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Matos AN, Silvestre SCDM, Fernandes SL, Pereira AA, Pimentel RFW, Carvalho-Rassbach M, Albuquerque LCD, Iucif Junior N. Nutrological therapy in oncology: from prevention to nutritional support during treatment. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e2024S123. [PMID: 38865543 DOI: 10.1590/1806-9282.2024s123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 10/31/2023] [Indexed: 06/14/2024]
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2
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Graham KL, Carty D, Poulter SP, Blackman C, Dunstan OG, Milton TL, Ferguson C, Smith K, Van Dijk E, Jongebloed D, Loeliger J, Baguley BJ. The nutrition-related adverse events associated with immune checkpoint inhibitor treatment for patients with non-small cell lung cancer: A systematic review. Nutr Diet 2024. [PMID: 38804022 DOI: 10.1111/1747-0080.12879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 03/24/2024] [Accepted: 04/15/2024] [Indexed: 05/29/2024]
Abstract
AIMS Immune checkpoint inhibitor therapy used for lung cancer has significantly changed response and survival rates, however, the impact on patients' nutritional status remains largely unexplored. This review aims to identify common adverse events that increase nutrition risk induced in non-small cell lung cancer patients treated with immune checkpoint inhibitor therapy and assess impact on nutritional status. METHODS PubMed, Medline and CINAHL were systematically searched in September 2023 for randomised controlled trials comparing immune checkpoint inhibitor treatment of non-small cell lung cancer to a control group. Treatment-related adverse events that increased nutrition impact symptoms identified in the patient-generated subjective global assessment and clinical guidelines were extracted and qualitatively analysed. Risk of bias was assessed using Cochrane Risk of Bias tool 2. RESULTS Eleven eligible randomised controlled trial studies were identified and analysed. The data demonstrated immune checkpoint inhibitor treatment was associated with a lower percentage of reported nutrition impact symptoms, for example, decreased appetite, nausea, vomiting, compared to chemotherapy treatment. Conversely, immune checkpoint inhibitor treated patients recorded a greater percentage of immune-related adverse events that alter metabolism or nutrient absorption. CONCLUSION Non-small cell lung cancer patients treated with immune checkpoint inhibitors still experience nutrition impact symptoms but less frequently than patients treated with chemotherapy. This combined with unique nutrition-related consequences from colitis and thyroid disorders induced by immune checkpoint inhibitor therapy indicates patients should be screened, assessed and interventions implemented to improve nutrition.
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Affiliation(s)
- Kate L Graham
- Nutrition & Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Danika Carty
- Nutrition & Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Shay P Poulter
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Chantal Blackman
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Olivia G Dunstan
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Taryn L Milton
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Cassie Ferguson
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Kaitlyn Smith
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Emilly Van Dijk
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Darcy Jongebloed
- Nutrition & Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jenelle Loeliger
- Nutrition & Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Brenton J Baguley
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
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Hush JM, Steffens D, Solomon MJ. A patient-designed integrative oncology intervention for stage IV locally recurrent rectal cancer: A case report. Explore (NY) 2024:S1550-8307(24)00084-3. [PMID: 38777724 DOI: 10.1016/j.explore.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 04/25/2024] [Accepted: 05/03/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION Stage IV colorectal cancer is a highly challenging condition to treat, with 5-year survival rates of 13% in Australia, improving to 40% for those patients with locally recurrent rectal cancer who are suitable for total neoadjuvant therapy and pelvic exenterative surgery. This study reports a unique case of a patient with Stage IV locally recurrent rectal cancer (LRRC), who designed and implemented a holistic integrative oncology intervention. CASE PRESENTATION The patient was 59-years-old when diagnosed with Stage IV locally recurrent rectal cancer, and referred to a highly specialised centre for colorectal cancer care at a tertiary teaching hospital in Sydney, Australia. Treatment included chemo/radiotherapy, liver resection and posterior pelvic exenteration surgery. The patient's background as a health researcher and clinician optimised her ability to design and implement an integrative oncology model of care, including yoga, mindfulness, Buddhist meditation and study, social connection, exercise, psychotherapeutic and nutritional support. This paper describes these mind-body practices and lifestyle modifications and outlines her experiences and outcomes at each stage of her extensive and radical treatment. CONCLUSION This case provides a unique perspective into how the integration of mind-body practices and lifestyle modifications with conventional treatment can support those living with colorectal cancer.
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Affiliation(s)
- Julia M Hush
- Faculty of Medicine and Health Sciences, Macquarie University, NSW 2109, Australia.
| | - Daniel Steffens
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Camperdown 2050, New South Wales, Australia; Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Camperdown, NSW 2006, Australia
| | - Michael J Solomon
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Camperdown, NSW 2006, Australia; Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, The University of Sydney, Camperdown 2050, New South Wales, Australia
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4
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Curtis AR, Kiss N, Livingstone KM, Daly RM, Ugalde A. Exploring dietitians' practice and perspectives on the role of dietary patterns during cancer treatment: A qualitative study. PLoS One 2024; 19:e0302107. [PMID: 38743744 PMCID: PMC11093385 DOI: 10.1371/journal.pone.0302107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 03/27/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Dietitians are nutrition professionals equipped with specialised skills required to prevent and treat malnutrition in cancer. Optimisation of dietary intake is recommended as the primary nutrition strategy for the treatment of cancer-related malnutrition. However, it is unclear whether dietary patterns, described as the combination, quantity, and frequency of food consumption, are considered. This study examined dietitians' current food-based management of malnutrition; explored dietitians' awareness of dietary patterns and assessed barriers and enablers to the use of dietary patterns in clinical practice. METHODS This qualitative study consisted of semi-structured interviews with oncology dietitians. Dietitians were recruited through national nutrition societies, social media, and professional networks. Audio-recorded interviews were transcribed verbatim and analysed using inductive thematic analysis. RESULTS Fourteen oncology dietitians from across four Australian states and territories participated. Three themes were identified: (i) principles to guide nutritional care, (ii) dietary patterns as a gap in knowledge and practice, and (iii) opportunities for better care with systems as both a barrier and enabler. Dietetic practice was food-focussed, encouraging energy and protein-rich foods consistent with nutrient-focussed evidence-based guidelines. Dietitians encouraged one of two nutrition-related approaches, either encouraging intake of 'any tolerated food' or 'foods supportive on longer-term health'. Dietitians were generally unaware of dietary patterns and questioned their relevance in certain clinical situations. A multidisciplinary team approach, adequate food service and dissemination of dietary patterns research and education were identified as opportunities for better patient care. CONCLUSIONS Recommendations for the treatment of malnutrition vary between oncology dietitians and uncertainty exists regarding dietary patterns and their relevance in clinical practice. Further exploration into the role of dietary patterns to treat cancer-related malnutrition and education for dietitians are required prior to implementation of a dietary patterns approach into clinical practice.
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Affiliation(s)
- Annie R. Curtis
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Nicole Kiss
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
- Allied Health Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | | | - Robin M. Daly
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Anna Ugalde
- School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia
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Benna-Doyle S, Baguley BJ, Laing E, Kiss N. Nutritional interventions during treatment for ovarian cancer: A narrative review and recommendations for future research. Maturitas 2024; 183:107938. [PMID: 38367367 DOI: 10.1016/j.maturitas.2024.107938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 02/19/2024]
Abstract
Most women with ovarian cancer are diagnosed at an advanced stage (stage III or IV), when the intraabdominal spread of the tumour impacts nutrient intake and absorption. Up to 70 % of women with ovarian cancer are malnourished and approximately 40 % are affected by muscle loss at the time of diagnosis. Women with ovarian cancer are at high risk of nutritional decline due to invasive treatment and the severity of side-effects. This review explores the evidence evaluating nutritional interventions during treatment for ovarian cancer and their effect on nutritional status, muscle mass, and clinical outcomes. Perioperative immunonutrition has been investigated with mixed results for immediate postoperative outcomes. Individualised nutrition counselling as part of a multimodal prehabilitation programme prior to surgery shows promising results; however, the effects are limited by sample size. Nutrition counselling as part of a mixed intervention with exercise shows high acceptability and suggests improvements in dietary intake and quality of life during chemotherapy treatment, while oral nutritional supplements and nutrition education appear to reduce symptom burden. Individualised nutrition counselling during treatment also appears to be associated with improved overall survival; however, the evidence is limited to a single retrospective study. A key finding from this review is that, despite the high prevalence of malnutrition and muscle loss in women with ovarian cancer and the critical importance of addressing these modifiable prognostic factors, nutrition intervention studies are limited. Prospective studies with samples large enough to provide adequate power to evaluate intervention effectiveness are urgently required to inform optimal management.
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Affiliation(s)
- Sarah Benna-Doyle
- Institute for Physical Activity and Nutrition, Deakin University, Locked Bag 20001, Geelong, VIC 3220, Australia.
| | - Brenton J Baguley
- Institute for Physical Activity and Nutrition, Deakin University, Locked Bag 20001, Geelong, VIC 3220, Australia.
| | - Erin Laing
- Peter McCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC 3000, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Grattan Street, Parkville, VIC 3010, Australia.
| | - Nicole Kiss
- Institute for Physical Activity and Nutrition, Deakin University, Locked Bag 20001, Geelong, VIC 3220, Australia.
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Loeliger J, Francis J, Kiss N, Stewart J, Chandler S, Donohoe K, Hughes V, Swan W, Kaegi K, Elliott A, McIntosh R. Enhancing the provision of cancer nutrition information to support care through experience-based co-design: a mixed-methods study. Support Care Cancer 2024; 32:257. [PMID: 38556587 DOI: 10.1007/s00520-024-08453-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 03/21/2024] [Indexed: 04/02/2024]
Abstract
PURPOSE Nutrition is essential within cancer care, yet patient and carer access to nutrition care and information is variable. This study aimed to (1) investigate patient and carer access and perceptions, and health professional views and practices, relating to cancer nutrition information and care; and (2) co-design interactive resources to support optimal nutrition care. METHODS Patients and carers completed a survey regarding access to nutrition care and information. Seven multidisciplinary health service teams were invited to participate in a survey and focus group to assess barriers and enablers in nutrition practices. Focus groups were recorded, transcribed and thematically analyzed. Eligible patients, carers, and health professionals were invited to four virtual workshops utilizing experience-based co-design methods to identify nutrition priority areas and design resources. Workshop participant acceptability of the resources was measured. RESULTS Of 104 consumer survey respondents (n = 97 patients, n = 7 carers), 61% agreed that it "took too much time to find evidence-based nutrition and cancer information", and 46% had seen a dietitian. Thirty-four of 38 health professionals completed the survey and 30 participated in a focus group, and it was identified the greatest barriers to delivering nutrition care were lack of referral services, knowledge or skill gaps, and time. Twenty participants (n = 10 patients and carers, n = 10 health professionals) attended four workshops and co-designed a suite of 46 novel resources rated as highly acceptable. CONCLUSION Improved communication, training, and availability of suitable resources could improve access to and support cancer nutrition information and care. New, co-designed cancer nutrition resources were created and deemed highly acceptable to patients, carers, and health professionals.
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Affiliation(s)
- Jenelle Loeliger
- Nutrition & Speech Pathology Department, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia.
- School of Exercise and Nutrition Sciences, Deakin University, Deakin, VIC, Australia.
| | - Jill Francis
- School of Health Sciences, University of Melbourne, Parkville, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, 3010, Australia
- Department of Health Services Research & Implementation Science, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Nicole Kiss
- Institute for Physical Activity and Nutrition, Deakin University, VIC, Australia
| | - Jane Stewart
- Nutrition & Speech Pathology Department, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
| | | | | | - Vanessa Hughes
- Nutrition & Speech Pathology Department, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
| | - Wendy Swan
- Nutrition & Dietetics, Goulburn Valley Health, Shepparton, VIC, Australia
| | - Kate Kaegi
- Nutrition Department, Austin Health, Heidelberg, VIC, Australia
| | - Andrea Elliott
- Nutrition and Dietetics Department, Alfred Health, Melbourne, VIC, Australia
| | - Rebecca McIntosh
- Nutrition & Speech Pathology Department, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
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Clode M, Tran D, Majumdar A, Ayer J, Ferrie S, Cordina R. Nutritional considerations for people living with a Fontan circulation: a narrative review. Cardiol Young 2024; 34:238-249. [PMID: 38258459 DOI: 10.1017/s1047951123004389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
The population of people living with a Fontan circulation are highly heterogenous, including both children and adults, who have complex health issues and comorbidities associated with their unique physiology throughout life. Research focused on nutritional considerations and interventions in the Fontan population is extremely limited beyond childhood. This review article discusses the current literature examining nutritional considerations in the setting of Fontan physiology and provides an overview of the available evidence to support nutritional management strategies and future research directions. Protein-losing enteropathy, growth deficits, bone mineral loss, and malabsorption are well-recognised nutritional concerns within this population, but increased adiposity, altered glucose metabolism, and skeletal muscle deficiency are also more recently identified issues. Emergencing evidence suggets that abnormal body composition is associated with poor circulatory function and health outcomes. Many nutrition-related issues, including the impact of congenital heart disease on nutritional status, factors contributing to altered body composition and comorbidities, as well as the role of the microbiome and metabolomics, remain poodly understood.
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Affiliation(s)
- Melanie Clode
- The University of Sydney, Sydney Medical School, Camperdown, NSW, Australia
- Heart Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Derek Tran
- The University of Sydney, Sydney Medical School, Camperdown, NSW, Australia
- Heart Research Institute, Newtown, NSW, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Avik Majumdar
- The University of Sydney, Sydney Medical School, Camperdown, NSW, Australia
| | - Julian Ayer
- The University of Sydney, Sydney Medical School, Camperdown, NSW, Australia
- The Heart Centre for Children, The Sydney Children's Hospital Network, Westmead, NSW, Australia
| | - Suzie Ferrie
- The University of Sydney, Sydney Medical School, Camperdown, NSW, Australia
- Department of Nutrition and Dietetics, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Rachael Cordina
- The University of Sydney, Sydney Medical School, Camperdown, NSW, Australia
- Heart Research Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Heart Research Institute, Newtown, NSW, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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8
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Vingrys K, Atkins L, Pape E, Shaw A, Drury A. Illuminating the nutrition-related policy-practice gaps in colorectal cancer survivorship. Support Care Cancer 2024; 32:131. [PMID: 38270678 PMCID: PMC10811039 DOI: 10.1007/s00520-024-08332-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 01/17/2024] [Indexed: 01/26/2024]
Abstract
PURPOSE Colorectal cancer (CRC) is among the three most commonly diagnosed cancers globally, after breast and lung cancer, with an estimated 2 million new cases each year, comprising ten per cent of all cancers worldwide. CRC has a complex aetiology associated with several nutrition-related risk factors. Cancer survivors frequently report alterations to their dietary habits and nutritional intake, with related adverse impacts on health-related quality of life (QOL). Whilst nutrition-related factors are recognised as survivor priorities and embedded in survivor care policies, dietary support is frequently not the standard of care in practice. METHODS AND RESULTS In this Commentary, we present details of a critical policy-practice gap for CRC survivors across the spectrum of nutrition care that we have seen growing in the literature, in hospitals, community and private practice. CONCLUSION As these nutrition concerns can adversely impact QOL and morbidity and mortality risks, we hope to raise awareness of these issues to provide a basis of future work in this area, so that policymakers and clinicians can improve support and outcomes for CRC survivors and their families.
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Affiliation(s)
- Kristina Vingrys
- Institute for Health and Sport, Victoria University, PO Box 14428, Melbourne, VIC, 8001, Australia.
- First Year College®, Victoria University, PO Box 14428, Melbourne, VIC, 8001, Australia.
| | - Lauren Atkins
- OnCore Nutrition, 863 Glen Huntly Rd, Melbourne, VIC, 3162, Australia
| | - Eva Pape
- Cancer Center, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, Belgium
| | - Annelie Shaw
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Amanda Drury
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Glasnevin, Dublin 9, Ireland
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Papadopetraki A, Giannopoulos A, Maridaki M, Zagouri F, Droufakou S, Koutsilieris M, Philippou A. The Role of Exercise in Cancer-Related Sarcopenia and Sarcopenic Obesity. Cancers (Basel) 2023; 15:5856. [PMID: 38136400 PMCID: PMC10741686 DOI: 10.3390/cancers15245856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/03/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
One of the most common adverse effects of cancer and its therapeutic strategies is sarcopenia, a condition which is characterised by excess muscle wasting and muscle strength loss due to the disrupted muscle homeostasis. Moreover, cancer-related sarcopenia may be combined with the increased deposition of fat mass, a syndrome called cancer-associated sarcopenic obesity. Both clinical conditions have significant clinical importance and can predict disease progression and survival. A growing body of evidence supports the claim that physical exercise is a safe and effective complementary therapy for oncology patients which can limit the cancer- and its treatment-related muscle catabolism and promote the maintenance of muscle mass. Moreover, even after the onset of sarcopenia, exercise interventions can counterbalance the muscle mass loss and improve the clinical appearance and quality of life of cancer patients. The aim of this narrative review was to describe the various pathophysiological mechanisms, such as protein synthesis, mitochondrial function, inflammatory response, and the hypothalamic-pituitary-adrenal axis, which are regulated by exercise and contribute to the management of sarcopenia and sarcopenic obesity. Moreover, myokines, factors produced by and released from exercising muscles, are being discussed as they appear to play an important role in mediating the beneficial effects of exercise against sarcopenia.
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Affiliation(s)
- Argyro Papadopetraki
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (A.P.)
| | - Antonios Giannopoulos
- Section of Sports Medicine, Department of Community Medicine & Rehabilitation, Umeå University, 901 87 Umeå, Sweden;
- National Centre for Sport and Exercise Medicine (NCSEM), School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire LE11 3TU, UK
| | - Maria Maridaki
- Faculty of Physical Education and Sport Science, National and Kapodistrian University of Athens, 172 37 Dafne, Greece
| | - Flora Zagouri
- Department of Clinical Therapeutics, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | | | - Michael Koutsilieris
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (A.P.)
| | - Anastassios Philippou
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (A.P.)
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Kiss N, Steer B, de van der Schueren M, Loeliger J, Alizadehsani R, Edbrooke L, Deftereos I, Laing E, Khosravi A. Machine learning models to predict outcomes at 30-days using Global Leadership Initiative on Malnutrition combinations with and without muscle mass in people with cancer. J Cachexia Sarcopenia Muscle 2023; 14:1815-1823. [PMID: 37259678 PMCID: PMC10401541 DOI: 10.1002/jcsm.13259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 11/29/2022] [Accepted: 04/15/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Equipment to assess muscle mass is not available in all health services. Yet we have limited understanding of whether applying the Global Leadership Initiative on Malnutrition (GLIM) criteria without an assessment of muscle mass affects the ability to predict adverse outcomes. This study used machine learning to determine which combinations of GLIM phenotypic and etiologic criteria are most important for the prediction of 30-day mortality and unplanned admission using combinations including and excluding low muscle mass. METHODS In a cohort of 2801 participants from two cancer malnutrition point prevalence studies, we applied the GLIM criteria with and without muscle mass. Phenotypic criteria were assessed using ≥5% unintentional weight loss, body mass index, subjective assessment of muscle stores from the PG-SGA. Aetiologic criteria included self-reported reduced food intake and inflammation (metastatic disease). Machine learning approaches were applied to predict 30-day mortality and unplanned admission using models with and without muscle mass. RESULTS Participants with missing data were excluded, leaving 2494 for analysis [49.6% male, mean (SD) age: 62.3 (14.2) years]. Malnutrition prevalence was 19.5% and 17.5% when muscle mass was included and excluded, respectively. However, 48 (10%) of malnourished participants were missed if muscle mass was excluded. For the nine GLIM combinations that excluded low muscle mass the most important combinations to predict mortality were (1) weight loss and inflammation and (2) weight loss and reduced food intake. Machine learning metrics were similar in models excluding or including muscle mass to predict mortality (average accuracy: 84% vs. 88%; average sensitivity: 41% vs. 38%; average specificity: 85% vs. 89%). Weight loss and reduced food intake was the most important combination to predict unplanned hospital admission. Machine learning metrics were almost identical in models excluding or including muscle mass to predict unplanned hospital admission, with small differences observed only if reported to one decimal place (average accuracy: 77% vs. 77%; average sensitivity: 29% vs. 29%; average specificity: 84% vs. 84%). CONCLUSIONS Our results indicate predictive ability is maintained, although the ability to identify all malnourished patients is compromised, when muscle mass is excluded from the GLIM diagnosis. This has important implications for assessment in health services where equipment to assess muscle mass is not available. Our findings support the robustness of the GLIM approach and an ability to apply some flexibility in excluding certain phenotypic or aetiologic components if necessary, although some cases will be missed.
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Affiliation(s)
- Nicole Kiss
- Institute for Physical Activity and NutritionDeakin UniversityGeelongAustralia
- Department of Allied HealthPeter MacCallum Cancer CentreMelbourneAustralia
| | - Belinda Steer
- Department of Nutrition and Speech PathologyPeter MacCallum Cancer CentreMelbourneAustralia
| | - Marian de van der Schueren
- Department of Nutrition, Dietetics and LifestyleHAN University of Applied SciencesNijmegenThe Netherlands
- Department of Human Nutrition and HealthWageningen University and ResearchWageningenThe Netherlands
| | - Jenelle Loeliger
- Department of Nutrition and Speech PathologyPeter MacCallum Cancer CentreMelbourneAustralia
| | - Roohallah Alizadehsani
- Institute for Intelligent Systems Research and InnovationDeakin UniversityWaurn PondsAustralia
| | - Lara Edbrooke
- Department of Health Services ResearchPeter MacCallum Cancer CentreMelbourneAustralia
- Department of PhysiotherapyThe University of MelbourneParkvilleAustralia
| | - Irene Deftereos
- Department of Surgery, Western HealthThe University of MelbourneParkvilleAustralia
- Department of Nutrition and DieteticsWestern Health, FootscrayAustralia
| | - Erin Laing
- Department of Nutrition and Speech PathologyPeter MacCallum Cancer CentreMelbourneAustralia
| | - Abbas Khosravi
- Institute for Intelligent Systems Research and InnovationDeakin UniversityWaurn PondsAustralia
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11
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Wu W, He X, Li S, Jin M, Ni Y. Pain nursing for gynecologic cancer patients. Front Oncol 2023; 13:1205553. [PMID: 37564934 PMCID: PMC10410261 DOI: 10.3389/fonc.2023.1205553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/11/2023] [Indexed: 08/12/2023] Open
Abstract
Gynecological malignancy remains a prevalent cause of mortality among women. Chronic cancer pain, as a severe complication of malignancy and its therapies, accounts for a substantial burden of physical and psychological distress in affected patients. Accordingly, early identification, assessment, and standardized management of such pain are crucial in the prevention or delay of its progression. In the present review, we provide a comprehensive overview of the pathological factors that contribute to pain in patients with gynecological malignancy while highlighting the underlying mechanisms of pain in this population. In addition, we summarize several treatment modalities targeting pain management in gynecologic cancer patients, including surgery, radiotherapy, and chemotherapy. These interventions are crucial for tumor elimination and patient survival. Chronic cancer pain exerts a significant impact on wellbeing and quality of life for patients with gynecologic cancer. Therefore, our review emphasizes the importance of addressing this pain and its psychological sequelae and advocates for a multidisciplinary approach that encompasses nursing and psychological support. In summary, this review offers valuable insights into the pathological factors underlying pain, reviews pain management modalities, and stresses the critical role of early intervention and comprehensive care in enhancing the quality of life of these patients.
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Affiliation(s)
| | - Xiaodan He
- Department of Gynecology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning, China
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12
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Ding L, Wang X, Mao T, Li J. Diagnostic Value of Serum Creatinine and Cystatin-C-Based Indices and Ishii Score in Cancer-Related Sarcopenia. Diagnostics (Basel) 2023; 13:2179. [PMID: 37443572 DOI: 10.3390/diagnostics13132179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/01/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Sarcopenia is a key factor affecting the prognosis of cancer patients; however, identifying patients at risk remains challenging. The serum creatinine/cystatin C ratio (CCR) and the sarcopenia index (SI) are new biomarkers for sarcopenia screening. The Ishii test score is an equation based on age, grip strength, and calf circumference for sarcopenia screening. However, their performances in advanced cancer patients have not been thoroughly studied. We aimed to evaluate and compare the accuracy of three screening tools in diagnosing cancer-related sarcopenia. METHODS A total of 215 cancer patients with a median age of 60.5 y were enrolled in this cross-sectional study. The Asian Working Group for Sarcopenia 2019 (AWGS2019) criteria were used as a standard. The diagnostic accuracies of the CCR, SI, and Ishii screening test were analyzed in terms of sensitivity, specificity, negative and positive predictive values, the Youden index, and the receiver operating characteristic (ROC) curve. RESULTS According to the AWGS2019 criteria, the prevalence of sarcopenia and severe sarcopenia was 47.9% and 18.6%, respectively. The CCR, SI (positively), and Ishii scores (negatively) were correlated with muscle mass. Accordingly, sarcopenia was negatively correlated with CCR and SI, while it was significantly positively correlated with the Ishii score. In males, the AUCs of the CCR, SI, and Ishii scores were 0.743 (95%CI 0.65-0.836), 0.758 (95%CI 0.665-0.852), and 0.833 (95%CI 0.751-0.909), respectively. In females, the AUCs of the CCR, SI, and Ishii scores were 0.714 (95%CI 0.61-0.818), 0.737 (95%CI 0.635-0.839), and 0.849 (95%CI 0.775-0.932), respectively. The AUC of the Ishii score was significantly higher than that of the other screening tools (p < 0.001). The cut-off value of the optimal Ishii score was 102.3 (sensitivity: 93.2%, specificity: 59.1%) for males and 98.3 (sensitivity: 93.3%, specificity: 64.7%) for females. CONCLUSIONS The CCR and SI based on serum CysC and creatinine had a remarkably similar overall diagnostic accuracy for sarcopenia in advanced cancer. Among the above three sarcopenia screening tools, the Ishii score chart seemed to have better predictive values of sarcopenia in cancer patients.
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Affiliation(s)
- Liming Ding
- School of Public Health, Chongqing Medical University, Chongqing 400016, China
- People's Hospital of Wuxi, Chongqing 405800, China
| | - Xingyu Wang
- People's Hospital of Wuxi, Chongqing 405800, China
| | - Tiantao Mao
- People's Hospital of Wuxi, Chongqing 405800, China
| | - Jibin Li
- School of Public Health, Chongqing Medical University, Chongqing 400016, China
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13
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Bakaloudi DR, Papaemmanouil A, Vadarlis A, Makrakis D, Germanidis G, Timotheadou E, Chourdakis M. Critical evaluation and comparison of nutritional clinical practice guidelines for cancer patients. Clin Nutr 2023; 42:670-686. [PMID: 36944289 DOI: 10.1016/j.clnu.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 02/09/2023] [Accepted: 03/09/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND The growing incidence of cancer globally, and the importance of nutrition support for these patients, emphasize the need for the development of nutritional clinical practice guidelines and consensus papers (CPGs) in the field. Numerous relevant CPGs have been published by several organizations worldwide. The aim of this systematic review was to compare the content of the existing CPGs and evaluate the quality of their development using the AGREE-II tool. METHODS A systematic literature search in PubMed, Embase and Web of Science databases was conducted for the identification of relevant CPGs and consensus papers. Eligible CPGs was blindly evaluated by four appraisers according to the Appraisal of Guidelines for Research and Evaluation ΙΙ (AGREE-II) tool. RESULTS In total 15 CPGs were identified and were evaluated. All but one set of CPGs underlined the importance of nutritional screening and assessment, whereas recommendations on nutritional interventions, supplements, management of complications and nutritional follow-up were also reported by several organizations. AGREE-II results showed that two CPGs were characterized as high, eight as moderate and five as low regarding their quality of development. CONCLUSIONS Variety on recommendations could be observed between CPGs that should be considered when applied into clinical practice. Limitations of the existing CPGs could be the fact that they are non-specific and only a minority of them are focused to specific cancer types. Frequent updates for CPGs and inclusion of more nutritional topics should be considered for some CPGs. Improvement of the quality of the CPGs development should also be pursued in future.
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Affiliation(s)
- Dimitra Rafailia Bakaloudi
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece; Department of Medical Oncology, General Hospital of Thessaloniki "G. Papageorgiou", Aristotle University of Thessaloniki, Greece; Division of Medical Oncology, Department οf Medicine, University of Washington, Seattle, WA, USA
| | - Androniki Papaemmanouil
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Andreas Vadarlis
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece; Department of Gastroenterology and Hepatology, General Hospital of Thessaloniki ''G. Papanikolaou", Greece
| | - Dimitrios Makrakis
- Department of Medicine, Jacobi Medical Center-Albert Einstein College of Medicine, Bronx, NY, USA
| | - Georgios Germanidis
- Division of Gastroenterology and Hepatology, 1st Department of Internal Medicine, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Eleni Timotheadou
- Department of Medical Oncology, General Hospital of Thessaloniki "G. Papageorgiou", Aristotle University of Thessaloniki, Greece
| | - Michail Chourdakis
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece.
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14
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Vangelov B, Bauer J, Moses D, Smee R. The use of the second thoracic vertebral landmark for skeletal muscle assessment and computed tomography-defined sarcopenia evaluation in patients with head and neck cancer. Head Neck 2023; 45:1006-1016. [PMID: 36811256 DOI: 10.1002/hed.27320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/17/2023] [Accepted: 01/30/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND The cross-sectional area (CSA) of skeletal muscle (SM) at the third lumbar vertebra (L3) is used to determine computed tomography (CT)-defined sarcopenia. We investigated the feasibility of SM assessment at the second thoracic vertebra (T2) in patients with head and neck cancer (HNC). METHODS Diagnostic PET-CT scans were used to develop a prediction model for L3-CSA using T2-CSA. Effectiveness of the model and cancer-specific survival (CSS) were investigated. RESULTS Scans of 111 patients (85% male) were evaluated. The predictive formula: L3-CSA (cm2 ) = 174.15 + [0.212 × T2-CSA (cm2 )] - [40.032 × sex] - [0.928 × age (years)] + [0.285 × weight (kg)] had good correlation r = 0.796, ICC = 0.882 (p < 0.001). SM index (SMI) mean difference (bias) was -3.6% (SD 10.2, 95% CI -8.7% to 1.3%). Sensitivity (82.8%), specificity (78.2%), with moderate agreement (ƙ = 0.540, p < 0.001). Worse 5-year CSS with lower quartile T2-SMI (51%, p = 0.003). CONCLUSIONS SM at T2 can be effectively used for CT-defined sarcopenia evaluation in HNC.
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Affiliation(s)
- Belinda Vangelov
- Department of Radiation Oncology, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia.,Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Randwick, New South Wales, Australia
| | - Judith Bauer
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Daniel Moses
- Graduate School of Biomedical Engineering, University of New South Wales, Randwick, New South Wales, Australia.,Department of Radiology, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
| | - Robert Smee
- Department of Radiation Oncology, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia.,Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Randwick, New South Wales, Australia.,Department of Radiation Oncology, Tamworth Base Hospital, Tamworth, New South Wales, Australia
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15
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Erickson N, Sullivan ES, Kalliostra M, Laviano A, Wesseling J. Nutrition care is an integral part of patient-centred medical care: a European consensus. Med Oncol 2023; 40:112. [PMID: 36881207 PMCID: PMC9992033 DOI: 10.1007/s12032-023-01955-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 01/18/2023] [Indexed: 03/08/2023]
Abstract
While healthcare is becoming more patient-centred, evidence-based nutrition interventions are still not accessible to all patients with cancer. As nutrition interventions directly improve clinical and socioeconomic outcomes, patient-centred care is not complete without nutrition care. While awareness of the negative impact of malnutrition on clinical outcomes, quality of life, and functional and emotional wellbeing in cancer is growing, there is relatively poor awareness amongst patients, clinicians, policymakers, and payers that nutrition interventions -particularly those begun in the early stages of the disease course- are an effective method for improving such outcomes. The European Beating Cancer Plan recognises the need for a holistic approach to cancer but lacks actionable recommendations to implement integrated nutrition cancer care at member state level. When considering nutrition care as a human right, the impact on quality of life and functional status must be prioritized, as these may be equally as important to patients, especially in advanced cancer where improvements in clinical outcomes such as survival or tumour burden may not be attainable. We formulate actions needed at the regional and the European level to ensure integrated nutrition care for all patients with cancer. The 4 main Take Home Messages are as follows: 1. The goals of Europe's Beating Cancer Plan cannot be achieved without integrating nutrition across the cancer care continuum. 2. Malnutrition negatively impacts clinical outcomes and has socioeconomic consequences for patients and healthcare systems. 3. Championing integrating nutrition care into cancer care is therefore the duty and ethical responsibility of clinicians (Hippocratic Oath-primum non nocere) and 4. Nutrition care is a cost effective, evidence-based therapy.
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Affiliation(s)
- Nicole Erickson
- Comprehensive Cancer Center Munich, Ludwig Maximilian University of Munich Hospital, Munich, Germany.
- Writing Group, The European Union Thematic Network on Integrated Nutrition in Cancer Care (INC2), Croydon, UK.
- European Federation of the Associations of Dietitians (EFAD), Naarden, The Netherlands.
| | - Erin Stella Sullivan
- Writing Group, The European Union Thematic Network on Integrated Nutrition in Cancer Care (INC2), Croydon, UK
- School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - Marianna Kalliostra
- Writing Group, The European Union Thematic Network on Integrated Nutrition in Cancer Care (INC2), Croydon, UK
- European Federation of the Associations of Dietitians (EFAD), Naarden, The Netherlands
- The European Nutrition for Health Alliance, London, UK
| | - Alessandro Laviano
- Writing Group, The European Union Thematic Network on Integrated Nutrition in Cancer Care (INC2), Croydon, UK
- The European Nutrition for Health Alliance, London, UK
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Joost Wesseling
- Writing Group, The European Union Thematic Network on Integrated Nutrition in Cancer Care (INC2), Croydon, UK
- The European Nutrition for Health Alliance, London, UK
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16
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Kasvis P, Vigano A, Bui T, Carli F, Kilgour RD. Impact of Dietary Counseling on Health-Related Quality of Life in Patients with Cancer Awaiting Hepato-Pancreato-Biliary Surgery. Nutr Cancer 2023; 75:1151-1164. [PMID: 36867443 DOI: 10.1080/01635581.2023.2178961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
We examined the effectiveness of dietary counseling performed within a trimodal prehabilitation study for patients with cancer awaiting hepato-pancreato-biliary (HPB) surgery. Additionally, we explored relationships between nutritional status and health-related quality of life (HRQoL). The dietary intervention aimed to achieve a protein intake of 1.5 g/kg/day and reduce nutrition-impact symptoms. Patients received dietary counseling 4 weeks prior to surgery (prehabilitation group); the rehabilitation group just before surgery. We used 3-day food journals to calculate protein intake and the abridged Patient-generated Subjective Global Assessment questionnaire (aPG-SGA) to determine nutritional status. We utilized the Functional Assessment of Cancer Therapy-General questionnaire to measure HRQoL. Sixty-one patients participated in the study (30 = prehabilitation). Dietary counseling achieved a significant increase in preoperative protein intake (+0.3 ± 0.1 g/kg/day, P = 0.007), with no change in the rehabilitation group. Dietary counseling did not mitigate a significant increase in aPG-SGA postoperatively (prehabilitation: +5.8 ± 1.0; rehabilitation: +3.3 ± 1.0; P < 0.05). aPG-SGA was predictive of HRQoL (β = -1.77, P < 0.0001). HRQoL remained unchanged in both groups over the study period. Dietary counseling within a HPB prehabilitation program improves preoperative protein intake, but not aPG-SGA, which is predictive of HRQoL. Future studies should examine whether specialized medical management of nutrition-impact symptoms would improve HRQoL outcomes within a prehabilitation model.
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Affiliation(s)
- Popi Kasvis
- McGill Nutrition and Performance Laboratory, McGill University Health Centre, Montreal, Quebec, Canada.,Supportive and Palliative Care Division, McGill University Health Centre, Montreal, Quebec, Canada.,Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, Quebec, Canada
| | - Antonio Vigano
- McGill Nutrition and Performance Laboratory, McGill University Health Centre, Montreal, Quebec, Canada.,Supportive and Palliative Care Division, McGill University Health Centre, Montreal, Quebec, Canada
| | - Tram Bui
- McGill Nutrition and Performance Laboratory, McGill University Health Centre, Montreal, Quebec, Canada
| | - Franco Carli
- Department of Anesthesia, McGill University Health Centre, Montreal, Quebec, Canada
| | - Robert D Kilgour
- McGill Nutrition and Performance Laboratory, McGill University Health Centre, Montreal, Quebec, Canada.,Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, Quebec, Canada
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17
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Chang VT, Sandifer C, Zhong F. GI Symptoms in Pancreatic Cancer. Clin Colorectal Cancer 2023; 22:24-33. [PMID: 36623952 DOI: 10.1016/j.clcc.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/21/2022] [Indexed: 12/31/2022]
Abstract
This review will apply a multidisciplinary approach to GI symptoms with attention to symptom assessment (instruments and qualitative aspects), differential diagnosis, and recent findings relevant to management of symptoms and underlying diseases. We conclude that further development of supportive interventions for GI symptoms for both patient and caregivers has the potential to reduce distress from GI symptoms, and anticipate better symptom control with advances in scientific knowledge and improvement of the evidence base.
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Affiliation(s)
- Victor T Chang
- Section Hematology Oncology (111), VA New Jersey Health Care System, East Orange, NJ; Department of Medicine, Rutgers - New Jersey Medical School, Newark, NJ.
| | | | - Fengming Zhong
- Section Hematology Oncology (111), VA New Jersey Health Care System, East Orange, NJ; Department of Medicine, Rutgers - New Jersey Medical School, Newark, NJ
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18
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Vangelov B, Bauer J, Moses D, Smee R. A prediction model for skeletal muscle evaluation and computed tomography-defined sarcopenia diagnosis in a predominantly overweight cohort of patients with head and neck cancer. Eur Arch Otorhinolaryngol 2023; 280:321-328. [PMID: 35835910 DOI: 10.1007/s00405-022-07545-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/05/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE This study investigates the feasibility of computed tomography (CT)-defined sarcopenia assessment using a prediction model for estimating the cross-sectional area (CSA) of skeletal muscle (SM) in CT scans at the third lumbar vertebra (L3), using measures at the third cervical level (C3) in a predominantly overweight population with head and neck cancer (HNC). METHODS Analysis was conducted on adult patients with newly diagnosed HNC who had a diagnostic positron emission tomography-CT scan. CSA of SM in CT images was measured at L3 and C3 in each patient, and a predictive formula developed using fivefold cross-validation and linear regression modelling. Correlation and agreement between measured CSA at L3 and predicted values were evaluated using intraclass correlation coefficients (ICC) and Bland-Altman plot. The model's ability to identify sarcopenia was investigated using Cohen's Kappa (k). RESULTS A total of 109 patient scans were analysed, with 64% of the cohort being overweight or obese. The prediction model demonstrated high level of correlation between measured and predicted CSA measures (ICC 0.954, r = 0.916, p < 0.001), and skeletal muscle index (SMI) (ICC 0.939, r = 0.883, p < 0.001). Bland-Altman plot showed good agreement in SMI, with mean difference (bias) = 0.22% (SD 8.65, 95% CI - 3.35 to 3.79%), limits of agreement (- 16.74 to 17.17%). The model had a sensitivity of 80.0% and specificity of 85.0%, with moderate agreement on sarcopenia diagnosis (k = 0.565, p = 0.004). CONCLUSION This model is effective in predicting lumbar SM CSA using measures at C3, and in identifying low SM in a predominately overweight group of patients with HNC.
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Affiliation(s)
- Belinda Vangelov
- Department of Radiation Oncology, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital and Community Health Services, Level 1
- Bright Building
- Barker St, Randwick, NSW, 2031, Australia. .,Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Randwick, NSW, 2031, Australia.
| | - Judith Bauer
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Clayton, VIC, 3168, Australia
| | - Daniel Moses
- Graduate School of Biomedical Engineering, University of New South Wales, Randwick, NSW, 2031, Australia.,Department of Radiology, Prince of Wales Hospital and Community Health Services, Randwick, NSW, 2031, Australia
| | - Robert Smee
- Department of Radiation Oncology, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital and Community Health Services, Level 1
- Bright Building
- Barker St, Randwick, NSW, 2031, Australia.,Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Randwick, NSW, 2031, Australia.,Department of Radiation Oncology, Tamworth Base Hospital, Tamworth, NSW, 2340, Australia
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19
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Pisani C, Mastroleo F, Collo A, Ferrante D, Carabelli G, Franco P, Riso S, Dell’Era V, Garzaro M, Aluffi Valletti P, Krengli M. Variation in Body Mass and Skeletal Muscle Indices in Head and Neck Cancer Patients Undergoing (Chemo)Radiotherapy and Nutritional Intervention. Curr Oncol 2022; 30:250-260. [PMID: 36661669 PMCID: PMC9857332 DOI: 10.3390/curroncol30010020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/16/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
The aim of this study was to analyze variation in body mass index (BMI) and skeletal muscle index (SMI) in head and neck squamous cell carcinoma (HNSCC) patients who underwent exclusive radiotherapy (RT) or concurrent chemo-radiotherapy (RT-CHT). We enrolled 73 HNSCC pts treated with definitive or post-operative RT (14 pts) or RT-CHT (59 pts). At the time of diagnosis (t0) and 3 months after treatment completion (t3), CT scans were retrieved to measure skeletal muscle at the level of the C3 vertebra. Median follow-up was 16 months. Nine disease progressions with distant metastases and eleven local relapses were observed. Fifty-three pts were free from progression at 1 year. At t0, average BMI was 25.8 (SD 4.1), while at t3 it was 24.5, with no reduction in 54 pts. A BMI decrease of −1.3 (p-value < 0.0001) between t0 and t3 was found with the Wilcoxon signed-rank test. SMI was 57.1 and 59.2 at t0 and t3, respectively (p-value = 0.005). According to our analysis, SMI variation seems to reflect the effect of an appropriate nutritional intervention and may represent a reliable, simple tool for muscle mass analysis.
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Affiliation(s)
- Carla Pisani
- Division of Radiation Oncology, University Hospital “Maggiore della Carità”, Corso Mazzini 18, 28100 Novara, Italy
| | - Federico Mastroleo
- Division of Radiation Oncology, University Hospital “Maggiore della Carità”, Corso Mazzini 18, 28100 Novara, Italy
- Department of Translational Medicine, University of Piemonte Orientale (UPO), Via Solaroli 17, 28100 Novara, Italy
| | - Alessandro Collo
- Clinical Nutrition and Dietetic Unit, University Hospital “Maggiore della Carità”, Corso Mazzini 18, 28100 Novara, Italy
| | - Daniela Ferrante
- Unit of Medical Statistics, Department of Translational Medicine, University of Piemonte Orientale (UPO) and Cancer Epidemiology, CPO Piemonte, Via Solaroli 17, 28100 Novara, Italy
| | - Greta Carabelli
- Division of Radiation Oncology, University Hospital “Maggiore della Carità”, Corso Mazzini 18, 28100 Novara, Italy
| | - Pierfrancesco Franco
- Division of Radiation Oncology, University Hospital “Maggiore della Carità”, Corso Mazzini 18, 28100 Novara, Italy
- Department of Translational Medicine, University of Piemonte Orientale (UPO), Via Solaroli 17, 28100 Novara, Italy
| | - Sergio Riso
- Clinical Nutrition and Dietetic Unit, University Hospital “Maggiore della Carità”, Corso Mazzini 18, 28100 Novara, Italy
| | - Valeria Dell’Era
- ENT Division, University Hospital “Maggiore della Carità”, Corso Mazzini 18, 28100 Novara, Italy
| | - Massimiliano Garzaro
- ENT Division, University Hospital “Maggiore della Carità”, Corso Mazzini 18, 28100 Novara, Italy
| | - Paolo Aluffi Valletti
- ENT Division, University Hospital “Maggiore della Carità”, Corso Mazzini 18, 28100 Novara, Italy
| | - Marco Krengli
- Division of Radiation Oncology, University Hospital “Maggiore della Carità”, Corso Mazzini 18, 28100 Novara, Italy
- Department of Translational Medicine, University of Piemonte Orientale (UPO), Via Solaroli 17, 28100 Novara, Italy
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20
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Baguley BJ, Dalla Via J, Fraser SF, Daly RM, Kiss N. Effectiveness of combined nutrition and exercise interventions on body weight, lean mass, and fat mass in adults diagnosed with cancer: a systematic review and meta-analysis. Nutr Rev 2022; 81:625-646. [PMID: 36206176 DOI: 10.1093/nutrit/nuac079] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
CONTEXT Changes in body weight and composition (fat and lean mass) are prominent side effects of cancer treatment. Nutrition and exercise interventions are both key strategies to protect against these adverse effects, yet their impact when combined has not been comprehensively reviewed in adults with cancer. OBJECTIVE This systematic review and meta-analysis aims to assess the effects of combined nutrition and exercise interventions on body weight and composition in adults with cancer. DATA SOURCES Four databases were searched until January 2021. Combined nutrition and exercise randomized controlled trials that detailed the nutrition and exercise prescription and reported body weight and composition outcomes were eligible. DATA EXTRACTION Risk of bias was assessed through the Cochrane Collaboration tool. The number of participants, mean values, and standard deviations of the outcome variables were extracted. Mean differences (MDs) were pooled using random-effects models. Predetermined subgroup analyses included cancer type, intervention intent, exercise modality, and use of behavior change strategies. DATA ANALYSIS Twenty-three RCTs were included. Nutrition plus exercise interventions significantly reduced body weight (MD - 2.13 kg; 95%CI, - 3.07 to - 1.19), fat mass (MD - 2.06 kg; 95%CI, - 3.02 to - 1.09), and lean mass (MD - 0.43; 95%CI, - 0.82 to - 0.04). Subgroup analyses in women with breast cancer showed that weight loss interventions and interventions incorporating behavior change strategies significantly reduced body weight and fat mass but also reduced lean mass. Interventions aiming to maintain body weight showed no changes in body weight, as intended. CONCLUSION Combined nutrition and exercise interventions successfully reduce body weight and fat mass in adults with cancer but also reduce lean mass. In contrast, weight loss-focused interventions are associated mostly with reduced lean mass. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number CRD42020161805.
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Affiliation(s)
- Brenton J Baguley
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Jack Dalla Via
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia.,Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Steve F Fraser
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Robin M Daly
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Nicole Kiss
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia.,Allied Health Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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21
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Holdoway A, Page F, Bauer J, Dervan N, Maier AB. Individualised Nutritional Care for Disease-Related Malnutrition: Improving Outcomes by Focusing on What Matters to Patients. Nutrients 2022; 14:3534. [PMID: 36079795 PMCID: PMC9460401 DOI: 10.3390/nu14173534+10.3390/nu14173534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/15/2022] [Accepted: 08/18/2022] [Indexed: 01/29/2024] Open
Abstract
Delivering care that meets patients' preferences, needs and values, and that is safe and effective is key to good-quality healthcare. Disease-related malnutrition (DRM) has profound effects on patients and families, but often what matters to patients is not captured in the research, where the focus is often on measuring the adverse clinical and economic consequences of DRM. Differences in the terminology used to describe care that meets patients' preferences, needs and values confounds the problem. Individualised nutritional care (INC) is nutritional care that is tailored to a patient's specific needs, preferences, values and goals. Four key pillars underpin INC: what matters to patients, shared decision making, evidence informed multi-modal nutritional care and effective monitoring of outcomes. Although INC is incorporated in nutrition guidelines and studies of oral nutritional intervention for DRM in adults, the descriptions and the degree to which it is included varies. Studies in specific patient groups show that INC improves health outcomes. The nutrition care process (NCP) offers a practical model to help healthcare professionals individualise nutritional care. The model can be used by all healthcare disciplines across all healthcare settings. Interdisciplinary team approaches provide nutritional care that delivers on what matters to patients, without increased resources and can be adapted to include INC. This review is of relevance to all involved in the design, delivery and evaluation of nutritional care for all patients, regardless of whether they need first-line nutritional care or complex, highly specialised nutritional care.
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Affiliation(s)
| | - Fionna Page
- First Page Nutrition Ltd., Chippenham SN15 5HS, UK
| | - Judy Bauer
- Department of Nutrition, Dietetics & Food, Monash University, Clayton, VIC 3168, Australia
| | - Nicola Dervan
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, DO4 V1W8 Dublin, Ireland
- Institute of Food and Health, University College Dublin, DO4 V1W8 Dublin, Ireland
| | - Andrea B. Maier
- Department of Human Movement Sciences, @AgeAmsterdam, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, 1081 BT Amsterdam, The Netherlands
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC 3050, Australia
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117456, Singapore
- Centre for Healthy Longevity, @AgeSingapore, National University Health System, Singapore 119074, Singapore
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22
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Holdoway A, Page F, Bauer J, Dervan N, Maier AB. Individualised Nutritional Care for Disease-Related Malnutrition: Improving Outcomes by Focusing on What Matters to Patients. Nutrients 2022; 14:3534. [PMID: 36079795 PMCID: PMC9460401 DOI: 10.3390/nu14173534 10.3390/nu14173534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/15/2022] [Accepted: 08/18/2022] [Indexed: 11/15/2023] Open
Abstract
Delivering care that meets patients' preferences, needs and values, and that is safe and effective is key to good-quality healthcare. Disease-related malnutrition (DRM) has profound effects on patients and families, but often what matters to patients is not captured in the research, where the focus is often on measuring the adverse clinical and economic consequences of DRM. Differences in the terminology used to describe care that meets patients' preferences, needs and values confounds the problem. Individualised nutritional care (INC) is nutritional care that is tailored to a patient's specific needs, preferences, values and goals. Four key pillars underpin INC: what matters to patients, shared decision making, evidence informed multi-modal nutritional care and effective monitoring of outcomes. Although INC is incorporated in nutrition guidelines and studies of oral nutritional intervention for DRM in adults, the descriptions and the degree to which it is included varies. Studies in specific patient groups show that INC improves health outcomes. The nutrition care process (NCP) offers a practical model to help healthcare professionals individualise nutritional care. The model can be used by all healthcare disciplines across all healthcare settings. Interdisciplinary team approaches provide nutritional care that delivers on what matters to patients, without increased resources and can be adapted to include INC. This review is of relevance to all involved in the design, delivery and evaluation of nutritional care for all patients, regardless of whether they need first-line nutritional care or complex, highly specialised nutritional care.
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Affiliation(s)
| | - Fionna Page
- First Page Nutrition Ltd., Chippenham SN15 5HS, UK
| | - Judy Bauer
- Department of Nutrition, Dietetics & Food, Monash University, Clayton, VIC 3168, Australia
| | - Nicola Dervan
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, DO4 V1W8 Dublin, Ireland
- Institute of Food and Health, University College Dublin, DO4 V1W8 Dublin, Ireland
| | - Andrea B. Maier
- Department of Human Movement Sciences, @AgeAmsterdam, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, 1081 BT Amsterdam, The Netherlands
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC 3050, Australia
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117456, Singapore
- Centre for Healthy Longevity, @AgeSingapore, National University Health System, Singapore 119074, Singapore
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Holdoway A, Page F, Bauer J, Dervan N, Maier AB. Individualised Nutritional Care for Disease-Related Malnutrition: Improving Outcomes by Focusing on What Matters to Patients. Nutrients 2022; 14:nu14173534. [PMID: 36079795 PMCID: PMC9460401 DOI: 10.3390/nu14173534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/15/2022] [Accepted: 08/18/2022] [Indexed: 11/17/2022] Open
Abstract
Delivering care that meets patients’ preferences, needs and values, and that is safe and effective is key to good-quality healthcare. Disease-related malnutrition (DRM) has profound effects on patients and families, but often what matters to patients is not captured in the research, where the focus is often on measuring the adverse clinical and economic consequences of DRM. Differences in the terminology used to describe care that meets patients’ preferences, needs and values confounds the problem. Individualised nutritional care (INC) is nutritional care that is tailored to a patient’s specific needs, preferences, values and goals. Four key pillars underpin INC: what matters to patients, shared decision making, evidence informed multi-modal nutritional care and effective monitoring of outcomes. Although INC is incorporated in nutrition guidelines and studies of oral nutritional intervention for DRM in adults, the descriptions and the degree to which it is included varies. Studies in specific patient groups show that INC improves health outcomes. The nutrition care process (NCP) offers a practical model to help healthcare professionals individualise nutritional care. The model can be used by all healthcare disciplines across all healthcare settings. Interdisciplinary team approaches provide nutritional care that delivers on what matters to patients, without increased resources and can be adapted to include INC. This review is of relevance to all involved in the design, delivery and evaluation of nutritional care for all patients, regardless of whether they need first-line nutritional care or complex, highly specialised nutritional care.
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Affiliation(s)
- Anne Holdoway
- Bath Clinic, Circle Health Group, Bath BA2 7BR, UK
- Correspondence: ; Tel.: +44-1225-835555
| | - Fionna Page
- First Page Nutrition Ltd., Chippenham SN15 5HS, UK
| | - Judy Bauer
- Department of Nutrition, Dietetics & Food, Monash University, Clayton, VIC 3168, Australia
| | - Nicola Dervan
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, DO4 V1W8 Dublin, Ireland
- Institute of Food and Health, University College Dublin, DO4 V1W8 Dublin, Ireland
| | - Andrea B. Maier
- Department of Human Movement Sciences, @AgeAmsterdam, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, 1081 BT Amsterdam, The Netherlands
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC 3050, Australia
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117456, Singapore
- Centre for Healthy Longevity, @AgeSingapore, National University Health System, Singapore 119074, Singapore
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Antiemetic Strategies in Patients Who Undergo Hematopoietic Stem Cell Transplantation. Clin Hematol Int 2022; 4:89-98. [PMID: 36131129 PMCID: PMC9492824 DOI: 10.1007/s44228-022-00012-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/31/2022] [Indexed: 11/16/2022] Open
Abstract
Hematopoietic stem cell transplantation (HSCT) is an integral part of the treatment strategy in patients with a hematological disorder. Chemotherapy-induced nausea and vomiting (CINV) is still an issue in patients who undergo HSCT. While several guidelines for the antiemetic therapy against CINV have been published, there is no detailed information about appropriate antiemetic drugs for each conditioning regimen in HSCT. Various studies reported that the triplet of 5-HT3RA, NK1RA, and dexamethasone appears useful in HSCT. However, each antiemetic has unique adverse effects or interactions with specific drugs. Here, we review the literature relating to clinical trials on the prevention of CINV, and summarize the information to clarify the benefit of antiemetic regimens.
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25
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Kerr A, Lugg ST, Kadiri S, Swift A, Efstathiou N, Kholia K, Rogers V, Fallouh H, Steyn R, Bishay E, Kalkat M, Naidu B. Feasibility study of a randomised controlled trial of preoperative and postoperative nutritional supplementation in major lung surgery. BMJ Open 2022; 12:e057498. [PMID: 35768119 PMCID: PMC9240939 DOI: 10.1136/bmjopen-2021-057498] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Malnutrition and weight loss are important risk factors for complications after lung surgery. However, it is uncertain whether modifying or optimising perioperative nutritional state with oral supplements results in a reduction in malnutrition, complications or quality of life. DESIGN A randomised, open label, controlled feasibility study was conducted to assess the feasibility of carrying out a large multicentre randomised trial of nutritional intervention. The intervention involved preoperative carbohydrate-loading drinks (4×200 mL evening before surgery and 2×200 mL the morning of surgery) and early postoperative nutritional protein supplement drinks two times per day for 14 days compared with the control group receiving an equivalent volume of water. SETTING Single adult thoracic centre in the UK. PARTICIPANTS All adult patients admitted for major lung surgery. Patients were included if were able to take nutritional drinks prior to surgery and give written informed consent. Patients were excluded if they were likely unable to complete the study questionnaires, they had a body mass index <18.5 kg/m2, were receiving parenteral nutrition or known pregnancy. RESULTS All patients presenting for major lung surgery were screened over a 6-month period, with 163 patients screened, 99 excluded and 64 (41%) patients randomised. Feasibility criteria were met and the study completed recruitment 5 months ahead of target. The two groups were well balanced and tools used to measure outcomes were robust. Compliance with nutritional drinks was 97% preoperatively and 89% postoperatively; 89% of the questionnaires at 3 months were returned fully completed. The qualitative interviews demonstrated that the trial and the intervention were acceptable to patients. Patients felt the questionnaires captured their experience of recovery from surgery well. CONCLUSION A large multicentre randomised controlled trial of nutritional intervention in major lung surgery is feasible and required to test clinical efficacy in improving outcomes after surgery. TRIAL REGISTRATION NUMBER ISRCTN16535341.
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Affiliation(s)
- Amy Kerr
- Department of Thoracic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sebastian T Lugg
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Salma Kadiri
- Department of Thoracic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Amelia Swift
- Institute of Clinical Sciences and School of Nursing, University of Birmingham, Birmingham, UK
| | - Nikolaos Efstathiou
- Institute of Clinical Sciences and School of Nursing, University of Birmingham, Birmingham, UK
| | - Krishna Kholia
- Department of Thoracic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Venessa Rogers
- Department of Thoracic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Hazem Fallouh
- Department of Thoracic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Richard Steyn
- Department of Thoracic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ehab Bishay
- Department of Thoracic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Maninder Kalkat
- Department of Thoracic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Babu Naidu
- Department of Thoracic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
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26
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Vaughan VC, Martin P. Multidisciplinary approaches to cancer cachexia: current service models and future perspectives. Expert Rev Anticancer Ther 2022; 22:737-749. [PMID: 35699257 DOI: 10.1080/14737140.2022.2088516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Cancer cachexia remains a complex unmet need in oncology, despite its high prevalence and high impact. Patients with cachexia experience numerous complications, including reduced tolerance and effectiveness of anti-cancer therapy, reduced mobility, and reduced functional status, leading to decreased quality of life and survival. AREAS COVERED As the field moves toward greater consensus of definitions and measurements, we highlight tools currently available for identification and staging of cachexia, and the barriers that people with cancer face in timely identification and management of cachexia. Multidisciplinary cachexia service models have emerged to address practice gaps and needs identified by patients and clinicians. Person-centred approaches to cachexia care demonstrate promising improvements in patient outcomes, but controlled trials of service models are lacking. EXPERT OPINION While significant advances have been made in the understanding of cachexia, future trials of clinical service models require standardisation of definitions and outcome measures, with more robust controlled studies to establish the efficacy of proposed best practice. We remain excited with the potential benefit of these innovative models and continue to advocate for implementation of dedicated multidisciplinary cachexia teams to ensure patients and their families receive the right support, in the right place, at the right time.
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Affiliation(s)
| | - Peter Martin
- School of Medicine, Deakin University, Waurn Ponds, Australia.,Barwon Health, Barwon Health Cachexia & Nutrition Support Service, Geelong, Australia
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Kiss N, Curtis A. Current Insights in Nutrition Assessment and Intervention for Malnutrition or Muscle Loss in People with Lung Cancer: A Narrative Review. Adv Nutr 2022; 13:2420-2432. [PMID: 35731630 PMCID: PMC9776626 DOI: 10.1093/advances/nmac070] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/17/2022] [Accepted: 06/16/2022] [Indexed: 01/29/2023] Open
Abstract
Up to 70% of people with lung cancer may be affected by cancer-related malnutrition or muscle loss, depending on treatment modality and disease stage. This narrative review explores recent studies on malnutrition and muscle loss as well as nutritional and multimodal interventions to treat these conditions in the context of the changing treatment landscape in lung cancer. Various types of interventions, including individualized counseling, protein and other specific nutrient supplementation, as well as multimodal interventions to treat malnutrition and muscle loss, have been investigated. Overall, individualized dietary counseling, increasing protein intake, and supplementation with omega-3 (n-3) fatty acids appear to be beneficial for some, albeit varying, patient outcomes. Multimodal interventions, generally including a nutrition and exercise component, show promising results; however, the impact on patient outcomes is mixed. A key finding of this review is a lack of large, randomized trials to guide nutrition intervention specifically in people with lung cancer. Despite the high prevalence of malnutrition and muscle loss in people with lung cancer and the known adverse outcomes, current evidence for nutrition intervention is limited. A targeted effort is required to improve the quality of evidence for nutrition intervention in this population to provide support for clinicians to deliver effective nutrition care.
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Affiliation(s)
| | - Annie Curtis
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
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28
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Recommendations for nutritional assessment across clinical practice guidelines: A scoping review. Clin Nutr ESPEN 2022; 49:201-207. [PMID: 35623814 DOI: 10.1016/j.clnesp.2022.04.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/13/2022] [Accepted: 04/19/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND & AIMS CPGs propose several methods and criteria to perform nutritional assessment, a key process to determine the type and severity of malnutrition, which generates variability in clinical practice and outcomes. The aim of the study was to describe the criteria considered by clinical practice guidelines (CPGs) for nutritional assessment. METHODS We performed a scoping review systematically searching in PubMed, Trip Database, Google Scholar, and Google, until November 5, 2021. We included all CPGs mentioning tools or criteria for nutritional assessment in adults from the general population or with any specific pathology or condition. Two authors independently reviewed and decided on study selection and data extraction. RESULTS We included 18 CPGs (12 elaborated in Europe). The CPGs recommended heterogeneous criteria for nutritional assessment: 16/18 CPGs included at least one body composition parameter (e.g., loss of muscle mass, loss of subcutaneous fat), 15/18 included history related to dietary intake, 15/18 included clinical history (e.g., weight loss), 10/18 included anthropometric measurement (e.g., low body mass index [BMI]), 11/18 included biochemical criteria (e.g., albumin, C-reactive protein), 8/18 included physical examination (e.g., fluid retention, sarcopenia, loss of subcutaneous fat), 8/18 included functional test (e.g., decreased handgrip strength), and 1/18 included catabolic state. Also, 9/18 CPGs mentioned a tool for nutritional assessment, the Subjective Global Assessment (SGA) the most common (8/18). None of the CPGs justified the inclusion of any of the tools or criteria they mentioned. CONCLUSIONS The CPGs mentioned heterogeneous criteria for nutritional assessment. The most commonly mentioned criteria were decreased food intake, loss of muscle mass, weight loss, and low BMI. The most mentioned tool was the SGA. None of the CPGs provided a clear rationale for using certain criteria or tools for nutritional assessment.
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29
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Fuji S, Cheng J, Yakushijin K, Wanitpongpun C. Nutritional support in allogeneic hematopoietic stem cell transplantation Asian perspective. BLOOD CELL THERAPY 2022; 5:54-60. [PMID: 36710949 PMCID: PMC9870687 DOI: 10.31547/bct-2021-024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/01/2022] [Indexed: 02/01/2023]
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is an integral part of the treatment strategy for patients with malignant or non-malignant hematological diseases. Clinical outcomes of patients undergoing allo-HSCT have significantly improved in recent decades. However, transplant-related morbidity and mortality remain major issues for allo-HSCT recipients. With regard to nutrition, patients undergoing allo-HSCT are at high risk for malnutrition. It is expected that clinical practice concerning nutritional support in allo-HSCT has been improving in recent decades; however, no data directly support this expectation. One major issue in managing nutritional support during allo-HSCT is the lack of large-scale randomized prospective studies, which leads to a lack of well-established strategies. Accordingly, we need to gather data from studies in non-HSCT and allo-HSCT settings. In some Asia-Pacific countries, a physician's lack of knowledge of nutritional support may impede the application of nutritional support practices recommended by existing guidelines. Another barrier may be the lack of access to an adequately qualified or trained registered dietitian (RD) at allo-HSCT units. Adequate training in the nutritional management of allo-HSCT patients should be provided to all RDs working with HSCT. Herein, we summarize the information on nutritional support in allo-HSCT, focusing on an Asian perspective.
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Affiliation(s)
- Shigeo Fuji
- Department of Hematology, Osaka International Cancer Institute, Osaka, Japan,Nutrition Support WG, Asia-Pacific Blood and Marrow Transplantation group
| | - Jessica Cheng
- Nutrition Support WG, Asia-Pacific Blood and Marrow Transplantation group,Bone Marrow Transplant & Haematology, St Vincent's Public Hospital Sydney, Sydney, Australia
| | - Kimikazu Yakushijin
- Nutrition Support WG, Asia-Pacific Blood and Marrow Transplantation group,Department of Medical Oncology and Hematology, Kobe University Hospital, Kobe, Japan
| | - Chinadol Wanitpongpun
- Nutrition Support WG, Asia-Pacific Blood and Marrow Transplantation group,Hematology Unit, Department of Internal Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand
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Development and Feasibility of an Inpatient Cancer-Related Sarcopenia Pathway at a Major Cancer Centre. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074038. [PMID: 35409719 PMCID: PMC8997788 DOI: 10.3390/ijerph19074038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/26/2022] [Accepted: 03/27/2022] [Indexed: 11/17/2022]
Abstract
Cancer-related sarcopenia is a complex condition; however, no cancer-specific clinical model is available to guide clinical practice. This study aims to (1) develop an evidence-based care pathway for the management of cancer-related sarcopenia (“sarc-pathway”) and (2) pilot test the feasibility (reach, intervention fidelity, patient and clinician acceptability) of the sarc-pathway in an inpatient cancer ward. The sarc-pathway was developed using a care pathway format and informed by the current literature. Patients admitted to a 32-bed inpatient cancer ward were recruited to receive sarc-pathway care and the feasibility outcomes were assessed. Of the 317 participants admitted, 159 were recruited over 3.5-months (median age 61 years; 56.0% males). Participant consent was high (99.4% of those approached) and 30.2% were at risk of/had sarcopenia. The sarc-pathway screening, assessment and treatment components were delivered as intended; however, low completion of clinical assessment measures were observed for muscle mass (bioimpedance spectroscopy, 20.5%) and muscle function (5-times chair stand test, 50.0%). The sarc-pathway was demonstrated to be acceptable to patients and multidisciplinary clinicians. In an inpatient cancer ward, the sarc-pathway is a feasible and acceptable clinical model and method to deliver and adhere to the sarcopenia clinical parameters specified, albeit with further exploration of appropriate clinical assessment measures.
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31
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Karavolia E, van Rijn-Dekker MI, Van den Bosch L, van den Hoek JGM, Oldehinkel E, Meijer TWH, Halmos GB, Witjes MJH, Oosting SF, van der Hoorn A, Langendijk JA, Steenbakkers RJHM. Impact of sarcopenia on acute radiation-induced toxicity in head and neck cancer patients. Radiother Oncol 2022; 170:122-128. [PMID: 35304862 DOI: 10.1016/j.radonc.2022.03.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Sarcopenia is related to late radiation-induced toxicities and worse survival in head and neck cancer (HNC) patients. This study tested the hypothesis that sarcopenia improves the performance of current normal tissue complication probability (NTCP) models of radiation-induced acute toxicity in HNC patients. MATERIAL/METHODS This was a retrospective analysis in a prospective cohort of HNC patients treated from January 2007 to December 2018 with (chemo)radiotherapy. Planning CT-scans were used for evaluating skeletal muscle mass. Characteristics of sarcopenic and non-sarcopenic patients were compared. The impact of sarcopenia was analysed by adding sarcopenia to the linear predictors of current NTCP models predicting physician- and patient-rated acute toxicities. RESULTS The cut-off values of sarcopenia in the study population (n=977) were established at skeletal muscle index <42.0 cm2/m2 (men) and <31.2 cm2/m2 (women), corresponding to the lowest sex-specific quartile. Compared to non-sarcopenic patients, sarcopenic patients were more frequently smokers (61% vs. 48%, p<0.001), had more often advanced stage of disease (stage III-IV, p=0.004), higher age (67 vs. 63 years, p<0.001) and experienced more pretreatment complaints, such as dysphagia (grade ≥2, p<0.001). Sarcopenia remained statistically significant, next to the linear predictor, only for physician-rated grade ≥3 dysphagia (week 3-6 during RT, p<0.01). However, sarcopenia did not improve the performance of these NTCP models (p>0.99). CONCLUSION Sarcopenia in HNC patients was an independent prognostic factor for radiation-induced physician-rated acute grade ≥3 dysphagia, which might be explained by its impact on swallowing muscles. However, addition of sarcopenia did not improve the NTCP model performance.
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Affiliation(s)
- Eleftheria Karavolia
- Department of Radiation Oncology, University Medical Centre Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Maria I van Rijn-Dekker
- Department of Radiation Oncology, University Medical Centre Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Lisa Van den Bosch
- Department of Radiation Oncology, University Medical Centre Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Johanna G M van den Hoek
- Department of Radiation Oncology, University Medical Centre Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Edwin Oldehinkel
- Department of Radiation Oncology, University Medical Centre Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Tineke W H Meijer
- Department of Radiation Oncology, University Medical Centre Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Gyorgy B Halmos
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Centre Groningen, The Netherlands
| | - Max J H Witjes
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Centre Groningen, The Netherlands
| | - Sjoukje F Oosting
- Department of Medical Oncology, University of Groningen, University Medical Centre Groningen, The Netherlands
| | - Anouk van der Hoorn
- Department of Radiology, University of Groningen, University Medical Centre Groningen, The Netherlands
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Centre Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Roel J H M Steenbakkers
- Department of Radiation Oncology, University Medical Centre Groningen, University of Groningen, 9700 RB Groningen, The Netherlands.
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Khorasanchi A, Nemani S, Pandey S, Del Fabbro E. Managing Nutrition Impact Symptoms in Cancer Cachexia: A Case Series and Mini Review. Front Nutr 2022; 9:831934. [PMID: 35308290 PMCID: PMC8928189 DOI: 10.3389/fnut.2022.831934] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/07/2022] [Indexed: 12/31/2022] Open
Abstract
Malnutrition is common in cancer patients and can occur throughout a patient’s disease course. The contributors to the clinical syndrome of cancer cachexia are often multifactorial, and produced by the cancer and associated pro-inflammatory response. Since cancer cachexia is a multifactorial syndrome, a multimodal therapeutic approach is ideal. A key component of therapy is identifying and managing symptom barriers to adequate oral intake, known as nutritional impact symptoms (NIS). NIS are associated with reduced intake and weight loss in patients with advanced cancer, and aggregate NIS are a predictor of survival in patients with Head and Neck Cancer and in patients undergoing surgery for esophageal cancer. Currently, there are no guidelines regarding the specific management of NIS in oncology patients. Experience from specialist centers suggest relatively simple assessments and inexpensive interventions are available for the diagnosis and treatment of NIS. We present three patient cases from a cachexia clinic, where NIS management decreased symptom burden and improved clinical outcomes such as weight and physical performance.
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Affiliation(s)
- Adam Khorasanchi
- Department of Internal Medicine, Division of Hematology, Oncology, and Palliative Care, Virginia Commonwealth University, Richmond, VA, United States
| | - Srinidhi Nemani
- Virginia Commonwealth University, Richmond, VA, United States
| | - Sudeep Pandey
- Department of Internal Medicine, Division of Hematology, Oncology, and Palliative Care, Virginia Commonwealth University, Richmond, VA, United States
| | - Egidio Del Fabbro
- Department of Internal Medicine, Division of Hematology, Oncology, and Palliative Care, Virginia Commonwealth University, Richmond, VA, United States
- *Correspondence: Egidio Del Fabbro,
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Djordjevic A, Deftereos I, Carter VM, Morris S, Shannon R, Kiss N, Yeung JMC. Ability of malnutrition screening and assessment tools to identify computed tomography defined low muscle mass in colorectal cancer surgery. Nutr Clin Pract 2022; 37:666-676. [DOI: 10.1002/ncp.10844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 11/23/2021] [Accepted: 01/01/2022] [Indexed: 01/04/2023] Open
Affiliation(s)
- Aleksandra Djordjevic
- Department of Surgery, Western Precinct The University of Melbourne Melbourne Australia
- Department of General Internal Medicine Western Health Footscray Australia
| | - Irene Deftereos
- Department of Surgery, Western Precinct The University of Melbourne Melbourne Australia
- Department of Nutrition and Dietetics Western Health Footscray Australia
| | - Vanessa M. Carter
- Department of Nutrition and Dietetics Western Health Footscray Australia
| | - Stephanie Morris
- Department of Nutrition and Dietetics Western Health Footscray Australia
| | - Roland Shannon
- Department of Radiology and Medical Imaging Western Health Footscray Australia
| | - Nicole Kiss
- Institute for Physical Activity and Nutrition Deakin University Geelong Australia
- Department of Allied Health Peter MacCallum Cancer Centre Melbourne Australia
| | - Justin M. C. Yeung
- Department of Surgery, Western Precinct The University of Melbourne Melbourne Australia
- Department of Colorectal Surgery Western Health Footscray Australia
- Western Health Chronic Disease Alliance, Western Health Melbourne Australia
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34
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Findlay M, White K, Stapleton N, Bauer J. Response to Comment: Evaluating sarcopenia in cancer patients: the role of muscle strength. Clin Nutr 2022; 41:780-781. [DOI: 10.1016/j.clnu.2022.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/31/2022] [Indexed: 11/03/2022]
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35
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Deftereos I, Kiss N, Brown T, Carey S, Carter VM, Usatoff V, Ananda S, Yeung JM. Awareness and perceptions of nutrition support in upper gastrointestinal cancer surgery: A national survey of multidisciplinary clinicians. Clin Nutr ESPEN 2021; 46:343-349. [PMID: 34857218 DOI: 10.1016/j.clnesp.2021.09.734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 09/08/2021] [Accepted: 09/13/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patients undergoing surgery for upper gastrointestinal (UGI) cancer are at high risk of malnutrition, and a multidisciplinary approach to management is recommended. This study aimed to determine practices, awareness and perceptions of multi-disciplinary clinicians with regards to malnutrition screening and provision of nutrition support. METHODS A national survey of dietitians, surgeons, oncologists and nurses was conducted using a 30-item online REDCap survey, including questions regarding self-reported malnutrition screening/nutrition support practices, awareness and perceptions, and barriers and enablers. The survey was distributed via professional organisations/networks between 1st September and 30th November 2020. Results are presented as counts and percentages. RESULTS There were 130 participants (56% dietitians, 25% surgeons, 11% nurses, 8% oncologists). The majority reported that dietitians and nurses performed malnutrition screening, and dietitians and surgeons prescribed nutrition support. Most participants reported that their health service had dietetics support available overall (98%), however only 41% reported having an outpatient service. Participants (>90%) demonstrated very high awareness of the significance of malnutrition and the importance of early nutrition support. Participants mostly perceived dietitians, nurses and surgeons to be responsible for malnutrition screening, whilst responsibility of prescription of nutrition support was mostly dietitians and surgeons. There were a higher number of barriers for the outpatient setting (48%) than the inpatient setting (38%). CONCLUSIONS Participants identified a high awareness of the importance of identification and treatment of malnutrition in UGI cancer surgery. However reported practices varied and appear to be lacking in the outpatient setting, with significant barriers identified to providing optimal nutrition care.
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Affiliation(s)
- Irene Deftereos
- Department of Surgery, Western Precinct, Melbourne Medical School, The University of Melbourne, St Albans, VIC 3021, Australia; Department of Nutrition and Dietetics, Western Health, Footscray, VIC 3011, Australia.
| | - Nicole Kiss
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC 3220, Australia; Allied Health Research, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia.
| | - Teresa Brown
- Department of Nutrition and Dietetics, Royal Brisbane & Women's Hospital, Brisbane, QLD 4029, Australia; School of Human Movement and Nutritional Sciences, The University of Queensland, Brisbane, QLD 4029, Australia.
| | - Sharon Carey
- Department of Nutrition and Dietetics, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia.
| | - Vanessa M Carter
- Department of Nutrition and Dietetics, Western Health, Footscray, VIC 3011, Australia.
| | - Val Usatoff
- Department of Surgery, Western Precinct, Melbourne Medical School, The University of Melbourne, St Albans, VIC 3021, Australia.
| | - Sumitra Ananda
- Department of Medicine, The University of Melbourne, Parkville, VIC 3010, Australia.
| | - Justin Mc Yeung
- Department of Surgery, Western Precinct, Melbourne Medical School, The University of Melbourne, St Albans, VIC 3021, Australia; Department of Colorectal Surgery, Western Health, Footscray, VIC 3011, Australia; Western Health Chronic Disease Alliance, Western Health, Footscray, VIC 3011, Australia.
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Findlay M, White K, Brown C, Bauer JD. Nutritional status and skeletal muscle status in patients with head and neck cancer: Impact on outcomes. J Cachexia Sarcopenia Muscle 2021; 12:2187-2198. [PMID: 34676673 PMCID: PMC8718020 DOI: 10.1002/jcsm.12829] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 09/05/2021] [Accepted: 09/11/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Computed tomography (CT)-defined skeletal muscle depletion and malnutrition are demonstrated as poor prognostic factors in patients with head and neck cancer (HNC), however to date, have only been explored in isolation. We aimed to describe body composition profile and examine the impact of nutritional status as well as independently and concurrently occurring body composition features on overall survival, treatment completion, unplanned admissions and length of stay (LOS) in patients undergoing radiotherapy (RT) or chemoradiotherapy (CRT) of curative intent for HNC. METHODS This work is a retrospective, observational study of patients who had completed treatment of curative intent for HNC. Scored Patient-Generated Subjective Global Assessment (PG-SGA) was used to determine nutritional status. Tissue-density data were derived at the third lumbar vertebra (L3) with sarcopenia and myosteatosis defined by published, sex-specific threshold values stratified by body mass index for skeletal muscle index (cm2 /m2 ) and skeletal muscle radiodensity (SMR, Hounsfield Unit). RESULTS Pre-treatment data (n = 277: 78% male, mean (SD) age 60 (13) years) revealed the prevalence of malnutrition (24.9%), sarcopenia (52.3%), myosteatosis (82.3%), and concurrently occurring sarcopenia and myosteatosis (39.7%). Malnutrition was independently associated with reduced OS for patients with moderate [hazard ratio (HR) 2.57; 95% confidence interval (CI) 1.45-4.55, P = 0.001] and severe (HR 3.19; 95% CI 1.44-7.07, P = 0.004) malnutrition on multivariable analysis but not sarcopenia (HR 1.09; 95% CI 0.70-1.71), P = 0.700 or myosteatosis (HR 1.28; 95% CI 0.57-2.84), P = 0.500). Malnutrition was associated with treatment discontinuation (P < 0.001), not completing RT as planned (P < 0.001), unplanned hospital admission (P = 0.021), and greater LOS (P < 0.001). Skeletal muscle status features were associated with unplanned hospital admissions for those with no features (32%), with sarcopenia only (50%), myosteatosis only (25%), and concurrent sarcopenia and myosteatosis (50%), P < 0.001. Similarly, a clinically relevant greater median (Q1, Q3) LOS was observed for those with sarcopenia only [5 (3, 32)], myosteatosis only [10 (5, 30)], concurrent sarcopenia, and myosteatosis [14 (4, 33)] days vs. those with no features [3 (2, 11)] days, P = 0.2. CONCLUSIONS Malnutrition was a more powerful prognostic indicator than CT-defined skeletal muscle depletion and was independently associated with reduced OS in patients undergoing RT or CRT of curative intent for HNC. CT-defined skeletal muscle depletion studies should recognize the multifaceted nature of human body composition and also measure nutritional status using validated methods in order to move towards developing a typology of high risk criteria for this complex patient group.
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Affiliation(s)
- Merran Findlay
- Cancer ServicesRoyal Prince Alfred HospitalCamperdownNSWAustralia
- Chris O'Brien Lifehouse, New South WalesCamperdownNSWAustralia
- Cancer Nursing Research Unit, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and HealthUniversity of SydneyCamperdownNSWAustralia
- The Daffodil CentreThe University of Sydney, a joint venture with Cancer CouncilNSWAustralia
| | - Kathryn White
- Cancer ServicesRoyal Prince Alfred HospitalCamperdownNSWAustralia
- Cancer Nursing Research Unit, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and HealthUniversity of SydneyCamperdownNSWAustralia
- The Daffodil CentreThe University of Sydney, a joint venture with Cancer CouncilNSWAustralia
| | - Chris Brown
- National Health and Medical Research Council Clinical Trials CentreThe University of SydneyCamperdownNSWAustralia
| | - Judith D. Bauer
- School of Human Movement and Nutrition SciencesUniversity of QueenslandSt LuciaQLDAustralia
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Prado CM, Laviano A, Gillis C, Sung AD, Gardner M, Yalcin S, Dixon S, Newman SM, Bastasch MD, Sauer AC, Hegazi R, Chasen MR. Examining guidelines and new evidence in oncology nutrition: a position paper on gaps and opportunities in multimodal approaches to improve patient care. Support Care Cancer 2021; 30:3073-3083. [PMID: 34811570 PMCID: PMC8857008 DOI: 10.1007/s00520-021-06661-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 10/27/2021] [Indexed: 12/12/2022]
Abstract
Malnutrition, muscle loss, and cachexia are prevalent in cancer and remain key challenges in oncology today. These conditions are frequently underrecognized and undertreated and have devastating consequences for patients. Early nutrition screening/assessment and intervention are associated with improved patient outcomes. As a multifaceted disease, cancer requires multimodal care that integrates supportive interventions, specifically nutrition and exercise, to improve nutrient intake, muscle mass, physical functioning, quality of life, and treatment outcomes. An integrated team of healthcare providers that incorporates societies' recommendations into clinical practice can help achieve the best possible outcomes. A multidisciplinary panel of experts in oncology, nutrition, exercise, and medicine participated in a 2-day virtual roundtable in October 2020 to discuss gaps and opportunities in oncology nutrition, alone and in combination with exercise, relative to current evidence and international societies' recommendations. The panel recommended five principles to optimize clinical oncology practice: (1) position oncology nutrition at the center of multidisciplinary care; (2) partner with colleagues and administrators to integrate a nutrition care process into the multidisciplinary cancer care approach; (3) screen all patients for malnutrition risk at diagnosis and regularly throughout treatment; (4) combine exercise and nutrition interventions before (e.g., prehabilitation), during, and after treatment as oncology standard of care to optimize nutrition status and muscle mass; and (5) incorporate a patient-centered approach into multidisciplinary care.
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Affiliation(s)
- Carla M Prado
- Human Nutrition Research Unit, Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Alessandro Laviano
- Department of Translation and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Chelsia Gillis
- Peri Operative Program, McGill University Health Center, Montreal, QC, Canada
| | - Anthony D Sung
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University School of Medicine, Durham, NC, USA
| | - Maureen Gardner
- Florida Cancer Specialists and Research Institute, Fort Myers, FL, USA
| | - Suayib Yalcin
- Department of Medical Oncology, Hacettepe University Cancer Institute, Sihhiye, Ankara, Turkey
| | | | | | | | - Abby C Sauer
- Scientific & Medical Affairs, Abbott Nutrition, Columbus, OH, USA
| | - Refaat Hegazi
- Scientific & Medical Affairs, Abbott Nutrition, Columbus, OH, USA
| | - Martin R Chasen
- Department of Medicine, University of Toronto, Toronto, Canada. .,William Osler Health System, Brampton, ON, Canada. .,Department of Family Medicine, McMaster University, Hamilton, ON, Canada.
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Di Giorgio A, Rotolo S, Cintoni M, Rinninella E, Pulcini G, Schena CA, Ferracci F, Grassi F, Raoul P, Moroni R, Pacelli F, Gasbarrini A, Mele MC. The prognostic value of skeletal muscle index on clinical and survival outcomes after cytoreduction and HIPEC for peritoneal metastases from colorectal cancer: A systematic review and meta-analysis. Eur J Surg Oncol 2021; 48:649-656. [PMID: 34696936 DOI: 10.1016/j.ejso.2021.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 09/30/2021] [Accepted: 10/12/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Cytoreductive surgery (CRS) and hypertermic intraperitoneal chemotherapy (HIPEC) represent the most effective strategy to manage peritoneal metastases (PM). This systematic review and meta-analysis aimed to assess the impact of body composition on clinical outcomes in patients with PM. METHODS A systematic literature search was performed using Medline, Web of Science and EMBASE databases from inception to the 20st August 2020. Data were independently extracted by 3 authors. Newcastle-Ottawa Scale was used to assess quality and risk of bias of studies. Pooled analyses were performed using Mantel-Haenszel method to estimate overall effect size with mean differences or odd ratios (ORs) and 95% confidence interval (CI). The primary outcome was postoperative complication (POC) rate, while secondary outcomes were severe POC and postoperative mortality. RESULTS A total of 4 studies were included in the systematic review and meta-analysis, including 582 patients. A significant association between low skeletal muscle mass and POC was found (OR 1.45, 95% CI 1.04 to 2.03; p = 0.03), while no differences were found in terms operative time, estimated blood loss, length of hospital stay, and postoperative mortality (p > 0.05). CONCLUSIONS Low skeletal muscle mass at diagnosis is a valid prognostic factor for POC development in colorectal and PM patients undergoing CRS. Prospective and larger studies are needed to better investigate the role of CT scan derived body composition and to understand how to implement this tool in clinical practice.
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Affiliation(s)
- Andrea Di Giorgio
- UOS Trattamenti Integrati Della Carcinosi Peritoneale Avanzata, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Stefano Rotolo
- UOC Chirurgia Del Peritoneo e Del Retroperitoneo, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy; Dipartimento di Discipline Chirurgiche, Oncologiche e Stomatologiche (Di.Chir.On.S.), Università Degli Studi di Palermo, Via Liborio Giuffrè 5, 90127, Palermo, Italy
| | - Marco Cintoni
- Scuola di Specializzazione in Scienza Dell'Alimentazione, Università di Roma Tor Vergata, Via Montpellier 1, 00133, Rome, Italy.
| | - Emanuele Rinninella
- UOC di Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Gabriele Pulcini
- UOSD di Nutrizione Avanzata in Oncologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Carlo Alberto Schena
- UOC Chirurgia Del Peritoneo e Del Retroperitoneo, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Federica Ferracci
- UOC Chirurgia Del Peritoneo e Del Retroperitoneo, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Futura Grassi
- UOC di Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Pauline Raoul
- UOSD di Nutrizione Avanzata in Oncologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Rossana Moroni
- Direzione Scientifica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Fabio Pacelli
- UOC Chirurgia Del Peritoneo e Del Retroperitoneo, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Antonio Gasbarrini
- UOC Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy; Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica Del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
| | - Maria Cristina Mele
- UOSD di Nutrizione Avanzata in Oncologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy; Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica Del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
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Deftereos I, Yeung JMC, Arslan J, Carter VM, Isenring E, Kiss N. Preoperative Nutrition Intervention in Patients Undergoing Resection for Upper Gastrointestinal Cancer: Results from the Multi-Centre NOURISH Point Prevalence Study. Nutrients 2021; 13:nu13093205. [PMID: 34579082 PMCID: PMC8467838 DOI: 10.3390/nu13093205] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/09/2021] [Accepted: 09/09/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Preoperative nutrition intervention is recommended prior to upper gastrointestinal (UGI) cancer resection; however, there is limited understanding of interventions received in current clinical practice. This study investigated type and frequency of preoperative dietetics intervention and nutrition support received and clinical and demographic factors associated with receipt of intervention. Associations between intervention and preoperative weight loss, surgical length of stay (LOS), and complications were also investigated. Methods: The NOURISH Point Prevalence Study was conducted between September 2019 and May 2020 across 27 Australian tertiary centres. Subjective global assessment and weight were performed within 7 days of admission. Patients reported on preoperative dietetics and nutrition intervention, and surgical LOS and complications were recorded. Results: Two-hundred patients participated (59% male, mean (standard deviation) age 67 (10)). Sixty percent had seen a dietitian preoperatively, whilst 50% were receiving nutrition support (92% oral nutrition support (ONS)). Patients undergoing pancreatic surgery were less likely to receive dietetics intervention and nutrition support than oesophageal or gastric surgeries (p < 0.001 and p = 0.029, respectively). Neoadjuvant therapy (p = 0.003) and malnutrition (p = 0.046) remained independently associated with receiving dietetics intervention; however, 31.3% of malnourished patients had not seen a dietitian. Patients who received ≥3 dietetics appointments had lower mean (SD) percentage weight loss at the 1-month preoperative timeframe compared with patients who received 0–2 appointments (1.2 (2.0) vs. 3.1 (3.3), p = 0.001). Patients who received ONS for >2 weeks had lower mean (SD) percentage weight loss than those who did not (1.2 (1.8) vs. 2.9 (3.4), p = 0.001). In malnourished patients, total dietetics appointments ≥3 was independently associated with reduced surgical complications (odds ratio 0.2, 95% confidence interval (CI) 0.1, 0.9, p = 0.04), and ONS >2 weeks was associated with reduced LOS (regression coefficient −7.3, 95% CI −14.3, −0.3, p = 0.04). Conclusions: Despite recommendations, there are low rates of preoperative dietetics consultation and nutrition support in this population, which are associated with increased preoperative weight loss and risk of increased LOS and complications in malnourished patients. The results of this study provide insights into evidence–practice gaps for improvement and data to support further research regarding optimal methods of preoperative nutrition support.
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Affiliation(s)
- Irene Deftereos
- Department of Surgery, Western Precinct, Melbourne Medical School, The University of Melbourne, St Albans, VIC 3021, Australia; (J.M.-C.Y.); (J.A.)
- Department of Nutrition and Dietetics, Western Health, Footscray, VIC 3011, Australia;
- Correspondence: ; Tel.: +61-3-8395-8116
| | - Justin M.-C. Yeung
- Department of Surgery, Western Precinct, Melbourne Medical School, The University of Melbourne, St Albans, VIC 3021, Australia; (J.M.-C.Y.); (J.A.)
- Department of Colorectal Surgery, Western Health, Footscray, VIC 3011, Australia
- Western Health Chronic Disease Alliance, Western Health, Footscray, VIC 3011, Australia
| | - Janan Arslan
- Department of Surgery, Western Precinct, Melbourne Medical School, The University of Melbourne, St Albans, VIC 3021, Australia; (J.M.-C.Y.); (J.A.)
| | - Vanessa M. Carter
- Department of Nutrition and Dietetics, Western Health, Footscray, VIC 3011, Australia;
| | - Elizabeth Isenring
- Faculty of Health Sciences and Medicine, Bond University, Robina, QLD 4226, Australia;
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia
| | - Nicole Kiss
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC 3220, Australia;
- Allied Health Research, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
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Poulter S, Steer B, Baguley B, Edbrooke L, Kiss N. Comparison of the GLIM, ESPEN and ICD-10 Criteria to Diagnose Malnutrition and Predict 30-Day Outcomes: An Observational Study in an Oncology Population. Nutrients 2021; 13:nu13082602. [PMID: 34444762 PMCID: PMC8402162 DOI: 10.3390/nu13082602] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 11/16/2022] Open
Abstract
The Global Leadership Initiative on Malnutrition (GLIM) criteria are consensus criteria for the diagnosis of malnutrition. This study aimed to investigate and compare the prevalence of malnutrition using the GLIM, European Society for Clinical Nutrition and Metabolism (ESPEN) and International Statistical Classification of Diseases version 10 (ICD-10) criteria; compare the level of agreement between these criteria; and identify the predictive validity of each set of criteria with respect to 30-day outcomes in a large cancer cohort. GLIM, ESPEN and ICD-10 were applied to determine the prevalence of malnutrition in 2794 participants from two cancer malnutrition point prevalence studies. Agreement between the criteria was analysed using the Cohen’s Kappa statistic. Binary logistic regression models were used to determine the ability of each set of criteria to predict 30-day mortality and unplanned admission or readmission. GLIM, ESPEN and ICD-10 criteria identified 23.0%, 5.5% and 12.6% of the cohort as malnourished, respectively. Slight-to-fair agreement was reported between the criteria. All three criteria were predictive of mortality, but only the GLIM and ICD-10 criteria were predictive of unplanned admission or readmission at 30 days. The GLIM criteria identified the highest prevalence of malnutrition and had the greatest predictive ability for mortality and unplanned admission or readmission in an oncology population.
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Affiliation(s)
- Shay Poulter
- School of Exercise and Nutrition Sciences, Deakin University, Melbourne 3125, Australia;
| | - Belinda Steer
- Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne 3000, Australia;
| | - Brenton Baguley
- Institute for Physical Activity and Nutrition, Deakin University, Geelong 3220, Australia;
| | - Lara Edbrooke
- Allied Health Department, Peter MacCallum Cancer Centre, Melbourne 3000, Australia;
- Physiotherapy Department, The University of Melbourne, Parkville 3052, Australia
| | - Nicole Kiss
- Institute for Physical Activity and Nutrition, Deakin University, Geelong 3220, Australia;
- Allied Health Department, Peter MacCallum Cancer Centre, Melbourne 3000, Australia;
- Correspondence:
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Gillis C, Hasil L, Kasvis P, Bibby N, Davies SJ, Prado CM, West MA, Shaw C. Nutrition Care Process Model Approach to Surgical Prehabilitation in Oncology. Front Nutr 2021; 8:644706. [PMID: 34249985 PMCID: PMC8264148 DOI: 10.3389/fnut.2021.644706] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/26/2021] [Indexed: 12/21/2022] Open
Abstract
The nutrition care process is a standardized and systematic method used by nutrition professionals to assess, diagnose, treat, and monitor patients. Using the nutrition care process model, we demonstrate how nutrition prehabilitation can be applied to the pre-surgical oncology patient.
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Affiliation(s)
- Chelsia Gillis
- Department of Anesthesia, McGill University, Montreal, QC, Canada
| | - Leslee Hasil
- Department of Nutrition Services, Alberta Health Services, Calgary, AB, Canada
| | - Popi Kasvis
- Department of Nutrition, McGill University Health Center, Montreal, QC, Canada
| | - Neil Bibby
- Manchester Royal Infirmary, Dietetics Department, Manchester University National Health Service (NHS) Foundation Trust, Manchester, United Kingdom
| | - Sarah J Davies
- Department of Dietetics/Speech and Language Therapy, University Hospital Southampton National Health Service (NHS) Foundation Trust, Southampton, United Kingdom
| | - Carla M Prado
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Malcolm A West
- School of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,University Hospital Southampton National Health Service (NHS) Foundation Trust, Southampton, United Kingdom.,National Institute for Health Research (NIHR) Biomedical Research Centre, University Hospital Southampton National Health Service (NHS) Foundation Trust, Southampton, United Kingdom.,Anaesthesia, Perioperative and Critical Care Research Group, National Institute for Health Research (NIHR) Biomedical Research Centre, University Hospital Southampton National Health Service (NHS) Foundation Trust, University of Southampton, Southampton, United Kingdom
| | - Clare Shaw
- Department of Nutrition and Dietetics, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
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Sarcopenia and serum biomarkers of oxidative stress after a 6-month physical activity intervention in women with metastatic breast cancer: results from the ABLE feasibility trial. Breast Cancer Res Treat 2021; 188:601-613. [PMID: 34013451 PMCID: PMC8272711 DOI: 10.1007/s10549-021-06238-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 04/20/2021] [Indexed: 01/04/2023]
Abstract
Purpose Sarcopenia has been identified as an important prognostic factor for patients with cancer. This study aimed at exploring the potential associations between a 6-month physical activity intervention and muscle characteristics, sarcopenia, oxidative stress and toxicities in patients with metastatic breast cancer. Methods Women newly diagnosed with metastatic breast cancer (N = 49) participated in an unsupervised, personalized, 6-month physical activity intervention with activity tracker. Computerized tomography images at the third lumbar vertebra were analysed at baseline, three months and six months to assess sarcopenia (muscle mass index < 40 cm2/m2) and muscle quality (poor if muscle attenuation < 37.8 Hounsfield Units). Oxidative markers included plasma antioxidant enzymes (catalase, glutathione peroxidase and superoxide dismutase activities), prooxidant enzymes (NADPH oxidase and myeloperoxidase activities) and oxidative stress damage markers (advanced oxidation protein products, malondialdehyde (MDA) and DNA oxidation. Results At baseline 53% (mean age 55 years (SD 10.41)) were sarcopenic and 75% had poor muscle quality. Muscle cross sectional area, skeletal muscle radiodensity, lean body mass remained constant over the six months (p = 0.75, p = 0.07 and p = 0.75 respectively), but differed significantly between sarcopenic and non-sarcopenic patients at baseline and 6-months. Sarcopenic patients at baseline were more likely to have an increase of MDA (p = 0.02) at 6 months. Being sarcopenic during at least one moment during the 6-month study was associated with a higher risk of developing severe toxicities (grade > 2) (p = 0.02). Conclusions This study suggests potential benefits of physical activity for maintenance of muscle mass. Sarcopenia can alter many parameters and disturb the pro and antioxidant balance. Supplementary Information The online version contains supplementary material available at 10.1007/s10549-021-06238-z.
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Chan DL, Clarke SJ, Engel A, Diakos CI, Pavlakis N, Roach PJ, Bailey DL, Bauer J, Findlay M. Computed tomography (CT)-defined sarcopenia and myosteatosis are prevalent in patients with neuroendocrine neoplasms (NENs) treated with peptide receptor radionuclide therapy (PRRT). Eur J Clin Nutr 2021; 76:143-149. [PMID: 33986486 DOI: 10.1038/s41430-021-00915-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 03/07/2021] [Accepted: 03/29/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES Neuroendocrine neoplasms (NEN) may predispose patients to malnutrition. CT-defined sarcopenia and myosteatosis are common in other tumour types and recognized adverse prognostic factors. However, the prevalence and prognostic impact of sarcopenia and myosteatosis remain undetermined in NEN patients to date. METHODS A retrospective study of NEN patients treated with peptide receptor radionuclide therapy (PRRT) at a tertiary institution from 2012 to 2017. Patients with PET/CT imaging at baseline and follow-up were included. The L3 slice of the co-localizing CT was analysed using the Alberta Protocol. Skeletal muscle cross-sectional area and muscle attenuation were measured and compared with pre-defined cut-offs. The primary endpoint was the prevalence of sarcopenia and myosteatosis according to previously published cut-offs. RESULTS Fourty-nine patients (median age 64 (range 26-80) years) were included. The most common primary sites of tumour were the small bowel (51%) and pancreas (26%). Baseline sarcopenia was prevalent in 67% of patients and myosteatosis in 71%. Forty-five percent of patients gained weight over the course of PRRT. The presence of baseline sarcopenia was not associated with progression-free survival (20.8 mo vs. 20.7 mo, HR 0.86, p = 0.70) nor overall survival. Similarly, baseline myosteatosis (PFS 19.5 mo vs. 20.8 mo, HR 0.77, p = 0.47) was not significantly associated with survival outcomes. The mean (SD) age of those with myosteatosis was 60.8 ± 11.6 years compared to 49.7 ± 12.7 years for those without (p = 0.003). CONCLUSIONS Body composition analysis is feasible using routinely acquired PET/CT data for patients with NEN. CT-defined sarcopenia and myosteatosis are prevalent in NEN patients, although myosteatosis is more common with increasing age. These findings were not associated with worsened overall or progression-free survival in the current study.
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Affiliation(s)
- David L Chan
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW, Australia. .,Bill Walsh Translational Cancer Research Laboratory, Kolling Institute, University of Sydney, Sydney, NSW, Australia. .,Sydney Vital Translational Cancer Research Centre, Sydney, NSW, Australia.
| | - Stephen J Clarke
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW, Australia.,Bill Walsh Translational Cancer Research Laboratory, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - Alexander Engel
- Sydney Vital Translational Cancer Research Centre, Sydney, NSW, Australia.,Department of Colorectal Surgery, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Connie I Diakos
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW, Australia.,Bill Walsh Translational Cancer Research Laboratory, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - Nick Pavlakis
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW, Australia.,Bill Walsh Translational Cancer Research Laboratory, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - Paul J Roach
- Department of Nuclear Medicine, Royal North Shore Hospital, Sydney, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Dale L Bailey
- Sydney Vital Translational Cancer Research Centre, Sydney, NSW, Australia.,Department of Nuclear Medicine, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Judith Bauer
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, QLD, Australia
| | - Merran Findlay
- Cancer Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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Findlay M, Bauer J, Shaw T, White K, Lai M, Rankin NM. "There's a lot of talent in the room but it's only really the medical talent that gets heard": a qualitative exploration of multidisciplinary clinicians' perspectives of optimal nutrition care of patients with head and neck cancer. Support Care Cancer 2021; 29:6399-6409. [PMID: 33890164 DOI: 10.1007/s00520-021-06162-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/16/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The high prevalence of malnutrition in patients with head and neck cancer (HNC) negatively impacts outcomes. The best-available evidence has been published in clinical nutrition guidelines; however, translation into practice has lagged. AIM This project aimed to explore multidisciplinary team (MDT) clinicians' perspectives regarding barriers and enablers to best-practice nutrition care in order to inform the design of a new model of care. METHOD Qualitative interviews were conducted with clinicians who were purposively sampled from a major HNC tertiary referral centre in Sydney, Australia. To elicit information regarding barriers and facilitators to change, a semi-structured interview schedule was developed, interviews were transcribed verbatim and analyzed employing an inductive thematic approach. The Consolidated Framework for Implementation Research (CFIR) was used to guide data analysis and interpretation of key themes identified. RESULTS Nineteen participants (11 supportive care and eight medical clinicians) representing allied health, medical, and nursing disciplines participated. Five key themes were identified: (1) acknowledgement of dietetics expertise and access to resources to deliver nutrition care; (2) proactive versus reactive nutrition care; (3) integrated and coordinated care-"The One Stop Shop"; (4) MDT favours the medical model; and (5) leadership-within disciplines, within the MDT. CONCLUSIONS MDT clinicians expressed similar views regarding delivering optimal nutrition care to this high nutritional risk patient group. However, perspectives differed at times between medical and supportive care clinicians, attributable to perceptions that current service structure favours the medical model. In order to design and deliver an evidence-based model of care, specific strategies will be required to ensure: early and ongoing access to expert nutrition care; nutrition care processes are proactive; integrated and coordinated care; and leadership, both intra- and inter-disciplinary. This novel exploration of MDT clinicians' views provides supporting evidence that multi-component implementation strategies comprising individual, team and system-level approaches will be essential to leverage sustainable change.
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Affiliation(s)
- Merran Findlay
- Cancer Services, Royal Prince Alfred Hospital, New South Wales, Australia. .,Chris O´Brien Lifehouse, Camperdown, New South Wales, Australia. .,Sydney Catalyst Translational Cancer Research Centre, University of Sydney, Sydney, New South Wales, Australia.
| | - Judith Bauer
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Tim Shaw
- Sydney Catalyst Translational Cancer Research Centre, University of Sydney, Sydney, New South Wales, Australia.,Research in Implementation Science and eHealth, Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia
| | - Kathryn White
- Cancer Services, Royal Prince Alfred Hospital, New South Wales, Australia.,Sydney Catalyst Translational Cancer Research Centre, University of Sydney, Sydney, New South Wales, Australia.,Cancer Nursing Research Unit, Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Michelle Lai
- Cancer Nursing Research Unit, Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Nicole M Rankin
- Sydney Catalyst Translational Cancer Research Centre, University of Sydney, Sydney, New South Wales, Australia.,Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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45
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Patient and carer experiences of nutrition in cancer care: a mixed-methods study. Support Care Cancer 2021; 29:5475-5485. [PMID: 33710413 DOI: 10.1007/s00520-021-06111-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 02/24/2021] [Indexed: 01/06/2023]
Abstract
PURPOSE Evidence-based guidelines exist to guide health professionals and services about cancer nutrition care; however, the views of cancer patients and carers are not well understood. This study aimed to understand the experience and needs of cancer patients and carers regarding nutrition care across the care continuum. METHODS Using a mixed-methods approach, cancer patients and carers completed a cross-sectional online survey and focus groups. Participants were recruited through health services and cancer organisation consumer networks via email distribution lists, e-newsletters, and social media. Focus groups were audio-recorded, transcribed, and analysed using content analysis. RESULTS Of 165 survey respondents, only 51% (n=84) reported they talked to a health professional about their nutrition care at any time-point, and only 32% with a dietitian. The majority (84%) of patients and carers felt nutrition was important at one or more time-points in their cancer path, indicating during and after cancer treatment the most important. However, perceived support from health professionals for nutrition care was deemed low at all time-points. Five focus groups were held (n=20; 16 patients, 2 carers, 2 both patients/carers) and five themes emerged: nutrition information, experiences and need; control over diet and nutrition; importance and value of nutrition; access to support; what optimal nutrition care looks like. CONCLUSION Patients and carers felt nutrition was important during their cancer path, but perceived support from health professionals for nutrition care was low. This study has highlighted patient and carer nutrition experiences that will inform development of a co-designed optimal cancer nutrition care pathway.
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The association between sarcopenia and quality of life in patients undergoing colorectal cancer surgery: an exploratory study. Support Care Cancer 2021; 29:3411-3420. [PMID: 33547963 DOI: 10.1007/s00520-021-06025-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 01/21/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To describe changes in health-related quality of life (QoL) from before colorectal cancer (CRC) surgery to 1 and 3-month post-surgery in patients diagnosed pre-operatively as sarcopenic or non-sarcopenic by computed tomography (CT) analysis. METHODS Secondary analysis of a prospective observational cohort study with one pre-operative and two post-operative assessments. Patient-reported outcome measures (PROMs) were collected at each timepoint using Functional Assessment of Cancer Therapy-Colorectal and the EuroQol-5D (EQ-5D) questionnaires. Pre-operative staging CT scans of the third lumbar vertebra (axial slice) were analysed using Slice-O-Matic Software to determine if patients had CT defined sarcopenia by employing sex-specific threshold values for skeletal muscle index. Patient-reported outcome measure scores were compared with minimal clinical important difference estimates to determine if changes were clinically significant. RESULTS Twenty-five of 40 patients were found to be sarcopenic. The difference between sarcopenic groups on the EQ-5D was medium-sized and clinically significant, with the sarcopenic group reporting lower health status. The non-sarcopenic group displayed a clinically significant reduction in physical wellbeing post-operatively. The sarcopenic group did not demonstrate a clinically important reduction in physical wellbeing. For functional wellbeing, the sarcopenic group recorded a clinically significant reduction at the 1-month timepoint, trending back towards baseline by the 3-month timepoint. The non-sarcopenic group recorded almost no change in functional scores. CONCLUSION This study explored the novel concept of the effect of sarcopenia on QoL in the CRC surgical setting. Clinically significant changes were identified at both post-operative timepoints. This highlights an important proof of concept that PROMs can detect meaningful clinical change in CRC patients in the context of sarcopenia and should be further explored.
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Findlay M, Bauer JD, Dhaliwal R, de van der Schueren M, Laviano A, Widaman A, Martin L, Day AG, Gramlich LM. Translating Evidence-Based Guidelines into Practice-Are We Getting It Right? A Multi-Centre Prospective International Audit of Nutrition Care in Patients with Foregut Tumors (INFORM). Nutrients 2020; 12:E3808. [PMID: 33322627 PMCID: PMC7763837 DOI: 10.3390/nu12123808] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/04/2020] [Accepted: 12/08/2020] [Indexed: 12/13/2022] Open
Abstract
Malnutrition is highly prevalent in patients with foregut tumors comprising head and neck (HNC) and esophageal (EC) cancers, negatively impacting outcomes. International evidence-based guidelines (EBGs) for nutrition care exist; however, translation of research evidence into practice commonly presents considerable challenges and consequently lags. This study aimed to describe and evaluate current international nutrition care practices compared with the best-available evidence for patients with foregut tumors who are at high risk of malnutrition. A multi-centre prospective cohort study enrolled 170 patients commencing treatment of curative intent for HNC (n = 119) or EC (n = 51) in 11 cancer care settings in North America, Europe and Australia between 2016 and 2018. Adherence criteria were derived from relevant EBG recommendations with pooled results for participating centres reported according to the Nutrition Care Model at either system or patient levels. Adherence to EBG recommendations was: good (≥80%) for performing baseline nutrition screening and assessment, perioperative nutrition assessment and nutrition prescription for energy and protein targets; moderate (≥60 to 80%) for utilizing validated screening and assessment tools and pre-radiotherapy dietitian consultation; and poor (60%) for initiating post-operative nutrition support within 24 h and also dietetic consultation weekly during radiotherapy and fortnightly for 6 weeks post-radiotherapy. In conclusion, gaps in evidence-based cancer nutrition care remain; however, this may be improved by filling known evidence gaps through high-quality research with a concurrent evolution of EBGs to also encompass practical implementation guidance. These should aim to support multidisciplinary cancer clinicians to close evidence-practice gaps throughout the patient care trajectory with clearly defined roles and responsibilities that also address patient-reported concerns.
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Affiliation(s)
- Merran Findlay
- Cancer Services, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
- Chris O’Brien Lifehouse, Camperdown, NSW 2050, Australia
| | - Judith D. Bauer
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, QLD 4072, Australia;
| | | | - Marian de van der Schueren
- Department of Nutrition, Dietetics and Lifestyle, School of Allied Health, HAN University of Applied Sciences, 6503 GL Nijmegen, The Netherlands;
- Department of Human Nutrition and Health, Wageningen University and Research, 6700 AA Wageningen, The Netherlands
| | - Alessandro Laviano
- Department of Translational and Precision Medicine, Sapienza University of Rome, I-00185 Rome, Italy;
| | - Adrianne Widaman
- Department of Nutrition, Food Science and Packaging, San Jose State University, San Jose, CA 95192, USA;
- University of California Davis Medical Center, Sacramento, CA 94558-5004, USA
| | - Lisa Martin
- Department of Medicine, Cross Cancer Institute, University of Alberta, Edmonton, AB T6G 1Z2, Canada;
| | - Andrew G. Day
- Department of Public Health Sciences, Queen’s University, Kingston, ON K7L 2V7, Canada;
| | - Leah M. Gramlich
- Royal Alexandra Hospital, Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB T5H 3V9, Canada;
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Kiss N, Loeliger J, Findlay M, Isenring E, Baguley BJ, Boltong A, Butler A, Deftereos I, Eisenhuth M, Fraser SF, Fichera R, Griffin H, Hayes S, Jeffery E, Johnson C, Lomma C, van der Meij B, McIntyre C, Nicholls T, Pugliano L, Skinner T, Stewart J, Bauer J. Clinical Oncology Society of Australia: Position statement on cancer-related malnutrition and sarcopenia. Nutr Diet 2020; 77:416-425. [PMID: 32803904 PMCID: PMC7540290 DOI: 10.1111/1747-0080.12631] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 12/30/2022]
Abstract
This position statement describes the recommendations of the Clinical Oncology Society of Australia (COSA) regarding management of cancer‐related malnutrition and sarcopenia. A multidisciplinary working group completed a review of the literature, focused on evidence‐based guidelines, systematic reviews and meta‐analyses, to develop recommendations for the position statement. National consultation of the position statement content was undertaken through COSA members. All people with cancer should be screened for malnutrition and sarcopenia in all health settings at diagnosis and as the clinical situation changes throughout treatment and recovery. People identified as “at risk” of malnutrition or with a high‐risk cancer diagnosis or treatment plan should have a comprehensive nutrition assessment; people identified as “at risk” of sarcopenia should have a comprehensive evaluation of muscle status using a combination of assessments for muscle mass, muscle strength and function. All people with cancer‐related malnutrition and sarcopenia should have access to the core components of treatment, including medical nutrition therapy, targeted exercise prescription and physical and psychological symptom management. Treatment for cancer‐related malnutrition and sarcopenia should be individualised, in collaboration with the multidisciplinary team (MDT), and tailored to meet needs at each stage of cancer treatment. Health services should ensure a broad range of health care professionals across the MDT have the skills and confidence to recognise malnutrition and sarcopenia to facilitate timely referrals and treatment. The position statement is expected to provide guidance at a national level to improve the multidisciplinary management of cancer‐related malnutrition and sarcopenia.
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Affiliation(s)
- Nicole Kiss
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia.,Allied Health, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jenelle Loeliger
- Allied Health, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Merran Findlay
- Cancer Services, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Elizabeth Isenring
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Brenton J Baguley
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Anna Boltong
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Alexis Butler
- GP Liaison, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Irene Deftereos
- Department of Surgery Western Health, University of Melbourne, Melbourne, Victoria, Australia.,Department of Nutrition and Dietetics, Western Health, Melbourne, Victoria, Australia
| | - Michelle Eisenhuth
- Nutrition and Dietetics Department, Nepean Hospital, Sydney, New South Wales, Australia
| | - Steve F Fraser
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Rebecca Fichera
- Nutrition and Dietetics Departments, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Hayley Griffin
- Clinical Oncology Society of Australia, Sydney, New South Wales, Australia
| | - Sandi Hayes
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Emily Jeffery
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Catherine Johnson
- Gastrointestinal Cancer Service, Calvary Mater Newcastle, Newcastle, New South Wales, Australia
| | - Chris Lomma
- Medical Oncology Department, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Barbara van der Meij
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia.,Dietetics and Food Services, Mater Health, Brisbane, Queensland, Australia
| | - Carolyn McIntyre
- School of Medical and Health Science, Exercise Medicine Research Institute, Edith Cowan University, Perth, Western Australia, Australia
| | - Tracey Nicholls
- Department of ENT Otolaryngology Head and Neck Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Lina Pugliano
- Medical Oncology, Northern Cancer Institute, Sydney, New South Wales, Australia
| | - Tina Skinner
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Jane Stewart
- Allied Health, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Judy Bauer
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia
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