Assessment of Nutritional Status and Nutrition Impact Symptoms in Patients Undergoing Resection for Upper Gastrointestinal Cancer: Results from the Multi-Centre NOURISH Point Prevalence Study

Abstract

Background: Identification and treatment of malnutrition are essential in upper gastrointestinal (UGI) cancer. However, there is limited understanding of the nutritional status of UGI cancer patients at the time of curative surgery. This prospective point prevalence study involving 27 Australian tertiary hospitals investigated nutritional status at the time of curative UGI cancer resection, as well as presence of preoperative nutrition impact symptoms, and associations with length of stay (LOS) and surgical complications. Methods: Subjective global assessment, hand grip strength (HGS) and weight were performed within 7 days of admission. Data on preoperative weight changes, nutrition impact symptoms, and dietary intake were collected using a purpose-built data collection tool. Surgical LOS and complications were also recorded. Multivariate regression models were developed for nutritional status, unintentional weight loss, LOS and complications. Results: This study included 200 patients undergoing oesophageal, gastric and pancreatic surgery. Malnutrition prevalence was 42% (95% confidence interval (CI) 35%, 49%), 49% lost ≥5% weight in 6 months, and 47% of those who completed HGS assessment had low muscle strength with no differences between surgical procedures (p = 0.864, p = 0.943, p = 0.075, respectively). The overall prevalence of reporting at least one preoperative nutrition impact symptom was 55%, with poor appetite (37%) and early satiety (23%) the most frequently reported. Age (odds ratio (OR) 4.1, 95% CI 1.5, 11.5, p = 0.008), unintentional weight loss of ≥5% in 6 months (OR 28.7, 95% CI 10.5, 78.6, p < 0.001), vomiting (OR 17.1, 95% CI 1.4, 207.8, 0.025), reduced food intake lasting 2–4 weeks (OR 7.4, 95% CI 1.3, 43.5, p = 0.026) and ≥1 month (OR 7.7, 95% CI 2.7, 22.0, p < 0.001) were independently associated with preoperative malnutrition. Factors independently associated with unintentional weight loss were poor appetite (OR 3.7, 95% CI 1.6, 8.4, p = 0.002) and degree of solid food reduction of <75% (OR 3.3, 95% CI 1.2, 9.2, p = 0.02) and <50% (OR 4.9, 95% CI 1.5, 15.6, p = 0.008) of usual intake. Malnutrition (regression coefficient 3.6, 95% CI 0.1, 7.2, p = 0.048) and unintentional weight loss (regression coefficient 4.1, 95% CI 0.5, 7.6, p = 0.026) were independently associated with LOS, but no associations were found for complications. Conclusions: Despite increasing recognition of the importance of preoperative nutritional intervention, a high proportion of patients present with malnutrition or clinically significant weight loss, which are associated with increased LOS. Factors associated with malnutrition and weight loss should be incorporated into routine preoperative screening. Further investigation is required of current practice for dietetics interventions received prior to UGI surgery and if this mitigates the impact on clinical outcomes.

Effect of Early and Intensive Telephone or Electronic Nutrition Counselling Delivered to People with Upper Gastrointestinal Cancer on Quality of Life: A Three-Arm Randomised Controlled Trial

“…A systematic review of nutrition interventions found that few studies have achieved nutritional adequacy to prevent weight loss in cancer therapy [ 15 ]. Nutrition impact symptoms are commonly reported in people with upper gastrointestinal cancers [ 37 ] and effective management is not achieved with dietetic care alone, because medication management is necessary and beyond the scope of dietetic practice. This highlights the importance of a multidisciplinary team approach to nutrition care during active cancer treatment.…”

Characteristics and in‐hospital outcomes of elderly patients with cancer in a top‐ranked hospital in China, 2016–2020: Real‐world study

“…No publications on the associations between reduced food intake and in‐hospital outcomes specifically in older patients with cancer have been identified. The multicenter NOURISH Point Prevalence Study 32 showed that in patients undergoing resection for upper gastrointestinal cancer with a mean age of 67 years, reduced food intake was independently associated with preoperative malnutrition and unintentional weight loss, both of which were independently associated with length of stay but not with complications. Patients with gastrointestinal or lung cancer reporting a reduced food intake had more symptoms 33 .…”

Interrelationships between Dietary Outcomes, Readmission Rates and Length of Stay in Hospitalised Oncology Patients: A Scoping Review

“…Oncology patients frequently suffer from impairments to oral intakes which inhibit patient appetite and/or ability to eat and digest food leading to nutritional inadequacy. Tumour location, disease-related primary anorexia and cancer treatments (including chemotherapy, radiotherapy and surgery) [ 2 , 3 , 4 , 5 ] all contribute to these nutrition-related symptoms which may present as oral ulceration, xerostomia, poor dentition, intestinal obstruction, malabsorption, constipation, diarrhoea, nausea, vomiting, decreased intestinal motility, chemosensory alteration, weakness, fatigue, depression, uncontrolled pain and the side-effects from drugs [ 3 , 4 , 6 , 7 , 8 , 9 ]. Therefore, understanding the predictors of inadequate dietary intakes is an essential part of patient management and treatment.…”

“…Therefore, understanding the predictors of inadequate dietary intakes is an essential part of patient management and treatment. Several recent studies of hospitalised oncology patients have found that the predictors of decreased dietary intake include: being female, increased age, stage III or IV cancer, three-month unplanned weight loss and hospital stays longer than four days [ 5 , 9 , 10 , 11 ]. Socioeconomic issues may also impact food intake.…”