Feasibility and efficacy of enteral tube feeding on weight stability, lean body mass, and patient‐reported outcomes in pancreatic cancer cachexia

726 Background: Unintentional weight loss affecting > 85% of pancreatic cancer (PC) patients contributes to low therapeutic tolerance, reduced quality of life, and overall mortality. Optimal treatment approaches have not been developed. We hypothesize that peptide-based enteral nutritional support in cachectic advanced PC patients, receiving palliative chemotherapy, results in improved weight, lean body mass (LBM), and hand-grip strength. Methods: Pancreatic adenocarcinoma patients with cachexia (> 5% unintentional weight loss within the previous 6 months) were provided a jejunal tube peptide-based diet for 3 months. Primary outcome was weight stability (0.1kg/BMI unit decrease). Secondary outcomes included changes from baseline in LBM, bone mineral density (BMD), total body fat mass (BFM), handgrip strength, physical activity (Fitbit), and CA19-9 and CRP. Planned interim analysis was performed after 14 patients completed treatment. Results: From 31 consenting patients, 16 were evaluable for the primary outcome. Patients receiving enteral therapy were 39% male, median age 69 (Range: 41 to 89 years), and 74% ECOG 1. A summary of change in outcomes at 3 months from baseline is shown in Table. The primary endpoint of weight stability in 10 (62.5%) patients was met, thus completing study. Overall survival was 6.5 months (n=31) and 9.9 months for evaluable patients (n=16). Weight stability was statistically associated with LBM (Pearson’s correlation: 0.87, p<0.001), but not survival (HR: 0.94, 95% CI 0.32, 2.83, p=0.92). Conclusions: Peptide-based enteral feeding resulted in weight stability and improvements in lean body mass and physical function. Further randomized trials assessing nutritional support in advanced patients are warranted. NIH/NCATS Grant # UL1TR000124. Clinical trial information: NCT02400398 . [Table: see text]

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212 Impact of enteral tube feeding on body fat and lean body mass

Journal of Cystic Fibrosis ◽

10.1016/s1569-1993(14)60347-7 ◽

2014 ◽

Vol 13 ◽

pp. S101 ◽

Cited By ~ 3

Author(s):

H. White ◽

A. Morton ◽

D. Peckham

Keyword(s):

Lean Body Mass ◽

Body Mass ◽

Body Fat ◽

Tube Feeding ◽

Enteral Tube Feeding

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Pancreatic Cancer Cachexia: The Role of Nutritional Interventions

Healthcare ◽

10.3390/healthcare7030089 ◽

2019 ◽

Vol 7 (3) ◽

pp. 89 ◽

Cited By ~ 6

Author(s):

Toni Mitchell ◽

Lewis Clarke ◽

Alexandra Goldberg ◽

Karen S. Bishop

Keyword(s):

Quality Of Life ◽

Pancreatic Cancer ◽

Lean Body Mass ◽

Body Mass ◽

Nutritional Support ◽

Cancer Cachexia ◽

Calorie Intake ◽

Nutritional Interventions ◽

Oral Nutritional Supplements

Pancreatic cancer is a cancer with one of the highest mortality rates and many pancreatic cancer patients present with cachexia at diagnosis. The definition of cancer cachexia is not consistently applied in the clinic or across studies. In general, it is “defined as a multifactorial syndrome characterised by an ongoing loss of skeletal muscle mass with or without loss of fat mass that cannot be fully reversed by conventional nutritional support and leads to progressive functional impairment.” Many regard cancer cachexia as being resistant to dietary interventions. Cachexia is associated with a negative impact on survival and quality of life. In this article, we outline some of the mechanisms of pancreatic cancer cachexia and discuss nutritional interventions to support the management of pancreatic cancer cachexia. Cachexia is driven by a combination of reduced appetite leading to reduced calorie intake, increased metabolism, and systemic inflammation driven by a combination of host cytokines and tumour derived factors. The ketogenic diet showed promising results, but these are yet to be confirmed in human clinical trials over the long-term. L-carnitine supplementation showed improved quality of life and an increase in lean body mass. As a first step towards preventing and managing pancreatic cancer cachexia, nutritional support should be provided through counselling and the provision of oral nutritional supplements to prevent and minimise loss of lean body mass.

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Body Weight and Body Mass Index in Patients with End-Stage Cystic Fibrosis Stabilize After the Start of Enteral Tube Feeding

Journal of the Academy of Nutrition and Dietetics ◽

10.1016/j.jand.2017.07.006 ◽

2017 ◽

Vol 117 (11) ◽

pp. 1808-1815 ◽

Cited By ~ 3

Author(s):

Francis M. Hollander ◽

Nicole M. de Roos ◽

Gerdien Belle van Meerkerk ◽

Ferdinand Teding van Berkhout ◽

Harry G.M. Heijerman ◽

...

Keyword(s):

Body Mass Index ◽

Cystic Fibrosis ◽

Body Weight ◽

Body Mass ◽

Tube Feeding ◽

Enteral Tube Feeding ◽

End Stage

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Are population‐based patient‐reported outcomes associated with overall survival in patients with advanced pancreatic cancer?

Cancer Medicine ◽

10.1002/cam4.2704 ◽

2019 ◽

Vol 9 (1) ◽

pp. 215-224 ◽

Cited By ~ 1

Author(s):

Wei Fang Dai ◽

Jaclyn Beca ◽

Helen Guo ◽

Wanrudee Isaranawatchai ◽

Deborah Schwartz ◽

...

Keyword(s):

Pancreatic Cancer ◽

Overall Survival ◽

Patient Reported Outcomes ◽

Advanced Pancreatic Cancer ◽

Population Based ◽

Patient Reported

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Clinical Measures and Their Contribution to Dysfunction in Individuals With Patellar Tendinopathy

Journal of Sport Rehabilitation ◽

10.1123/jsr.2017-0196 ◽

2019 ◽

Vol 28 (2) ◽

pp. 165-170 ◽

Cited By ~ 1

Author(s):

Hyunjae Jeon ◽

Melanie L. McGrath ◽

Neal Grandgenett ◽

Adam B. Rosen

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Regression Models ◽

Patient Reported Outcomes ◽

Pelvic Tilt ◽

Knee Extension ◽

Patellar Tendinopathy ◽

Q Angle ◽

Patient Reported ◽

Flexion Strength

Context: Patellar tendinopathy (PT) is prevalent in physically active populations, and it affects their quality of living, performance of activity, and may contribute to the early cessation of their athletic careers. A number of previous studies have identified contributing factors for PT; however, their contributions to self-reported dysfunction remain unclear. Objective: The purpose of this investigation was to determine if strength, flexibility, and various lower-extremity static alignments contributed to self-reported function and influence the severity of PT. Design: Cross-sectional research design. Setting: University laboratory. Participants: A total of 30 participants with PT volunteered for this study (age: 23.4 [3.6] y, height: 1.8 [0.1] m, mass: 80.0 [20.3] kg, body mass index: 25.7 [4.3]). Main Outcome Measures: Participants completed 7 different patient-reported outcomes. Isometric knee extension and flexion strength, hamstring flexibility and alignment measures of rearfoot angle, navicular drop, tibial torsion, q-angle, genu recurvatum, pelvic tilt, and leg length differences were assessed. Pearson’s correlation coefficients were assessed to determine significantly correlated outcome variables with each of the patient-reported outcomes. The factors with the highest correlations were used to identify factors that contribute the most to pain and dysfunction using backward selection, linear regression models. Results: Correlation analysis found significant relationships between questionnaires and body mass index (r = −.35–.46), normalized knee extension (r = .38–.50) and flexion strength (r = −.34–.50), flexibility (r = .32–.38, q-angle (r = .38–.56), and pelvic tilt (r = −.40). Regression models (R2 = .22–.54) identified thigh musculature strength and supine q-angle to have greatest predictability for severity in patient-reported outcomes. Conclusions: These findings put an emphasis of bodyweight management, improving knee extensor and flexor strength, and posterior flexibility in PT patients.

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Are real-world patient-reported outcomes associated with survival in patients with advanced pancreatic cancer?

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.30_suppl.205 ◽

2018 ◽

Vol 36 (30_suppl) ◽

pp. 205-205

Author(s):

Wei Fang Dai ◽

Jaclyn Marie Beca ◽

Helen Guo ◽

Lucy Qiao ◽

Wanrudee Isaranuwatchai ◽

...

Keyword(s):

Pancreatic Cancer ◽

Symptom Score ◽

Patient Reported Outcomes ◽

Cox Model ◽

Advanced Pancreatic Cancer ◽

Symptom Burden ◽

Physical Symptoms ◽

Funding Program ◽

Patient Reported ◽

Edmonton Symptom Assessment Scale

205 Background: Advanced pancreatic cancer (APC) patients often have a substantial symptom burden. In Ontario, patients visiting cancer clinics routinely complete the Edmonton Symptom Assessment Scale (ESAS), which screens for 9 symptoms (scale: 0-10). Using ESAS, we explored the association between baseline patient-reported outcomes and overall survival (OS). Methods: APC Patients with ESAS records prior to receiving publicly-funded drugs from November 2008 to March 2016 were identified from Cancer Care Ontario’s New Drug Funding Program and Symptom Management databases. We examined 3 baseline composite ESAS scores: Total Symptom Distress Score (TSDS: all 9 symptoms), Physical Symptom Score (PHS: 6/9 symptoms), and Psychological Symptom Score (PSS: 2/9 symptoms); Composite scores greater than a threshold (defined as number of symptoms in composite score multiplied by clinically relevant score (≥4)) were categorized as High Symptom Burden (TSDS ≥ 36, PHS ≥ 24, PSS ≥ 8). The primary endpoint, OS, was assessed using Kaplan-Meier. Multivariable Cox models were used to adjust for age, gender, income, prior therapies (surgery, adjuvant gemcitabine, radiation), and Charlson's comorbidity. Analysis was repeated in a sub-cohort with identifiable ECOG status and stage. Results: We identified 2,199 APC patients (mean age 64 years, 55% male) with ESAS records prior to receiving gemcitabine (54%), FOLFIRINOX (40%) or gemcitabine/nab-paclitaxel (6%). Crude median survival was 4.5 and 7.3 months for patients with high and low TSDS burden, respectively (HR = 1.50, 95% CI: 1.36, 1.66). After adjustment with multivariable Cox model, high TSDS burden was associated with lower OS (HR = 1.47, 95% CI: 1.33, 1.63). Similar trends were observed for PHS and PSS. When adjusting for both PHS and PSS in a Cox model, only the effect of PHS remained significant. In the sub-cohort (n = 393), high TSDS burden (HR = 1.34, 95% CI: 1.04, 1.73) was associated with lower OS, after adjusting for ECOG and stage. Conclusions: Among APC patients, a higher burden of patient-reported symptoms, via ESAS, at baseline was associated with reduced OS. The effect was prominent for physical symptoms, even after adjusting for treatment, stage and ECOG.

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