scholarly journals Malnutrition and cancer, diagnosis and treatment

2021 ◽  
Author(s):  
Angelika Beirer
Keyword(s):  
Weight Loss ◽  
Cancer Patients ◽  
Cancer Cachexia ◽  
Screening Tool ◽  
Psychological Treatment ◽  
Early Stage ◽  
Nutritional Therapy ◽  
German Society ◽  
Fat Free Mass ◽  
Nutritional Risk

Summary Background The prevalence of malnutrition in cancer patients ranges from about 20% to more than 70%. However, 10–20% of cancer patients’ deaths are related to malnutrition, not the malignancy itself. To reverse the pattern of weight loss, improve the patients’ quality of life, reduce the treatment toxicity, the psychological stress and the risk of mortality, the diagnosis of malnutrition should be made as early as possible to facilitate the best possible treatment. Methods A systematic literature search was conducted following guidelines of ESPEN (European Society for Clinical Nutrition), DGEM (German Society for Nutritional Medicine) and ASPEN (American Society for Parenteral and Enteral Nutrition). Results and conclusion To assess the risk of malnutrition, all cancer patients should be screened regularly with a valid screening tool (e.g., MUST [Malnutrition Universal Screening Tool], NRS [Nutritional Risk Screening] or PG-SGA [Scored Patient-Generated Subjective Global Assessment]). If risk of malnutrition is present, adequate nutritional therapy is recommended to stop involuntary weight loss. Patients should engage in exercise to maintain and improve muscle mass, strength and function. They should be offered regular dietetic counselling, and their muscle depletion should be monitored by determining fat-free mass. As cachectic patients in particular are at risk, the presence of cachexia should also be recognized at an early stage. Three consensus-based definitions are widely accepted: Fearon et al. and the EPCRC (European Palliative Care Research Collaborative) propose definitions specifically for cancer cachexia, while Evans et al. put forward a definition for cachexia associated with all types of underlying chronic diseases. However, if there is a cancer cachexia diagnosis, additional pharmacological and psychological treatment should be considered.

scholarly journals Evaluation of a protocol to detect malnutrition and provide nutritional care for cancer patients undergoing chemotherapy

2020 ◽  
Author(s):  
ELENA ÁLVARO SANZ ◽  
JIMENA ABILÉS ◽  
MARGARITA GARRIDO SILES ◽  
FRANCISCO RIVAS RUÍZ ◽  
BEGOÑA TORTAJADA GOITIA ◽  
...  
Keyword(s):  
Weight Loss ◽  
Weight Gain ◽  
Cancer Patients ◽  
Early Stage ◽  
Nutritional Intervention ◽  
Normal Weight ◽  
Nutritional Risk ◽  
Nutritional Interventions ◽  
Patients With Cancer ◽  
The Mean

Abstract Background Patients with cancer frequently experience malnutrition, which is associated with higher rates of morbidity and mortality. Therefore, the implementation of strategies for its early detection and for intervention should improve the evolution of these patients. Our study aim is to design and implement a protocol for outpatients starting chemotherapy, by means of which any malnutrition can be identified and treated at an early stage. Methods Before starting chemotherapy for patients with cancer, a complete assessment was made of their nutritional status, using the Nutriscore screening tool. When nutritional risk was detected, an interventional protocol was applied. Results Of 234 patients included in the study group, 84 (36%) required an individualised nutritional approach: 27 (32.1%) presented high nutritional risk, 12 had a Nutriscore result ≥ 5 and 45 experienced weight loss during chemotherapy. Among this population, the mean weight loss (with respect to normal weight) on inclusion in the study was − 3.6% ±8.2. By the end of the chemotherapy, the mean weight gain was 0% ±7.3 (p < 0.001) and 71.0% of the patients had experienced weight gain or maintenance, with respect to the initial weight. Conclusion More than a third of cancer patients who start chemotherapy are candidates for early nutritional intervention. This finding highlights the importance of early identification of patients at risk in order to improve the efficacy of nutritional interventions, regardless of the stage of the disease.

scholarly journals Evaluation of a protocol to detect malnutrition and provide nutritional care for cancer patients undergoing chemotherapy

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Elena Álvaro Sanz ◽  
Jimena Abilés ◽  
Marga Garrido Siles ◽  
Francisco Rivas Ruíz ◽  
Begoña Tortajada Goitia ◽  
...  
Keyword(s):  
Weight Loss ◽  
Weight Gain ◽  
Cancer Patients ◽  
Early Stage ◽  
Nutritional Intervention ◽  
Normal Weight ◽  
Nutritional Risk ◽  
Nutritional Interventions ◽  
Patients With Cancer ◽  
The Mean

AbstractPatients with cancer frequently experience malnutrition, which is associated with higher rates of morbidity and mortality. Therefore, the implementation of strategies for its early detection and for intervention should improve the evolution of these patients. Our study aim is to design and implement a protocol for outpatients starting chemotherapy, by means of which any malnutrition can be identified and treated at an early stage. Before starting chemotherapy for patients with cancer, a complete assessment was made of their nutritional status, using the Nutriscore screening tool. When nutritional risk was detected, an interventional protocol was applied. Of 234 patients included in the study group, 84 (36%) required an individualised nutritional approach: 27 (32.1%) presented high nutritional risk, 12 had a Nutriscore result ≥ 5 and 45 experienced weight loss during chemotherapy. Among this population, the mean weight loss (with respect to normal weight) on inclusion in the study was − 3.6% ± 8.2. By the end of the chemotherapy, the mean weight gain was 0% ± 7.3 (p < 0.001) and 71.0% of the patients had experienced weight gain or maintenance, with respect to the initial weight. More than a third of cancer patients who start chemotherapy are candidates for early nutritional intervention. This finding highlights the importance of early identification of patients at risk in order to improve the efficacy of nutritional interventions, regardless of the stage of the disease.

Importance of body composition in grading body mass index and weight loss-related nutritional risk in cancer patients

2020 ◽  
Vol 40 ◽  
pp. 550-551
Author(s):  
E. Cereda ◽  
F. Lobascio ◽  
S. Masi ◽  
S. Crotti ◽  
S. Cappello ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Weight Loss ◽  
Body Composition ◽  
Cancer Patients ◽  
Body Mass ◽  
Nutritional Risk

scholarly journals Altered Preoperative Nutritional Status in Colorectal Cancer: A Not So Infrequent Issue

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Javier Páramo-Zunzunegui ◽  
Araceli Ramos-Carrasco ◽  
Marcos Alonso-García ◽  
Rosa Cuberes-Montserrat ◽  
Gil Rodríguez-Caravaca ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Weight Loss ◽  
Observational Study ◽  
Nutritional Status ◽  
Cancer Patients ◽  
Prospective Observational Study ◽  
Colorectal Neoplasia ◽  
Nutritional Risk ◽  
A Value ◽  
Asymptomatic Patients

Introduction. Malnutrition and weight loss in cancer patients is a common problem that affects the prognosis of the disease. In the case of CRC, malnutrition rates range between 30 and 60%. Objectives. Description of the preoperative nutritional status of patients diagnosed with colorectal neoplasia who will undergo surgery. Materials and Methods. A prospective observational study is performed. Results. Of 234 patients studied, we observed that 139 (59%) had some degree of nutritional risk. Of all of them, 44.9% (N = 47) had 1-2 points according to MUST and 25% (N = 27) had more than 2 points. No differences were found when studying nutritional risk according to the location of the neoplasm. It was observed that 2.15% of the patients were underweight, 51% overweight, and 23% obese. 19.4% of patients lost less than 5 kg in the 3–6 months prior to diagnosis, 20.7% lost between 5 and 10 kg, and 2.1% lost more than 10 kg. In asymptomatic patients, the weight loss was lower than in symptomatic patients, loss <5 kg, 8.2% vs. 22.8%, and loss 5–10 kg, 16.2% vs. 29.3%, with a value of p = 0.016 . 5% (N = 7) of the patients had hypoalbuminemia record. 16.5% (N = 23) had some degree of prealbumin deficiency and 20.9% (N = 29) of hypoproteinemia. Symptomatic patients had more frequent analytical alterations, 1-2 altered parameters in 48.8% (N = 20) of asymptomatic vs. 61.2% (N = 22) in the symptomatic, p = 0.049 .

PP072-MON: Brake on Weight Loss in Cancer Patients with Nutritional Risk After Intervention with a High Calorie and Hyperproteic Supplement Specific

2014 ◽  
Vol 33 ◽  
pp. S156-S157
Author(s):  
J.M. Garcia-Almeida ◽  
J. Ruiz-Nava ◽  
Y. Lupiáñez-Pérez ◽  
M. Blanco-Naveira ◽  
I. Cornejo-Pareja ◽  
...  
Keyword(s):  
Weight Loss ◽  
Cancer Patients ◽  
Nutritional Risk ◽  
High Calorie

scholarly journals Safety and Feasibility of Fasting-Mimicking Diet and Effects on Nutritional Status and Circulating Metabolic and Inflammatory Factors in Cancer Patients Undergoing Active Treatment

Cancers ◽  
2021 ◽  
Vol 13 (16) ◽  
pp. 4013
Author(s):  
Francesca Valdemarin ◽  
Irene Caffa ◽  
Angelica Persia ◽  
Anna Laura Cremonini ◽  
Lorenzo Ferrando ◽  
...  
Keyword(s):  
Body Composition ◽  
Growth Factors ◽  
Nutritional Status ◽  
Cancer Patients ◽  
Fat Mass ◽  
Negative Impact ◽  
The Body ◽  
Fat Free Mass ◽  
Nutritional Risk ◽  
Inflammatory Factors

In preclinical studies, fasting was found to potentiate the effects of several anticancer treatments, and early clinical studies indicated that patients may benefit from regimes of modified fasting. However, concerns remain over possible negative impact on the patients’ nutritional status. We assessed the feasibility and safety of a 5-day “Fasting-Mimicking Diet” (FMD) as well as its effects on body composition and circulating growth factors, adipokines and cyto/chemokines in cancer patients. In this single-arm, phase I/II clinical trial, patients with solid or hematologic malignancy, low nutritional risk and undergoing active medical treatment received periodic FMD cycles. The body weight, handgrip strength and body composition were monitored throughout the study. Growth factors, adipokines and cyto/chemokines were assessed by ELISA. Ninety patients were enrolled, and FMD was administered every three weeks/once a month with an average of 6.3 FMD cycles/patient. FMD was largely safe with only mild side effects. The patients’ weight and handgrip remained stable, the phase angle and fat-free mass increased, while the fat mass decreased. FMD reduced the serum c-peptide, IGF1, IGFBP3 and leptin levels, while increasing IGFBP1, and these modifications persisted for weeks beyond the FMD period. Thus, periodic FMD cycles are feasible and can be safely combined with standard antineoplastic treatments in cancer patients at low nutritional risk. The FMD resulted in reduced fat mass, insulin production and circulating IGF1 and leptin. This trial was registered on Clinicaltrials.gov in July 2018 with the identifier NCT03595540.

scholarly journals Weight Changes According to Treatment in a Diverse Cohort of Breast Cancer Patients

2021 ◽  
Author(s):  
Jami Fukui ◽  
Kami White ◽  
Timothy Frankland ◽  
Caryn Oshiro ◽  
Lynne Wilkens
Keyword(s):  
Breast Cancer ◽  
Weight Loss ◽  
Weight Gain ◽  
Cancer Patients ◽  
Early Stage ◽  
Early Stage Breast Cancer ◽  
Therapeutic Window ◽  
Breast Cancer Patients ◽  
Weight Changes ◽  
Time Points

Abstract BackgroundWeight changes are common among breast cancer patients. The majority of studies to date have focused on weight gain after a breast cancer diagnosis and its implications on health in survivors. Fewer studies have examined weight loss and its related characteristics. Weight changes have been reported to be influenced by several factors such as age, treatment, stage and pre-diagnostic weight. We evaluated weight changes during key treatment time points in early stage breast cancer patients.MethodsWe characterized 389 female patients diagnosed in Hawaii with early stage breast cancer from 2003-2017 in the Multiethnic Cohort (MEC) linked with Kaiser Permanente Hawaii electronic medical record data. We evaluated weight changes from surgery to 4 years post-diagnosis with six time points along a patient’s treatment trajectory (chemotherapy, radiation, endocrine, or surgery alone) and annually thereafter, adjusting for age, race/ethnicity and initial body mass index (BMI).ResultsWe found key time points of significant weight change for breast cancer patients according to their adjuvant treatment. In patients who had surgery alone (S), surgery-radiation (SR), or surgery-endocrine therapy (SE), the majority of patients had stable weight, although this consistently decreased over time. However, the percentages of patients with weight loss and weight gain during this time steadily increased up to 4 years after initial surgery. Weight loss was more common than weight gain by about 2 fold in these treatment groups. For patients with surgery-chemotherapy (SC), there was significant weight loss seen within the first 3 months after surgery, during the time when patients receive chemotherapy. And this weight loss persisted until year 4. Weight gain was less commonly seen in this treatment group.ConclusionsWe identified key time points during breast cancer treatment that may provide a therapeutic window to positively influence outcomes. Tailored weight management interventions should be utilized to promote overall health and long term survivorship.

scholarly journals P-P51 Assessing the severity of pre and post-operative malnutrition in cancer patients undergoing pancreaticoduodenectomy: A review of a virtual dietetic prehabilitation service

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Leah Cox
Keyword(s):  
Pancreatic Cancer ◽  
Weight Loss ◽  
Nutritional Status ◽  
Cancer Patients ◽  
Nutritional Assessment ◽  
Nutritional Risk ◽  
Perioperative Outcomes ◽  
Risk Patients ◽  
Median Weight Loss ◽  
Dietetic Intervention

Abstract Background The prevalence of malnutrition amongst pancreatic cancer patients is widely reported. This is due to reduced nutritional intake, increased energy expenditure and increased nutrient losses secondary to malabsorption. A Whipple's procedure or pancreaticoduodenectomy is the only potentially curable intervention for pancreatic cancer patients. Malnutrition is associated with increased peri and post-operative complications including delayed wound healing, longer hospital admission and higher mortality rate. Dietetic prehabilitation is a proactive intervention to assess patients’ nutritional status in preparation for elective surgery and, through early dietetic intervention, has the potential to improve perioperative outcomes. This pilot study reviewed the severity of nutritional risk in both the pre and post-operative stages to understand the need for dietetic prehabilitation in this patient group. Methods All patients referred were nutritionally assessed as part of a dietetic cancer prehabilitation pathway, which includes pre-surgical nutritional assessment within one week of referral and early post discharge nutritional assessment. Nutritional assessment was carried out using the PG-SGA short form and patients were triaged as requiring either a universal, targeted or specialist dietetic intervention dependent on severity of nutritional risk. Patients who scored &lt;4 were triaged as universal, and were low nutritional risk. Patients who scored 5-9 were triaged as targeted and were medium nutritional risk, and patients who scored &gt;9 were triaged as specialist, and were high nutritional risk. Results 35 patients were referred for dietetic prehabilitation assessment. 71% of patients were triaged as requiring either a targeted or specialist prehabilitiation intervention. BMI ranged from 15.7kg/m² to 35.9kg/m² and median weight loss was 10.0%. 23 patients received early post surgical nutritional assessment, within 12 days of discharge from hospital. All 23 patients required targeted or specialist dietetic intervention. 22 patients reported post-operative weight loss, with a median weight loss of 7.5%. There was no correlation between pre-surgical and post-surgical nutritional risk. Conclusions Patients undergoing pancreaticoduodenectomy are at high nutritional risk in both the pre and post-operative periods. Patients without evidence of malnutrition in the pre-operative stage remain at high risk of malnutrition and the associated complications in the post operative stage. A prehabilitation programme can identify patients at nutritional risk and institute interventions to optimise perioperative nutritional status.  Findings from this review will form the basis of a study examining the effects of a prehabilitation programme on outcomes following pancreaticoduodenectomy.

scholarly journals Weight changes according to treatment in a diverse cohort of breast cancer patients.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e12513-e12513
Author(s):  
Jami Aya Fukui ◽  
Kami White ◽  
Timothy Frankland ◽  
Caryn Oshiro ◽  
Lynne Wilkens
Keyword(s):  
Breast Cancer ◽  
Weight Loss ◽  
Weight Gain ◽  
Cancer Patients ◽  
Early Stage ◽  
Early Stage Breast Cancer ◽  
Therapeutic Window ◽  
Breast Cancer Patients ◽  
Weight Changes ◽  
Time Points

e12513 Background: Weight changes are common among breast cancer patients. The majority of studies to date have focused on weight gain after a breast cancer diagnosis and its implications on health in survivors. Fewer studies have examined weight loss and its related characteristics. Weight changes have been reported to be influenced by several factors such as age, treatment, stage and pre-diagnostic weight. We evaluated weight changes during key treatment time points in early stage breast cancer patients. Methods: We characterized 389 female patients diagnosed in Hawaii with early stage breast cancer from 2003-2017 in the Multiethnic Cohort (MEC) linked with Kaiser Permanente Hawaii electronic medical record data. We evaluated weight changes from surgery to 4 years post-diagnosis with six time points along a patient’s treatment trajectory (chemotherapy, radiation, endocrine, or surgery alone) and annually thereafter, adjusting for age, race/ethnicity and initial body mass index (BMI). Results: We found key time points of significant weight change for breast cancer patients according to their adjuvant treatment. In patients who had surgery alone (S), surgery-radiation (SR), or surgery-endocrine therapy (SE), the percentage of patients with stable weight, while generally comprising the majority, consistently decreased over time. However, the percentages of patients with weight loss and weight gain during this time steadily increased up to 4 years after initial surgery. Weight loss was more common than weight gain by about 2 fold in these treatment groups (weight loss 33.2%-42% vs weight gain 11.6%-21.4%). For patients with surgery-chemotherapy (SC), there was significant increase in patients with weight loss seen within the first 3 months after surgery (16.2% to 43.7%), during the time when patients receive chemotherapy. And this weight loss trend persisted until year 4. Weight gain was less commonly seen in this treatment group. Conclusions: We identified key time points during breast cancer treatment that may provide a therapeutic window to positively influence outcomes. Tailored weight management interventions should be utilized to promote overall health and long term survivorship.

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