Weight stabilisation is associated with improved survival duration and quality of life in unresectable pancreatic cancer

Davidson, Wendy; Ash, Susan; Capra, Sandra; Bauer, Judy

doi:10.1016/j.clnu.2003.07.001

Cited by 166 publications

(134 citation statements)

References 36 publications

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“…The weight loss seen in patients with cachexia is from both muscle and fat, which is distinct to that seen in patients with malnutrition or anorexia where weight loss is predominantly from fat (Evans et al 2008). This variation is due to the metabolic alterations and inflammatory state that occurs in Weight stabilisation is an appropriate nutrition intervention goal for patients with cancer cachexia as it has been shown to improve quality of life and prolong survival compared to patients who lose weight (Andreyev et al 1998, Davidson et al 2004). In order to accomplish weight maintenance in patients with cancer cachexia, it is important to ensure that patients have optimal symptom control and can achieve adequate energy and protein intakes.…”

Section: Cancer Cachexiamentioning

confidence: 99%

Nutrition Intervention Improves Nutritional Status and Quality of Life Outcomes in Patients Undergoing Radiotherapy

Isenring¹

2013

Frontiers in Radiation Oncology

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Section: Cancer Cachexiamentioning

confidence: 99%

Nutrition Intervention Improves Nutritional Status and Quality of Life Outcomes in Patients Undergoing Radiotherapy

Isenring¹

2013

Frontiers in Radiation Oncology

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“…Cachexia occurs in up to 80% of deaths in patients with advanced pancreatic cancer (5). Cachexia has been shown to worsen prognosis and has also been associated with impairment of physical function, increased psychological distress, and low quality of life (6,7). Patients with pancreatic cancer often report a decreased dietary intake and many symptoms such as anorexia, early satiety, anxiety, depression, pain, and nausea (8).…”

mentioning

confidence: 99%

Sarcopenia in an Overweight or Obese Patient Is an Adverse Prognostic Factor in Pancreatic Cancer

Tan

Birdsell

Martin

et al. 2009

Clinical Cancer Research

594

448

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Purpose: The average weight-losing pancreatic cancer patient undergoing palliative therapy is frequently overweight rather than underweight, and this can confound conventional measures used for risk stratification. The aim of this study was to evaluate if weight and body composition, specifically sarcopenia, assessed from diagnostic computed tomography (CT) scans, is of prognostic value in patients with pancreatic cancer. The nature and extent of tissue loss over subsequent months was also evaluated. Experimental Design: A total of 111 patients entering a palliative therapy program, who had CT images and had undergone nutritional screening, were studied. In patients for whom follow-up scans were available (n = 44), longitudinal changes in body composition were studied at a mean of 230 ± 62 and 95 ± 60 days prior to demise. Results: Sixty-two patients (55.9%) were sarcopenic, 44 (39.6%) were overweight/ obese, and 18 (16.2%) were both. Age ≥59 years (hazard ratio, 1.71; 95% confidence interval, 1.10-2.66; P = 0.018), and overweight/obese sarcopenia (hazard ratio, 2.07; 95% confidence interval, 1.23-3.50; P = 0.006) were identified as independent predictors of survival on multivariate analysis. Longitudinal analysis revealed that total fat-free mass index decreased from 15.5 ± 2.5 kg/m 2 to 14.5 ± 2.0 kg/m 2 (P = 0.002), and total fat mass index decreased from 7.5 ± 2.0kg/m 2 to 6.0 ± 1.5kg/m 2 (P < 0.0001) over 135 days. Conclusions: Sarcopenia in overweight/obese patients with advanced pancreatic cancer is an occult condition but can be identified using CT scans. This condition is an independent adverse prognostic indicator that should be considered for stratification of patients' entering clinical trials, systemic therapy, or support care programs. (Clin Cancer Res 2009;15(22):6973-9) Pancreatic cancer is the fourth leading cause of cancer-related death in Western countries (1). At the time of diagnosis, tumor resection with curative intent is only possible in 10% to 15% of subjects (2, 3), leaving a large population with poor prognosis and limited therapeutic options. Overall, the 5-year survival rate is only about 4% (4).One of the most distressing features of pancreatic cancer is marked and progressive weight loss. Cachexia occurs in up to 80% of deaths in patients with advanced pancreatic cancer (5). Cachexia has been shown to worsen prognosis and has also been associated with impairment of physical function, increased psychological distress, and low quality of life (6, 7). Patients with pancreatic cancer often report a decreased dietary intake and many symptoms such as anorexia, early satiety, anxiety, depression, pain, and nausea (8).Due to the epidemic of obesity in Western society, a substantial proportion of oncology patients at the start of palliative therapy now have a body mass index (BMI) in the overweight range (9), and this can confound conventional measures used for risk stratification. Indeed recent studies have reported that obesity (i.e., BMI ≥30 kg/m 2

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“…12 In addition to this, pancreatic cancer is often accompanied by pain, nausea, anorexia, early satiety, 8,[13][14][15][16] changes in metabolic rate, 17 catabolic cytokines 18 and cachectic factors such as proteolysis inducing factor, 19 all of which can affect food intake and utilisation. If this proportion of patients with tumours in the pancreatic head have potential malabsorption, it is important to assess their nutritional status pre-operatively (which this survey revealed only occurs in four of the centres who replied), especially prior to a PD resection where considerable pancreatic exocrine function will be removed.…”

Section: Discussionmentioning

confidence: 99%

“…8 However, weight alone can be misleading when assessing patients' nutrition with pancreatic cancer due to the confounding effects of oedema, ascites and abdominal muscle wasting. 8 It has been reported that 80-90% of patients with cancer of the head of pancreas have exocrine dysfunction and malabsorption, the degree of which is related to the proportion of pancreatic duct stenosis and the proximity of the cancer to the duodenum.…”

Section: Discussionmentioning

confidence: 99%

Feeding Patients Following Pancreaticoduodenectomy: A UK National Survey

Phillips

Lordan

Menezes

et al. 2009

annals

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Ann R Coll Surg Engl 2009; 91: 385-388 385Pancreatic surgery is becoming more common for both benign and malignant disorders due to the increasing accuracy of imaging and improved experience in critical care. However, pancreaticoduodenectomy (PD) remains associated with a substantial and well-documented morbidity (29-52%) 1-4 and mortality (1-4%) in experienced centres. 5,6A total of 144 consecutive PD resections were performed in our institution by four surgeons. However, a recent audit in our unit showed that there was no consensus regarding the type and route of the postoperative provision of nutrition by these four surgeons. The National Institute for Health and Clinical Excellence (NICE; Nutrition Support in Adults, February 2006) and European guidelines available provide guidelines for assessment and provision of nutrition for patients undergoing abdominal surgery in general.7 However, to the authors' knowledge, there are no specific nutritional guidelines for patients undergoing PD resections.A survey was, therefore, constructed and sent to all the pancreatic centres in the UK to obtain a consensus on best medical practice regarding nutritional assessment and provision following PD resection. Materials and MethodsA questionnaire was sent to the Department of Nutrition and Dietetics at each of the 31 specialist pancreatic centres listed with the Pancreatic Society of Great Britain and Ireland. Questions were asked regarding the nutritional assessment and treatment of patients undergoing classical PD and pylorus-preserving PD (PPPD) resections. ResultsTwenty-two (71%) centres responded to the questionnaire. Table 1 shows the questions posed and the answers received. Following PD and PPPD resections, 18 centres routinely feed patients and seven centres have a set initial nutrition regimen. A variety of enteral and parenteral routes are utilised and the number of days taken to achieve UPPER GASTROINTESTINALAnn R Coll Surg Engl 2009; 91: 385-388 doi 10. 1308/003588409X428270The Royal College of Surgeons of England KEYWORDS Pancreaticoduodenectomy -Nutrition CORRESPONDENCE TOJeffrey Lordan, Department of Surgery, The Royal Surrey County Hospital, Egerton Road, Guildford, Surrey GU2 7XX, UK E: dr_lordan@yahoo.co.uk Feeding patients following pancreaticoduodenectomy: a UK national survey MARY PHILLIPS, JEFFREY T LORDAN, NEVILLE MENEZES, NARIMAN D KARANJIAThe Royal Surrey County Hospital, Guildford, Surrey, UK ABSTRACT INTRODUCTION Providing nutrition for patients following pancreaticoduodenectomy (PD) is vital but can be challenging. Due to the lack of UK national guidelines for the provision of nutrition and nutritional pre-operative assessment regarding PD, a national survey was conducted. PATIENTS AND METHODS A questionnaire was sent to the Department of Nutrition and Dietetics at each of the 31 specialist pancreatic centres listed with the Pancreatic Society of Great Britain and Ireland. Questions were asked regarding the nutritional assessment and treatment of patients undergoing classical PD and pylorus-p...

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Weight stabilisation is associated with improved survival duration and quality of life in unresectable pancreatic cancer

Cited by 166 publications

References 36 publications

Nutrition Intervention Improves Nutritional Status and Quality of Life Outcomes in Patients Undergoing Radiotherapy

Nutrition Intervention Improves Nutritional Status and Quality of Life Outcomes in Patients Undergoing Radiotherapy

Sarcopenia in an Overweight or Obese Patient Is an Adverse Prognostic Factor in Pancreatic Cancer

Feeding Patients Following Pancreaticoduodenectomy: A UK National Survey

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