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PTU-149 Malnutrition And Gastrointestinal (gi) Symptoms In Patients With Upper-gi Cancer
  1. E Grace1,2,
  2. K Mohammed3,
  3. C Shaw1,
  4. K Whelan2,
  5. J Andreyev3
  1. 1Department of Nutrition and Dietetics, The Royal Marsden NHS Foundation Trust, UK
  2. 2Diabetes and Nutritional Sciences Division, King’s College London, UK
  3. 3GI Unit, The Royal Marsden NHS Foundation Trust, London, UK

Abstract

Introduction Persistent GI symptoms and malnutrition have been associated with poorer quality of life in upper-GI cancer patients. This study aims to assess GI symptoms and nutritional status in patients undergoing modern treatment.

Methods Patients with newly diagnosed upper-GI cancer were prospectively reviewed at the time of diagnosis and at 3- and 12-months following radical treatment. Nutritional assessment was performed using the patient-generated subjective global assessment (PG-SGA), which is considered the ‘gold-standard’ for nutritional assessment and has been validated in the oncology setting (score ≥ 4 intervention needed; score ≥ 9 critical intervention needed). The gastrointestinal symptom rating scale (GSRS) was used to evaluate the presence/absence and severity of 22 GI symptoms using a 4-point response scale. Total scores range from 0–66, where 0 = all symptoms absent and 66 = all symptoms severe.

Results 61 males and 19 females, median age 66 (range 46–89) years were recruited (61% oesophageal, 33% gastric, 6% gastro-oesophageal junction tumours). Of these, 68 were reviewed at 3-months and 25 at 12-months. Mean (SD) body weight and body mass index (BMI) were 76.7 kg (17.4) and 26.7 kg/m2 (4.7) at baseline, 74.4 kg (14.8) and 25.9 kg/m2 (4.4) at 3-months and 72.1 kg (16.3) and 24.7 kg/m2 (4.4) at 12-months. There was a significant mean difference in weight (-2.0 kg, p = 0.002) and BMI (-0.56 kg/m2, p = 0.006) at 3-months compared to baseline. These reduced further by 12-months. Mean (SD) PG-SGA score at baseline 9.0 (6.3), 3-months 7.8 (5.6), and 12-months 7.4 (5.0) indicated that intervention was required. At baseline, 3- and 12-months 61%, 52% and 68% of patients respectively were considered moderately or severely malnourished. Mean (SD) total GSRS scores were 14.2 (10.8), 12.0 (9.4) and 15.5 (11.5) at baseline, 3- and 12-months respectively. The symptoms with the greatest increase in prevalence (% more patients) from baseline to 3-months (n = 68) were nausea (+24%), loose stool (+16%), urgency (+6%), flatulence (+6%) and early satiety (+6%). Those with the greatest decrease in prevalence (% less patients) during this time were difficulty swallowing (-24%), painful swallowing (-24%), regurgitation (-21%), belching (-15%) and acid reflux (-12%). Of the n = 25 followed up at 12-months, the most common symptoms reported were flatulence (76%), belching (72%), abdominal pain (68%), abdominal grumbling (56%) and early satiety (52%).

Conclusion After treatment commences there is progressive weight loss over time. Troublesome GI symptoms persist at 12-months and may be contributing to this weight loss. Optimising nutritional status and controlling GI symptoms is required throughout the treatment pathway.

Disclosure of Interest None Declared.

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