Nutrition risk and mortality in older oncology patients: An exploratory study

Abstract

Aim: The primary aim of this analysis was to identify if two standard measures incorporated into the comprehensive geriatric assessment; specifically, malnutrition risk and body mass index (BMI), could predict 12-month mortality in older patients with solid tumours. The secondary aim was to evaluate if malnutrition risk and BMI were associated with chemotherapy outcomes (discontinuation/modification of treatment) in older patients with solid tumours. Methods: Older patients (aged ≥70 years) with solid cancers were recruited from the outpatient oncology clinic of a tertiary hospital in Brisbane, Australia. Participants' nutritional parameters, BMI, and malnutrition risk (determined using the Malnutrition Screening Tool (MST)) were recorded at baseline. Mortality data and chemotherapy outcomes were recorded for 12 months. Results: Seventy-four participants (67% males, median age 77 (AE4.4) years) were recruited. Nearly half the cohort was at-risk of malnutrition at baseline (n = 39, 46%). Chemotherapy was prescribed to 39% (n = 29) of the cohort. For patients receiving chemotherapy neither being underweight nor having a low or medium risk of malnutrition was associated with adverse chemotherapy outcomes or 12-month mortality. At a bivariate level, malnutrition risk was significantly associated with 12-month mortality in patients who did not receive chemotherapy (P = 0.018), but not BMI. Conclusions: This analysis indicates that malnutrition risk was a potential indicator of 12-month mortality in cases where chemotherapy was considered unfeasible. However, this was not an independent risk factor. Further investigation using a larger sample is required to determine the association between malnutrition risk, quality of life and mortality in patients who are not considered to be fit for chemotherapy.

Nursing assessment and management of nutrition in older people with cancer: An integrative review

“…The incidence of cancer is increasing, primarily due to the ageing population. The estimated number of new cases in people aged 65 and older is expected to increase from 9.95 million in 2020 to 18.6 million in 2040 (Botero et al, 2019;World Health Organization, 2021). People with cancer aged 65 and older are predisposed to a range of comorbidities, including hypertension, heart disease, dyslipidemia and diabetes (Australian Institute of Health and Welfare, 2021; Davis et al, 2011).…”

“…Malnutrition is known to be one of the most serious comorbidities that influence the trajectory of cancer-related symptoms (Botero et al, 2019). Malnutrition or undernutrition is defined as "a state resulting from lack of intake or uptake of nutrition that leads to altered body composition and body cell mass leading to diminished physical and mental function and impaired clinical outcomes from disease" (European Society for Clinical Nutrition and Metabolism, 2021, p. 51).…”

“…Further, malnutrition rates in older people with cancer are between 30-80% (Mostame et al, 2019) with this reported as a prognostic indicator for poorer health outcomes in people with cancer. These health outcomes include, declining survival rates, quality of life, and increased risk of treatment toxicities (Botero et al, 2019).…”

The risk of malnutrition and its clinical implications in older patients with cancer

“…In a study by Zükeran et al, it was observed that frailty is higher in older patients at risk of malnutrition [16]. In another study with older patients with cancer, a close relationship was found between malnutrition risk and 12-month mortality [17]. Therefore, older patients with cancer should be carefully evaluated for malnutrition risk and a systematic approach is necessary.…”

Contemporary issues in dietetics

“…The study brings into focus past dietary patterns affecting malnourished patients on admission. Botero et al 11 undertook an exploratory study of 74 oncology patients to identify if adding malnutrition risk and body mass index (BMI) could predict 12‐month mortality. A secondary aim of this study was to evaluate if malnutrition risk and BMI were associated with chemotherapy outcomes.…”