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PTH-163 Malnutrition persists or develops in the majority of patients with upper-gastrointestinal cancer: a longitudinal cohort study
  1. EM Grace1,2,
  2. K Mohammed3,
  3. C Shaw1,
  4. J Andreyev3,
  5. K Whelan2
  1. 1Department of Nutrition and Dietetics, Royal Marsden NHS Foundation Trust
  2. 2Diabetes and Nutritional Sciences Division, King’s College London
  3. 3GI Unit, Royal Marsden NHS Foundation Trust, London, UK

Abstract

Introduction In patients with cancer, malnutrition is associated with increased treatment toxicity, poorer quality of life and lower survival. Patients with upper-gastrointestinal (GI) cancer may be at particular risk of malnutrition due to the tumour location. However, most studies are cross-sectional in design and measure the prevalence of malnutrition at the acute presentation of cancer. This study aimed to measure the prevalence of malnutrition in upper-GI cancer and to determine whether it persists or develops between diagnosis and the acute (3-month) and chronic (12-month) period of radical treatment.

Method Patients with newly diagnosed upper-GI cancer were recruited to a longitudinal cohort study and assessed at the time of diagnosis and at 3-m and 12-m following the start of radical treatment. Nutritional assessment was performed using the Patient-Generated Subjective Global Assessment (PG-SGA), which has been validated in the oncology setting. The PG-SGA produced two Results

(a) total score (score ≥4 intervention needed; score ≥9 critical intervention needed); and (b) subjective global rating (SGA A= well nourished, B= moderately malnourished and C= severely malnourished).

Results In total, 80 patients were recruited at diagnosis, of which 68 were reviewed at 3-m and 57 at 12-m. Mean (SD) body weight was 76.6 kg (17.2) at baseline, 74.4 kg (14.8) at 3-m and 71.6 kg (16.7) at 12-m. In those with data at both time points, the reduction in body weight between diagnosis and 3-m (-2.3 kg, p = 0.003) and between 3-m and 12-m (–4.0 kg, p < 0.001) were statistically significant. Median (range) PG-SGA total score changed from 9 (0–28) at diagnosis, 6 (2–26) at 3-m and 7 (0–19) at 12-m. In addition, 61%, 62% and 60% of patients were considered moderately/severely malnourished (SGA B or C) at the three time points. Reduced food intake contributed to malnutrition in 61% at diagnosis, 48% at 3-m and 52% at 12-m. In those with data at 12-m (n = 57), trends in the SGA category showed that 19 (33%) patients were moderately/severely malnourished at both diagnosis and 12-m (malnutrition ‘persisted’), while 15 (27%) were well-nourished at diagnosis but became moderately/severely malnourished by 12-m (malnutrition ‘developed’).

Conclusion Patients with upper-GI cancer experience progressive weight loss over time, with malnutrition either persisting or developing in the majority (60%) during the first year. Optimising nutritional status throughout the treatment pathway should be considered a priority in this high-risk group.

Disclosure of interest None Declared.

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