combined with dietary education may help improve weight and BMI in cancer patients, warranting further research to confirm these benefits and assess long-term effects.

Assessing the Impact of Nutritional Status on the Quality of Life in Head and Neck Cancer Patients-The Need for Comprehensive Digital Tools

Background/Objectives: Malnutrition is a key determinant of quality of life (QoL) in patients with head and neck cancers (HNCs), influencing treatment outcomes and the occurrence of adverse events (AEs). Despite there being numerous studies on nutritional status and QoL, there is no standardized risk or prognostic model integrating clinical and demographic factors. Methods: A literature search was conducted in September 2024 in Scopus, PubMed, and Web of Science, covering studies published between 2013 and 2024. Articles were selected based on their relevance to AEs, nutritional interventions, and QoL assessments in HNC patients. Results: The key factors influencing QoL in HNC patients include age, sex, weight, BMI, educational level, and tumor features. Mucositis was identified as the most significant food intake-impairing AE, contributing to malnutrition and reduced QoL. Current QoL assessments rely on descriptive questionnaires, which lack personalization and predictive capabilities. Digital tools, including machine learning models and digital twins, offer potential solutions for risk prediction and personalized nutritional interventions. Conclusions: Despite significant research efforts, QoL assessment in HNC patients remains non-uniform, and risk models integrating nutritional status are lacking. A comprehensive, personalized approach is needed, leveraging digital tools to improve nutritional intervention strategies.

NCR as a biomarker for nutritional status and inflammation in predicting outcomes in patients with cancer cachexia: a prospective, multicenter study

BACKGROUND

Systemic inflammation and nutritional status are key factors affecting the prognosis of patients with cancer cachexia. This study aims to evaluate the prognostic value of a new nutritional and inflammatory index, Prognostic Nutritional CRP Ratio (NCR), in patients with cancer cachexia.

METHODS

This prospective multicenter study analyzed 3,447 patients diagnosed with cancer cachexia across over 40 clinical centers in China, from June 2012 to December 2023. The NCR was calculated as BMI × albumin / CRP. The Cox proportional hazards regression model was utilized to analyze hazard ratios (HRs) for all-cause mortality. The relationship between NCR and all-cause mortality was assessed using restricted cubic spline modeling. The optimal cutoff value for NCR was determined through maximally selected rank statistics.

RESULTS

Among the 3,447 individuals diagnosed with cancer cachexia in our study, 2,296 (66.6%) were men, and 1,151 (33.4%) were women. With a median follow-up duration of 45.33 months, the mean age of the participants was 63.8 ± 11.4 years. We observed that lower NCR levels were prevalent among cachexia patients across a spectrum of cancer types, including lung, colorectal, liver, esophageal, breast, ovarian, and cervical cancers. We observed that lower NCR levels were prevalent among cachexia patients across a spectrum of cancer types, including lung, colorectal, liver, esophageal, breast, ovarian, and cervical cancers. This correlation held true across diverse patient subgroups, delineated by gender, age, smoking status, BMI, TNM stage, and tumor types, underscoring the broad applicability of NCR as a prognostic marker. Moreover, our findings highlighted that cancer cachexia patients with higher NCR levels experienced a significantly improved quality of life.

CONCLUSION

The NCR, indicative of nutritional status and inflammation, is associated with reduced all-cause mortality and could be a valuable prognostic marker for patients with cancer cachexia.

The Impact of Peri-Operative Nutritional Status on Survival in Gastroesophageal Adenocarcinoma

In patients with gastric, gastroesophageal junction or esophageal adenocarcinoma (GOC), peri-operative multimodal therapies have improved survival; however, prognosis remains underwhelming. Pre-operative nutritional decline and weight are linked with poorer patient outcomes. This study retrospectively analyzed the impact of peri-operative nutritional status (as assessed by patient-generated subjective global assessment, PG-SGA), and weight loss on the survival of patients undergoing curative surgery for GOC (2013 to 2022). Of the 148 patients who underwent surgery, PG-SGA and weight data were available for 107 (72%) and 121 (82%), respectively. At presentation, 44% (n = 47) of patients were well nourished, dropping to 17% (n = 18) post-operatively. Lower post-operative nutritional status correlated to worse overall survival (OS) (p < 0.001). Patients who stayed well nourished or improved their nutritional status had better survival outcomes (HR: 2.7; 95%CI: 1.2-6.1; p = 0.01). Significant weight loss (>10%) was ubiquitously observed in 54% (n = 64) of patients, and this group had shorter OS (HR: 2.2; 95%CI: 1.2-4.1; p = 0.009). In conclusion, both nutritional decline and weight loss negatively impacted survival. Maintenance of nutritional status over the peri-operative period resulted in better outcomes. This study highlights the need for improved nutritional support during curative treatment in GOC.

The use of artificial nutrition at the end-of-life: a cross-sectional survey exploring the beliefs and decision-making among physicians and nurses

BACKGROUND

The use of artificial nutrition in the last month of life raises many concerns for patients, relatives, and healthcare professionals.

AIM

To describe physicians and nurses' beliefs, knowledge, and decision-making related to introducing and withdrawing artificial nutrition at the end-of-life. Physicians and nurses' factors affecting these decisions were examined.

DESIGN

A cross-sectional study was conducted between May and July 2022. A questionnaire was sent by email to physicians and nurses.

SETTING AND PARTICIPANTS

Physicians and nurses working in internal medicine, oncology, and palliative medicine divisions in three Swiss University Hospitals.

RESULTS

Two hundred and thirty physicians and nurses completed the survey (21% response rate). Most responders, aged 25-45, were women with < 10 years of experience, 61% lacked palliative care experience. End-of-life decision-making on artificial nutrition was reported as common by 89%. Whereas physicians and nurses played an important role in the decision, fulfilling patients' wishes (84% of cases) tended to dominate over professionals' intentions (physicians 52%, nurses 67%) as motivators at final decision. The main reasons for introducing artificial nutrition included improving nutritional status (54%), reducing broncho-aspiration (67%), and preventing pressure ulcers (53%). Having palliative care experience was the only variable modifying the beliefs of these motivations.

CONCLUSION

Whereas decisions on artificial nutrition at the end of life are common they may be mostly guided by physicians and nurses' beliefs, and patients' requests more than by robust evidence. Fostering palliative care education is pivotal. Our results emphasize the need to improve physicians and nurses' awareness of the complex interplay between values and evidence when decisions concerning artificial nutrition are taken.

Landscape of Clinical Trials in Cancer Cachexia: Assessment of Trends From 1995-2024

Cancer cachexia (CC), a multifactorial syndrome characterized by unintentional weight loss, is a frequent complication of cancer that impacts patients' quality of life and survival. In this retrospective review, we evaluated the landscape of clinical trials (CTx) registered on ClinicalTrials.gov for the consideration of potential factors contributing to human heterogeneity in their design and analyses. Among CTx registered from 1995-2024, we observed a trend toward equality in including female participants, but lack of reporting of sex as a biological variable. Limited demographic diversity was observed with ~93% White population participation. There was a substantial divergence in the diagnostic criteria and a wide range of tools employed to measure CC. Lastly, few studies considered cancer type and stage as clinical variables. Overall, a substantial gap remains in our knowledge of CC in non-white and female populations. Ultimately, these underreported data across CC CTx complicate the comparison and interpretation of CTx results, both within understudied populations and in specific cancer types. The current evolution of knowledge and new methodologies used for CC assessment reinforce the need for a constant revision of the CC consensus definition and diagnosis criteria to align with current advances in our understanding of human heterogeneity in CC.

Nutritional factors and survival in a cohort of patients with oral cancer

Background

Malnutrition commonly affects patients with oral squamous cell carcinoma (OSCC), which contributes to worsening prognosis. Moreover, specific strategies for diagnosing and managing malnutrition in OSCC are lacking. We aimed to investigate if the modality of nutritional treatment as standard oral (ON) or artificial enteral nutrition (AN), assigned by a dedicated nutritional team or not, influences survival in patients with OSCC. Moreover, given the difficulties in obtaining adequate nutritional evaluation in patients with OSCC we preliminary evaluated the magnetic resonance imaging volumetric reconstruction of posterior paraspinal muscles at the level of the third cervical vertebra (MRI-C3) as a tentative new approach to investigate sarcopenia.

Methods

This retrospective study included 52 consecutive patients with OSCC who underwent surgery at the University Hospital of Palermo (I) from Jan 2020 to May 2023. In-hospital nutritional support was provided by a dedicated team. The patients were retrospectively compared with a control group of 11 patients who were surgically treated for OSCC between January and December 2019 in the same unit of surgery, in the absence of a dedicated nutritional team. Upon discharge, the nutritional treatment consisted of ON or AN. In 2020-2023, industrially produced special medical food formulations were used rather than natural foods as it was in use in 2019; also, adequate protein supplements were assigned in order to reach the recommended protein intake of 1-0-1.2 g/kg ideal body weight. The MRI-C3 volumetric reconstruction was obtained in 16 patients.

Findings

As per-protocol, the patients were categorized according to pre-surgery TNM stage: groups A (TNM stages I-III) and B (IVa-IVc). The prevalence of group A patients was 59.6% in the case group and 85.7% in the control group (p < 0.001), with higher survival rates at follow-up in the control group (80.5% vs. 27.3%), therefore, the two historical groups were not comparable. Given the limited number of cases, all patients were included in a unique group. Advanced stages of OSCC (log-rank test, p < 0.001) and AN (p < 0.001) were independently associated with a lower survival rates. The 3-12 month post-surgery MRI_C3 volume increased in patients who received ON treatment and decreased in those who received AN treatment (p < 0.001).

Conclusion

AN is associated with lower survival probability than ON in patients with OSCC. The MRI-C3 measurement of paravertebral muscles is a promising technique for detecting sarcopenia that needs to be confirmed by further studies including larger groups of patients.

Conventional Radiotherapy Timing and Wound Complication Avoidance After Surgery for Metastatic Spine Disease. A LatAm Modified Delphi Study

BACKGROUND

Combining surgery and radiotherapy is the gold standard in treating spinal metastasis when spinal stabilization or surgical decompression is required. Determining the optimal timing for radiotherapy postsurgery is crucial to balance treatment efficacy minimizing wound complications. The study aimed to identify consensus and nonconsensus areas among Latin American spinal surgeons regarding the use, timing, risks, and surgical approach to conventional external beam radiotherapy (cEBRT) following spinal surgery for metastases, specifically focusing on the risk of radiotherapy-related wound complications.

METHODS

A modified Delphi survey was conducted. The expert panel included active members of AOSpine Latin America with extensive experience in vertebral metastasis surgery. The surveys include 37 statements covering areas of interest. Inter-expert consensus was considered weak (70-79.9%), moderate (80-89.9%), and strong (≥90%).

RESULTS

At least 70% consensus was reached on 32 of the 37 statements (86.5%). This included strong consensus on 10 statements, moderate on 13, and weaker on nine. There was high consensus on sutures and lower consensus on risk factors for cEBRT delay. Experts reached strong agreement on the importance of poor nutrition as a risk factor for cEBRT-related wound complications. Perception of wound risk was greater with a posterior midline approach compared to other approaches, and the highest perceived complication risks were for junctional locations and sacral spine.

CONCLUSIONS

We report strong agreements among the experts on important issues such as waiting times and risk factors for cEBRT. The findings underscore the significance of considering factors such as, spinal levels, surgical approaches, and sutures when making clinical decisions.

Prevalence of Nutritional Risk and Obesity in Mexican Cancer Outpatients

Introduction: Malnutrition is a critical issue among cancer patients, leading to adverse clinical outcomes, including increased treatment toxicity, reduced physical function, and decreased survival. Nutritional screening is essential to identify patients at risk and provide timely interventions. Objectives: This study aimed to assess the effectiveness of various nutritional screening tools in identifying the risk of malnutrition and obesity in Mexican cancer outpatients. Methods: A cross-sectional study was conducted with 396 adult cancer outpatients at a public hospital in Mexico. Nutritional risk was evaluated using NRS-2002, MUST, MST, NUTRISCORE, and PG-SGA, while malnutrition was assessed using GLIM criteria and PG-SGA. Anthropometric and demographic data were collected. Sensitivity, specificity, and kappa coefficients were calculated to determine the performance of the screening tools. Results: Nutritional risk was identified in 22.7-26.5% of patients, with the highest agreement observed between MUST and PG-SGA (k = 0.64). Malnutrition prevalence was higher using GLIM criteria (37.4%) compared to PG-SGA (25.8%, p < 0.001). Overweight and obesity affected 37.1% and 23.5% of patients, respectively. Low BMI and reduced HGS were strongly associated with nutritional risk and malnutrition (p < 0.001). Conclusions: MUST and PG-SGA are reliable tools for nutritional screening in cancer outpatients, while GLIM criteria detect a higher prevalence of malnutrition than PG-SGA. The high rates of overweight and obesity highlight the complex nutritional challenges in this population, emphasizing the need for tailored nutritional assessments and interventions.

The impact of preoperative immunonutritional status on prognosis in ovarian cancer: a multicenter real-world study

BACKGROUND

To investigate the effect of preoperative immunonutritional status on prognosis in epithelial ovarian cancer patients.

METHODS

A multicenter real-world study included 922 patients with histologically confirmed epithelial ovarian cancer who received comprehensive staged surgery or debulking surgery at seven tertiary hospitals in China between 2012 and 2023. Prognostic nutritional index (PNI) and systemic immune-inflammation index (SII) were used to assess the immunonutritional status for their superior predictive power to indicate the nutritional status and the inflammatory immunity. Cox regression analyses were employed to identify variables associated with progression-free survival (PFS) and overall survival (OS).

RESULTS

In the early-stage cohort of 224 epithelial ovarian cancer patients, the optimal cut-off value for PNI was 47.47 for both PFS and OS, while the optimal cut-off value for SII values were 551.37 for PFS and 771.78 for OS. In the late-stage group of 698 patients, the optimal PNI thresholds were 47.76 for PFS and 46.00 for OS, with SII values of 720.96 for PFS and 1686.11 for OS. In multivariate analysis of early-stage patients, high PNI was an independent protective factor for PFS (hazard ratio (HR), 0.39 (95% confidence interval (CI) 0.20-0.76), P = 0.006) and OS (HR, 0.44 (95% CI 0.20-0.97), P = 0.042), respectively. High SII was significantly associated with PFS (HR, 2.43 (95% CI 1.23-4.81), P = 0.011) and marginally unfavorable for OS (HR, 2.05 (95% CI 0.96-4.39), P = 0.064). In advanced population, PNI (HR, 0.77 (95% CI 0.60-0.99), P = 0.043) and SII (HR, 1.34 (95% CI 1.01-1.78), P = 0.041) were independent prognostic factors for OS but had no impact on PFS (P = 0.185, P = 0.188, respectively).

CONCLUSION

Poor preoperative immunonutritional status has a deleterious effect on the prognosis of patients with ovarian cancer. Intervention in patients suffering from suboptimal preoperative immunonutritional status may facilitate improved survival outcomes.

Application of oral nutritional supplements to control body weight loss in postoperative patients suffering from solid tumors: a systematic review and meta-analysis

Objective

This study aims to summarize the impact of oral nutritional supplements (ONSs) on mitigating body weight loss (BWL) in patients following surgical treatment for solid tumors.

Methods

A systematic and comprehensive search of four major publicly available databases was conducted up to May 2024 to identify studies for inclusion in the analysis. Data from eligible studies were extracted, and pooled mean differences (MD) along with their 95% confidence intervals (CIs) for BWL were computed.

Results

A total of 12 randomized controlled trials (RCTs) with 2,268 participants were finally included. The group receiving oral nutritional supplements demonstrated a statistically significant reduction in weight loss compared to the control group, with a mean difference of 1.11 (95% CI: 0.52-1.70), an I 2 statistic of 97.0%, and a p-value less than 0.01.

Conclusion

The meta-analysis provide evidence that ONSs effectively reduce BWL in postoperative patients with solid tumors. Additionally, ONS with lower daily caloric intake demonstrated superior efficacy in reducing BWL.

Ultrasound for skeletal muscle assessment in surgical oncology: A scoping review

BACKGROUND

Skeletal muscle wasting in cancer patients is associated with adverse outcomes. Ultrasound offers a non-invasive muscle assessment, but no previous review has focused on its application during perioperative period. This scoping review aims to map the current literature on the ultrasound use for skeletal muscle assessment in cancer patients during the perioperative period and identify knowledge gaps for future research.

METHODS

A systematic literature search was conducted in the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, Embase, Medline, and Web of Science. Two independent reviewers screened studies for eligibility and extracted relevant data, including study characteristics, population, ultrasound protocols, and outcomes. Inclusion criteria were primary studies involving adults undergoing cancer surgery with ultrasound used for skeletal muscle assessment during the perioperative period.

RESULTS

Thirteen studies were included. The majority assessed quantitative parameters, with the rectus femoris muscle being the most evaluated. Muscle thickness and cross-sectional area were the most frequently reported parameters. Studies validated ultrasound parameters against established tools and clinical indicators, including sarcopenia, frailty, muscle strength, and biomarker. Ultrasound was also used to predict postoperative outcomes and assess perioperative interventions. However, variability in ultrasound protocols highlights the need for standardized practices, and the lack of consensus on cutoffs warrants future research.

CONCLUSIONS

This review demonstrated the validity and the applications of ultrasound for skeletal muscle assessment in cancer patients during the perioperative period. Significant variability in ultrasound protocols and the absence of standardized cutoffs highlight the need for further research.

The relationship between tumour necrosis, systemic inflammation, body composition and survival in patients with colon cancer

BACKGROUND

In cancer cachexia the relationship between the tumour, its environment and the systemic inflammatory response is not clear. This study aims to examine this relationship in greater detail.

METHODS

Host characteristics included the presence of a Systemic Inflammatory Response (SIR) as measured by Systemic Inflammatory Grade (SIG), sarcopenia (SMI) and myosteatosis (SMD) were measured. Categorical variables were analysed using χ2 test for linear-by-linear association, or χ2 test for 2 by 2 tables. Survival analysis was carried out using univariate and multivariate Cox regression.

RESULTS

A total of 473 patients were included. Of these, 70.4% were over 65 years of age, 54.8% were male and 49.8% had an ASA grade of 1 or 2. Pathological examination showed that the majority of patients had a T3 (53.7%) or a T4 (34.0%) cancer and 73.0% had evidence of necrosis. A SIG score of 0 or 1 was present in 57.7% of patients. Tumour necrosis was associated with age (p < 0.01), tumour location (p < 0.01), T-stage (p < 0.001), margin involvement (p < 0.05), SIG (p < 0.001), SMI (p < 0.01), SMD (p < 0.05) and 5-year survival (p < 0.001). On multivariate survival analysis in patients with T3 cancers age (HR: 1.45 95% CI 1.13-1.86 p < 0.01), ASA grade (HR: 1.50 95% CI 1.15-1.95 p < 0.01) and SIG (HR: 1.28 95% CI 1.11-1.48 p < 0.001) remained independently associated with survival.

CONCLUSION

These results suggest that tumour necrosis and the subsequent SIR could result in profound changes in body composition and survival. Further pre-clinical and clinical work is required to prove causation.

Changes in nutritional status and effectiveness of the dietary intervention of multimodal prehabilitation for patients with colorectal cancer: A secondary analysis of the PREHAB randomized clinical trial

BACKGROUND & AIMS

Prehabilitation is a preoperative multimodal program including exercise, nutritional, and psychological support. Little is known about changes in nutritional status during prehabilitation.

METHODS

This secondary analysis of the PREHAB trial aims to assess changes in nutritional status and explore the effectiveness of a four-week nutritional intervention. Data were collected at baseline and preoperatively (end of the program), including body composition with bioelectrical impedance analysis (single frequency, 50 kHz), muscle strength (indirect 1RM leg press), three-day food diaries and the scored PG-SGA. Protein requirements were set at 1.5 g/kg body weight.

RESULTS

Sixty-seven participants were enrolled, 34 to standard care and 33 to four-week prehabilitation. Nutritional status improved in both groups: -1 point change in the standard care group (p = , 0.027), and -1.5 point in the prehabilitation group (p = 0.015). Those who received prehabilitation statistically increased fat free mass (0.9 kg, p = 0.017) and appendicular skeletal muscle mass (0.5 kg, p = 0.007. In contrast, an increase in fat mass (0.6 kg, p = 0.016) was observed within the standard care group only. Participants in the prehabilitation group had a substantial increase of 27 % muscle strength (p = <0.001). Optimal protein intake was more often achieved within the prehabilitation group (47 %, p = <0.001).

CONCLUSION

Our study provides evidence for the positive impact of multimodal prehabilitation on preoperative nutritional status in adult patients with CRC, especially in body composition and muscle strength. Achieving optimal protein intake was challenging, both dietary counseling and supplements are recommended to improve intake.

TRIAL REGISTER

PREHAB RCT: NTR5947.

A cross-sectional survey exploring knowledge, beliefs and barriers to whole food plant-based diets amongst registered dietitians in the United Kingdom and Ireland

BACKGROUND

Plant-based diets (PBDs) have gained popularity in recent years due to their co-benefits for human and planetary health. Although clinical guidelines now recommend well-balanced PBDs, it remains unclear how dietitians in the United Kingdom (UK) and Republic of Ireland (ROI) view such diets and their implementation in practice. This study aimed to evaluate the perspectives of registered dietitians (RDs) on the role of a whole food plant-based diet (WFPBD) in clinical practice.

METHODS

A cross-sectional online survey was conducted amongst RDs in the UK and ROI between September and November 2023.

RESULTS

A total of 335 RDs participated in the survey. Most RDs (76%) agree that a well-planned WFPBD is suitable for all stages of life, with some (48%) expressing concerns over the risk of malnutrition and micronutrient deficiencies. Three-quarters of RDs (75%) incorrectly thought that plant protein is incomplete, necessitating protein combining. A WFPBD was on average ranked fourth out of 14 dietary strategies for managing some of the leading non-communicable diseases. Excluding dairy and eggs was the primary reason preventing RDs from personally adopting a WFPBD, whereas meal preparation and cost were the main barriers for their clients. The majority of RDs (79%) feel they did not receive sufficient education on WFPBDs, with 58% agreeing there are insufficient evidence-based resources available in their field. Only 33% feel supported when advocating for a WFPBD in their workplace.

CONCLUSIONS

Although many RDs view WFPBDs as viable and clinically relevant, significant barriers to their implementation exist, underscoring the need for enhanced education and support.

Prognostic impact of adipose tissue loss at 1 month after surgery in patients with gastric cancer

BACKGROUND

The postoperative impact of short-term changes in skeletal muscle loss (SML) and adipose tissue loss (ATL) on treatment outcomes is unclear in patients with gastric cancer (GC). We investigate the role of SML and ATL at 1 month after surgery in determining postoperative survival and recurrence rates in patients with GC.

METHODS

We analyzed 540 patients with GC and assessed their skeletal muscle mass, visceral fat mass, and subcutaneous fat mass using computed tomography scans preoperatively and 1 month postoperatively. Patients were categorized into high and low groups based on their levels of SML, visceral ATL (v-ATL), and subcutaneous ATL (s-ATL). Additionally, they were classified into three groups (high ATL, intermediate ATL, and low ATL) based on their v-ATL and s-ATL measurements.

RESULTS

Patients with higher v-ATL and s-ATL had lower overall survival (OS) and recurrence-free survival (RFS) rates. High ATL was an independent prognostic factor for decreased OS (hazard ratio [HR] 2.27; 95% confidence interval [CI] 1.16-4.42; and P = 0.02) and RFS (HR 2.51; 95% CI 1.34-4.71; and P = 0.004) rates.

CONCLUSION

A reduction in adipose tissue volume shortly after surgery (1 month) could potentially indicate an increased risk of recurrence and mortality in patients with GC.

Preoperative immunonutrition and postoperative outcomes in patients with cancer undergoing major abdominal surgery: Retrospective cohort study

BACKGROUND AND OBJECTIVES

Surgical resection is a first-line treatment for patients with cancer, but preoperative malnutrition is a risk factor for postoperative complications. This study aimed to evaluate the association between preoperative administration of an immunonutrition regimen and postoperative clinical outcomes in patients with cancer undergoing major abdominal surgery.

METHODS

The Surgical Prehabilitation Multimodal Oncology (SUPREMO) retrospective cohort study, conducted from January 2021 to December 2023, included patients with cancer undergoing major abdominal surgery. Patients were categorized based on whether they received a complete immunonutrition regimen or an incomplete or no regimen. Demographic and clinical data were extracted from electronic health records for descriptive analysis. Logistic regression was used to assess the impact of immunonutrition on the risk of infectious complications, with clinical and demographic variables as explanatory factors.

RESULTS

A total of 620 patients were included, with 49 % receiving a complete preoperative immunonutrition regimen. Bivariate analysis indicated that complete regimen administration was associated with lower intensive care unit (ICU) admission, invasive mechanical ventilation (IMV), and vasopressor support requirements (p = 0.005, p = 0.019, and p = 0.032, respectively). The logistic regression model showed a significant reduction in in-hospital infectious complications (odds ratio 0.54, 95 % confidence interval 0.31-0.98; p = 0.044).

CONCLUSION

Administering a complete preoperative immunonutrition regimen may be associated with reduced infectious complications, ICU and IMV requirements, and vasopressor support use.

Prognostic impact of inflammatory and nutritional biomarkers in pancreatic cancer

Pancreatic cancer is usually associated with a poor prognosis. Surgery is the main curative treatment but pancreatic operations are aggressive and new tools that help clinicians to predict surgical and prognostic outcomes are necessary. Lu et al recently published a retrospective, single centre cohort study evaluating the impact of seven nutritional and inflammatory markers in pancreatic cancer surgical patients: The albumin-to-globulin ratio, prognostic nutritional index (PNI), systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), nutritional risk index, and the geriatric nutritional risk index. A significant correlation was found between the PNI, SII, NLR, and PLR and a hospital discharge of less than 15 days. In a univariable analysis, PNI, SII, NLR and PLR were significantly related to recurrence-free survival and, in a multivariable analysis PNI was associated with overall survival. Various meta-analyses corroborate the results in terms of prognosis but individual studies are discordant on their usefulness. Besides, the cut-off values for these markers vary significantly between studies and there are no clinical trials comparing them to identify the most relevant ones. These are limitations when implementing nutritional and inflammatory biomarkers into clinical practice and further studies are needed in order to answer these questions.

Nutritional support in children treated for advanced adrenocortical carcinoma

PURPOSE

Adrenocortical carcinoma (ACC) is a rare, aggressive pediatric malignancy. Advanced ACC requires multimodal treatment, including surgery and systemic chemotherapy including cisplatin, etoposide, doxorubicin, and mitotane. This is associated with significant gastrointestinal toxicity, resulting in many patients being unable to complete scheduled therapy. Often, supplemental nutrition is required if oral intake during treatment is poor. We assessed the frequency of nutritional supplement use in pediatric patients treated for advanced ACC.

METHODS

This was a retrospective observational study of patients with ACC treated at St. Jude Children's Research Hospital over 10 years (2012-2022). Patient demographics, treatment received, and the need for supplemental enteral or parenteral nutrition were reviewed.

RESULTS

A total of 18 patients with ACC were treated from 2012 to 2022, with 11 having advanced ACC. 54.5% of patients required supplemental nutrition, both enteral and parenteral. All patients requiring supplemental nutrition were intolerant of oral intake, with a mean weight loss of 13.8% (range: 5.9-35%). Mean duration of nutritional support was 362 ± 337 days. Patients requiring supplemental nutrition tended to be younger than others (mean age: 4.45 ± 3.63 vs. 9.14 ± 4.59 years; median age: 3.35 vs. 8.40 years; range: 0.90-11.0 vs. 3.30-15.1 years) (p = 0.082).

CONCLUSIONS

Most patients with stage IV ACC require nutritional support during their treatment course, especially younger patients. Preemptive feeding tube placement should be considered to avoid delays in treatment.

Comparison of Patient-Generated Subjective Global Assessment (PG-SGA) and Mini Nutritional Assessment (MNA) for nutritional assessment in hepatocellular carcinoma patients

BACKGROUND

Malnutrition affects the prognosis and response to treatment in cancer patients. There is no gold standard for nutritional assessment in patients with hepatocellular carcinoma (HCC). This study aimed to compare Patient-Generated Subjective Global Assessment (PG-SGA) and Mini Nutritional Assessment (MNA) in predicting mortality in HCC patients.

METHOD

We included HCC patients in the outpatient clinic at HRH Maha Chakri Sirindhorn Medical Center. The nutritional status was assessed according to PG-SGA and MNA. Patients were followed up for 1 year to verify the incidence of death and complications.

RESULT

Eighty-nine HCC patients were included. The mean age was 62.2 years. Most of the patients were treated with transarterial chemoembolization. Malnutrition identified by PG-SGA and MNA was 53.9% and 51.7%, respectively. The mortality rate was 2.65 cases per 100 persons. Overall survival rate was 90% and 81.5% at 12 and 24 months, respectively. Patients with malnutrition assessed by PG-SGA and MNA had significantly higher mortality than patients without malnutrition. PG-SGA had a sensitivity of 80% for predicting mortality. PG-SGA had higher accuracy for predicting the mortality of HCC patients than MNA (AUROC PG-SGA 0.7148 and MNA 0.7098).

CONCLUSION

HCC patients with malnutrition were evaluated by PG-SGA and MNA had higher mortality than HCC patients without malnutrition. PG-SGA had higher accuracy in predicting mortality than MNA.

Preoperative management in octogenarian patients with rectal cancer

Background

In recent years, the rise in average lifespan has been linked to an increase in the occurrence of diseases associated with aging worldwide. Rectal tumors often occur in elderly patients.

Methods

Between January and August 2024, 6 experts in colorectal cancer met to develop an algorithm to organize the interdisciplinary and multimodal preoperative approaches in the octogenarian population with rectal cancer. To develop the algorithm, we conducted a straightforward search within the PubMed database and also reviewed the citations of the most pertinent articles we discovered. The quality of the methods used in the final selection of 76 sources was evaluated, every single source was scrutinized and analyzed, and a team of six experts created an algorithm.

Results

An algorithm for preoperative management of octogenarian patients with rectal cancer was created to encapsulate essential information and provide a contemporary resource for physicians, surgeons, physiotherapists, and nutritionists to utilize in optimal clinical practice.

Conclusions

Octogenarian patients with rectal cancer are special-character groups and require specific preoperative management to better the surgical outcome.

Near-Death Quality of Life in Cancer Patients on Home Parenteral Nutrition

Background: The impact of home parenteral nutrition (HPN) on the quality of life (QoL) of cancer patients has been previously investigated. However, scarce data are available regarding near-death QoL in patients with cancer receiving HPN. This study aims to investigate the changes of QoL in these patients in the last two months before death. Methods: This is a secondary analysis of a previous, prospective, longitudinal, observational study. QoL was assessed using the EORTC QLQ-C30 questionnaire. Results: Eighty-four adult cancer patients who died on HPN and had filled out the questionnaire between 31 and 60 days (M2) and within 30 days prior (M1) to death were included in this analysis. The questionnaires filled out at M2 and M1 were compared with those filled out by the same patients at HPN start (T0). At M2, there was a significant improvement in both the global QoL and symptoms scales (p < 0.001 and p < 0.033, respectively), while at M1, a significant improvement in the global QoL scale persisted (p < 0.035) compared with T0. Conclusions: Our study first reports that HPN, if started early and according to European guidelines, is associated with an improvement in the QoL of patients with cancer even in the last two months before death.

Effect of a Novel Food Rich in Miraculin on the Intestinal Microbiome of Malnourished Patients with Cancer and Dysgeusia

BACKGROUND/OBJECTIVES

Dysgeusia contributes to malnutrition and worsens the quality of life of patients with cancer. Despite the different strategies, there is no effective treatment for patients suffering from taste disorders provided by the pharmaceutical industry. Therefore, we developed a novel strategy for reducing side effects in cancer patients by providing a novel food supplement with the taste-modifying glycoprotein miraculin, which is approved by the European Union, as an adjuvant to medical-nutritional therapy.

METHODS

A pilot randomized, parallel, triple-blind, and placebo-controlled intervention clinical trial was carried out in which 31 malnourished patients with cancer and dysgeusia receiving antineoplastic treatment were randomized into three arms-standard dose of dried miracle berries (DMBs) (150 mg DMB/tablet), high dose of DMBs (300 mg DMB/tablet), or placebo (300 mg freeze-dried strawberry)-for three months. Patients consumed a DMB or placebo tablet before each main meal (breakfast, lunch, and dinner). Using stool samples from patients with cancer, we analyzed the intestinal microbiome via nanopore methodology.

RESULTS

We detected differences in the relative abundances of genera Phocaeicola and Escherichia depending on the treatment. Nevertheless, only the Solibaculum genus was more abundant in the standard-dose DMB group after 3 months. At the species level, Bacteroides sp. PHL 2737 presented a relatively low abundance in both DMB groups, whereas Vescimonas coprocola presented a relatively high abundance in both treatment groups after 3 months. Furthermore, a standard dose of DMB was positively associated with TNF-α levels and Lachnoclostridium and Mediterraneibacter abundances, and a high dose of DMB was negatively associated with TNF-α levels and the relative abundance of Phocaeicola. Following the administration of a high dose of DMB, a positive correlation was observed between erythrocyte polyunsaturated fatty acids and the presence of Lachnoclostridium and Roseburia. Additionally, a positive association was identified between Phocaeicola and the acetic acid concentration of feces. There was a negative association between the relative abundance of Phocaeicola and taste perception in the high-dose DMB group.

CONCLUSIONS

The combination of DMB intake with nutritional treatment and individualized dietary guidance results in positive changes in the intestinal microbiome of patients with cancer and dysgeusia. Changes observed in the intestinal microbiome might contribute to maintaining an appropriate immune response in cancer patients. As the current pilot study included a limited number of participants, further clinical trials on a larger group of patients are needed to draw robust findings.

Immunonutrition to improve the quality of life of upper gastrointestinal cancer patients undergoing neoadjuvant treatment prior to surgery (NEOIMMUNE): double-blind randomized controlled multicenter clinical trial

BACKGROUND

Malnutrition is common with esophagogastric cancers and is associated with negative outcomes. We aimed to evaluate if immunonutrition during neoadjuvant treatment improves patient's health-related quality of life (HRQOL) and reduces postoperative morbidity and toxicities during neoadjuvant treatment.

METHODS

A multicenter double-blind randomized controlled trial (RCT) was undertaken. Included patients had untreated nonmetastatic esophagogastric tumor, aged 18 ≥ years with a life expectancy of >3 months. The study was powered for 80% power to detect a clinically relevant difference in EORTC-QLQC30 with standard deviation of 15 between groups. Primary end point was the quality of life as measured by the global health status at 30 days after surgery. An intention-to-treat analysis was employed.

RESULTS

The study was terminated at the interim analysis stage. About 300 patients were randomized: 149 to the IMPACT group and 151 to the control-formula group. Patient groups were well-balanced in terms of age, sex, body mass index, WHO performance status, and clinical tumor stage. Analysis of the primary end point for the study of global health status at 30-day postoperatively failed to show any significant differences between the groups (55.4 ± 18.6 [IMPACT] vs. 55.9 ± 19.8 [control]; P = 0.345). No significant differences between the groups were detected in the majority of domains from EORTC QLQC30 and OG25 tools after neoadjuvant therapy and 30 days postoperatively. Finally, no significant differences were seen between groups in neoadjuvant therapy or postoperative complications, or tumor response.

CONCLUSION

The results of this multicenter double-blind RCT fail to demonstrate any HRQOL benefits to the utilization of immunonutrition during neoadjuvant therapy in patients with esophagogastric cancer.

Progress and Challenges in Integrating Nutritional Care into Oncology Practice: Results from a National Survey on Behalf of the NutriOnc Research Group

INTRODUCTION

Nutritional care is a cornerstone of cancer treatment, with the potential to significantly improve patient outcomes by addressing malnutrition and enhancing recovery. Despite growing awareness, the integration of evidence-based nutritional strategies into oncology remains inconsistent. Following a 2020 survey that highlighted critical gaps, the NutriOnc Research Group launched targeted initiatives to raise awareness and improve practices. This study reassesses progress in integrating nutritional care and identifies persistent challenges.

METHODS

A 29-question survey was conducted in 2024 among 73 early-career oncologists, surgeons, radiation oncologists, and nutrition specialists across Italy. Respondents provided insights into clinical nutrition program availability, multidisciplinary team composition, screening practices, and educational needs.

RESULTS

Encouraging advancements were noted, with 80.8% of respondents reporting the presence of clinical nutrition programs, compared to fewer structured efforts in 2020. However, only 26.0% included nutrition specialists in multidisciplinary teams, and barriers such as financial constraints, limited product availability, and the absence of trained professionals persisted. While 82.2% performed nutritional screening, variability in tools and practices highlighted the need for standardization. Strikingly, 98.6% expressed a strong demand for advanced education on clinical nutrition, emphasizing the need for innovative and accessible training programs.

CONCLUSIONS

This study reveals a landscape of progress tempered by persistent inequities. To close the gap, oncology must embrace standardized protocols, expand access to trained nutrition specialists, and invest in educational initiatives. The findings offer actionable insights for transforming cancer care through nutrition, underscoring its potential to improve survival, quality of life, and overall treatment success.

SARC-CalF using calf circumference adjusted for BMI predicts 6-mo readmission and mortality in hospitalized patients: a secondary analysis of a cohort study

BACKGROUND

Sarcopenia is a prevalent condition associated with worse clinical outcomes in hospitalized patients. The SARC-CalF is an accurate instrument for its screening; however, it includes the calf circumference (CC) measure as a criterion, which is influenced by adiposity. An adjustment for CC based on body mass index (BMI) has been proposed, but the literature lacks studies evaluating the SARC-CalF using adjusted CC.

OBJECTIVES

This study aimed to evaluate the prognostic value of the SARC-CalF with BMI-adjusted CC and compare it between adult and older hospitalized patients.

METHODS

This is a secondary analysis of a cohort with prospective data collection, including individuals aged ≥18 y who were lucid and able to communicate. SARC-CalF was applied using BMI-adjusted CC, obtained by subtracting 3, 7, and 12 cm from CC values when BMI was 25 to 29.99, 30 to 39.99, and ≥40 kg/m2, respectively. Outcomes of interest included prolonged hospital stay, in-hospital death, hospital readmission, and mortality 6 mo after discharge. Logistic and Cox regression analyses, adjusted for Charlson Comorbidity Index and sex, were performed.

RESULTS

We analyzed data from 554 patients (mean age 55.2 ± 14.9 y, 52.9% male). Suggestive signs of sarcopenia by SARC-CalF with BMI-adjusted CC were identified in 40.4% of patients (38.6% of adults and 42.7% of older patients, P = 0.380). Suggestive signs of sarcopenia were associated with hospital readmission in adults (odds ratio [OR]: 1.8; 95% confidence interval [CI]: 1.1, 2.9), and 6-mo death in both adult (OR: 4.0; 95% CI: 1.3, 12.1) and older patients (OR: 2.8; 95% CI: 1.2, 6.6). It was not independently associated with in-hospital outcomes.

CONCLUSIONS

SARC-CalF with BMI-adjusted CC identifies a high frequency of patients with suggestive signs of sarcopenia, regardless of age, and it is independently associated with worse outcomes 6 mo after discharge.

Sarcopenia and cachexia: molecular mechanisms and therapeutic interventions

Sarcopenia is defined as a muscle-wasting syndrome that occurs with accelerated aging, while cachexia is a severe wasting syndrome associated with conditions such as cancer and immunodeficiency disorders, which cannot be fully addressed through conventional nutritional supplementation. Sarcopenia can be considered a component of cachexia, with the bidirectional interplay between adipose tissue and skeletal muscle potentially serving as a molecular mechanism for both conditions. However, the underlying mechanisms differ. Recognizing the interplay and distinctions between these disorders is essential for advancing both basic and translational research in this area, enhancing diagnostic accuracy and ultimately achieving effective therapeutic solutions for affected patients. This review discusses the muscle microenvironment's changes contributing to these conditions, recent therapeutic approaches like lifestyle modifications, small molecules, and nutritional interventions, and emerging strategies such as gene editing, stem cell therapy, and gut microbiome modulation. We also address the challenges and opportunities of multimodal interventions, aiming to provide insights into the pathogenesis and molecular mechanisms of sarcopenia and cachexia, ultimately aiding in innovative strategy development and improved treatments.

Nutritional interventions in randomised clinical trials for people with incurable solid cancer: A systematic review

BACKGROUND & AIMS

Malnutrition is highly prevalent in those with cancer and more so in those with incurable cancer. In incurable cancer, it is widely agreed that optimal nutritional care has the potential to positively impact patient and caregiver distress and oncological outcomes. The aim of this systematic review was to describe the diversity and frequency of nutritional interventions, whether given in isolation or as part of a multimodal intervention in those with incurable cancer, in randomised controlled trials. The secondary aims were to describe adherence and their efficacy.

METHODS

This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The following databases were searched electronically: Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica database (EMBASE), Cumulated Index to Nursing and Allied Health Literature (CINAHL) and Cochrane Central Register of Controlled Trials (CENTRAL) with the time frame from January 2000 to 7th September 2023. Eligible studies included adult patients (≥18 years) diagnosed with incurable solid cancer with a sample size ≥40. Studies were to be primary research and delivered for at least 14 days to allow for efficacy. They were to include a nutritional intervention encompassing at least one of the following: dietary counselling, oral nutritional supplements (ONS), enteral tube feeding and/or parenteral nutrition (PN), given in isolation or as part of a multi-modal intervention. Studies were excluded if the population contained patients who had completed curative treatment or are being treated with curative intent, haematological cancers, or if they examined the effects of micronutrients, proteins, amino acids or fatty acids given in isolation. The quality of the included studies was assessed using the Cochrane risk of bias tool for randomised trials (RoB2). A balloon plot was produced to present the results in addition to a table with a narrative summary of the primary outcomes.

RESULTS

A total of 7968 studies were identified, of which 18 met the eligibility criteria. This included 2720 study participants. The included studies comprised: multimodal interventions (n = 7), dietary counselling (n = 2), nutritional supplementation with or without dietary counselling (n = 7) and PN (n = 2). Primary outcomes included quality of life (QoL), body composition and nutritional status. For QoL, this was reported in 15 studies, 4 studies showed a significant improvement. Body composition was evaluated in 15 studies, 5 of which showed a significant improvement in body weight and two in fat-free mass (FFM). Nutritional status was reported in 6 studies with one showing a significant difference in Patient-Generated Subjective Global Assessment (PG-SGA) score. The risk of bias was deemed 'low' in 6 studies, with 'some concerns' in 10 studies and a 'high risk' in 2 studies. There was heterogeneity between the studies.

CONCLUSION

This systematic review has highlighted some positive findings in regard to QoL, body weight and nutritional intake. Optimum nutritional intervention was not identified. Future studies should evaluate the effectiveness of earlier nutritional interventions at the point of diagnosis, including regular reviews and the impact this has on nutritional outcomes, QoL and overall survival (OS).

Prognostic value of serum 25-hydroxyvitamin D levels and malnutrition status on postoperative complications in patients following laryngectomy with neck dissection

BACKGROUND

Postoperative complications (PCs) following total laryngectomy remain a significant challenge, with recent investigations directed toward the impact of nutrition status and vitamin D deficiency.

OBJECTIVES

To elucidate the association between preoperative vitamin D level status, malnutrition risk score, and surgical and survival outcomes in patients with advanced laryngeal cancer following total laryngectomy.

STUDY DESIGN

Prospective cohort study.

METHODS

Sixty-four patients with advanced laryngeal carcinoma treated with total laryngectomy were included in the study. Serum levels of 25(OH) D3 were measured employing a commercial chemiluminescent immunoassay kit, while nutrition status was evaluated using the nutrition risk index (NRI) and Malnutrition universal screening tool (MUST).

RESULTS

The mean serum 25(OH) D level was 37.1 ± 19.4 nmol/L (range 11.0-100.6 nmol/L), with 47% of patients exhibiting vitamin D deficiency and 31% displaying insufficiency. Medium/high MUST score had 53% of patients, and moderate/severe NRI was verified in 48% of patients. Univariate logistic regression analysis identified MUST score, GPS score, neutrophil-to-lymphocyte ratio, and circulating 25(OH) D levels as predictive for the occurrence of PCs. In multivariate analysis, MUST score and circulating 25(OH) D levels remained significantly associated with PCs. Patients with high nutrition risk had significantly lower two-year OS rates compared to the medium and low nutrition risk groups, respectively (30% vs. 62% and 83%, p = 0.010).

CONCLUSION

Early identification of malnourished or patients with vitamin D deficiency and those who would benefit from specific nutritional support could be beneficial for minimizing the risk of development of surgical complications and help improve our clinical outcomes.

The Effect of Nutritional Intervention in Nutritional Risk Screening on Hospitalised Lung Cancer Patients

BACKGROUND

Lung cancer (LC) patients are prone to suffer from malnutrition. Malnutrition negatively affects patients' response to therapy, increases the incidence of treatment-related side effects, and decreases survival. Early identification of LC patients who are malnourished or at risk of malnutrition can promote recovery and improve prognosis.

OBJECTIVE

This study aimed to assess the risk and nutritional status of lung cancer patients who are hospitalised, as well as to evaluate the impact of nutritional intervention on the risk of malnutrition.

METHODS

From January 2022 to December 2023, 53 LC patients hospitalised in a pulmonology department had their nutritional risk (initial and final) and nutritional status (initial) assessed. All were selected for nutritional intervention. Nutrition counselling was the first intervention option, along with dietary changes with/without oral nutritional supplements.

RESULTS

At the time of hospitalisation, 90.6% of the patients were at nutritional risk, 45.3% were classified as moderately malnourished, and 35.8% were classified as severely underweight. After the hospitalisation, 73.6% were at nutritional risk at the time of discharge, suggesting a statistically significant decrease in the number of patients with nutritional risk.

CONCLUSIONS

Most LC patients hospitalised presented an altered nutritional status. Our study suggests that a nutritional intervention must be implemented to reduce malnutrition risk, which may impact prognosis. The comprehensive nutritional problems experienced by LC patients require nutritional assessment and improved individually tailored nutritional support.