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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