Nutritional status and symptom burden in advanced non-small cell lung cancer: results of the dietetic assessment and intervention in lung cancer (DAIL) trial

2021 ◽  
pp. bmjspcare-2020-002838
Author(s):  
Iain Phillips ◽  
Lindsey Allan ◽  
Adele Hug ◽  
Naomi Westran ◽  
Claudia Heinemann ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Weight Loss ◽  
Nutritional Status ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Symptom Burden ◽  
Small Cell ◽  
Nutritional Deficiencies ◽  
Small Cell Lung ◽  
Dietetic Intervention

IntroductionEuropean Society for Clinical Nutrition and Metabolism guidelines recommend that patients with cancer should be screened for malnutrition at diagnosis. The dietetic assessment and intervention in lung cancer study investigated the nutritional status of patients with non-small cell lung cancer (NSCLC) and the need for dietetic intervention.MethodsIn this observational cohort pilot study, patients with stage 3b and 4 NSCLC were assessed prior to starting first line systemic anticancer therapy (SACT) with a range of measurements and questionnaires. We report the outcomes related to the Patient Generated Subjective Global Assessment tool (PG-SGA),Results96 patients were consented between April 2017 and August 2019. The PG-SGA identified that 78% of patients required specialist nutritional advice; with 52% patients having a critical need for dietetic input and symptom management. Results were dominated by symptom scores. As a screening test, one or more symptoms or recent weight loss history had a sensitivity of 88% (95% CI 78.44% to 94.36%) and specificity of 95.24% (95% CI 76.18% to 99.88%) for need for dietetic intervention.ConclusionA large proportion of patients with NSCLC have a high symptom burden and are at risk of malnutrition prior to starting SACT and would benefit from dietetic review. It is imperative that oncologists and healthcare professionals discuss weight loss history and symptoms with lung cancer patients to correct nutritional deficiencies and resolve symptoms prior to starting treatment.

scholarly journals Early body weight loss during concurrent chemo-radiotherapy for non-small cell lung cancer

2014 ◽  
Vol 5 (2) ◽  
pp. 127-137 ◽  
Author(s):  
Céline M. H. Op den Kamp ◽  
Dirk K. M. De Ruysscher ◽  
Marieke van den Heuvel ◽  
Meike Elferink ◽  
Ruud M. A. Houben ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Weight Loss ◽  
Body Weight ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Body Weight Loss ◽  
Small Cell ◽  
Small Cell Lung

The effect of sex and BMI on outcomes in patients with metastatic non-small cell lung cancer treated with immunotherapy.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e21085-e21085
Author(s):  
Jingxiao Jin ◽  
Jacqueline Visina ◽  
Timothy F. Burns ◽  
Brenda Diergaarde ◽  
Laura P. Stabile
Keyword(s):  
Lung Cancer ◽  
Weight Loss ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Concurrent Chemotherapy ◽  
Small Cell ◽  
Obese Patients ◽  
Small Cell Lung ◽  
Underweight Patients ◽  
Nsclc Patients

e21085 Background: Recent studies suggest that among non-small cell lung cancer (NSCLC) patients treated with immunotherapy (IT), those who are male and/or have higher body mass index (BMI) benefit most; however, the role of other factors such as pretreatment weight loss is not clear. We conducted a retrospective study to further characterize the relationship between sex, BMI and response to IT in NSCLC. Methods: Patients with stage IV NSCLC treated with IT between 2017 and 2019 at UPMC Hillman Cancer Center were included. Demographic and clinical data were obtained from medical records. Chi-square test was used to compare baseline patient characteristics, best response (CR, PR and SD vs. PD), and presence of immune-related adverse events (iRAEs) between BMI and sex categories. Cox proportional hazards models were used to assess the effect of BMI and sex on progression free survival (PFS) and overall survival (OS). Analyses were conducted overall as well as stratified by treatment regime (1st line monotherapy, non-1st line monotherapy, and concurrent chemotherapy). Results: The study population consisted of 297 patients; 50.2% female (N=149), 87.8% white (N=261), and mean age at IT initiation 68 yrs (range: 36-91 yrs). Median follow-up time: 21 months. At IT initiation, 27 patients were underweight (BMI <18.5), 107 normal weight (BMI 18.5-24.9), 96 overweight (BMI 25-29.9), and 67 obese (BMI ≥30). Among underweight patients, weight loss pretreatment (≥10 lbs) was significantly more common ( P=0.02), and response to IT significantly worse (33% vs 61% good response; P=0.005) compared to those with BMI ≥18.5. No significant difference in response was observed between normal, overweight and obese patients, nor between men and women. The presence of iRAEs did not differ by BMI or sex. Females had better OS than males [HR (95%CI): 0.65 (0.47-0.90)] but PFS was similar. In stratified analyses, better OS among females was limited to the concurrent chemotherapy group [0.52 (0.30-0.92)]. Overall, underweight patients had worse OS than those with BMI ≥18.5 [1.71 (1.01-2.92)]; this was not significant after adjusting for pretreatment weight loss [1.48 (0.87-2.53)]. No difference was observed in OS and PFS between normal, overweight and obese patients. In stratified analyses, underweight individuals had worse OS [4.12 (1.55-10.94)] and PFS [3.87 (1.44-10.38)] than those with BMI ≥18.5 when treated with 1st line monotherapy. Weight loss pretreatment was independently associated with worse OS [2.20 (1.51-3.20)] and PFS [1.47 (1.05-2.05)]. Conclusions: In contrast to prior reports, NSCLC patients receiving IT did not benefit from higher BMI or male sex. Females treated with concurrent chemotherapy had improved OS, and pretreatment weight loss was an indicator of poor prognosis. Further study is required to understand the pathobiology behind these predictors.

scholarly journals Prediction of Postoperative Pulmonary Complications Using Preoperative Controlling Nutritional Status (CONUT) Score in Patient with Resectable Non-small Cell Lung Cancer (P12-032-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Ah Young Leem ◽  
Ji Ye Jung ◽  
Sang Chul Lee ◽  
Eun Young Kim ◽  
Sang Hoon Lee ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Nutritional Status ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Pulmonary Complications ◽  
Small Cell ◽  
Postoperative Pulmonary Complications ◽  
Small Cell Lung ◽  
Prolonged Air Leak ◽  
Conut Score

Abstract Objectives Postoperative pulmonary complications (PPCs) significantly impact surgical outcome, but the clinical usefulness of various models used to predict PPCs is questionable. The controlling nutritional status (CONUT) score reflects nutritional deficiency and inflammation and is used to predict clinical outcomes in various malignancies. We aimed to investigate the ability of the CONUT score to predict PPCs after lung resection in patients with non-small cell lung cancer (NSCLC). Methods We retrospectively reviewed data of 922 patients with NSCLC who underwent complete resection at Severance Hospital in South Korea during January 2016–December 2017. We analyzed the predictability of the CONUT score for PPCs compared with other inflammatory prognostic markers and PPCs risk scoring systems (prognostic nutritional index [PNI], Glasgow prognostic score [GPS], and assessment of respiratory risk in surgical patients in Catalonia [ARISCAT] score) using receiver operating characteristic curves analysis. Results Of 922 study subjects, 522 (56.6%) were male; the mean age was 64.2 years. Lobectomy was the most common type of operation (n = 737, 79.9%). Total incidence of PPCs was 8.6% (n = 79). Prolonged air leak (44.3%) was the most common PPC, followed by pneumonia (32.9%) and pneumothorax (11.4%). The proportion of pneumonia was significantly larger in the high CONUT group (P < 0.05). The CONUT consistently had a higher area under curve (AUC) value (0.64) than other prognostic models (PNI: AUC = 0.61, GPS: AUC = 0.57, and ARISCAT: AUC = 0.54). Multivariate analysis identified male sex (odds ratio [OR] = 1.94), low body mass index (OR = 4.57), and high CONUT score (OR = 1.91) as independent PPCs prognostic factors. Kaplan-Meier analysis revealed a significantly higher 1-year mortality rate for the high CONUT group (hazard ratio = 7.97; 95% confidence interval, 1.78–35.59). Conclusions Preoperative CONUT score is an independent predictor of PPCs and 1-year mortality in patients with NSCLC. Funding Sources None.

scholarly journals Association of baseline symptom burden with efficacy outcomes: Exploratory analysis from the randomized phase III REVEL study in advanced non-small-cell lung cancer

Lung Cancer ◽  
2019 ◽  
Vol 131 ◽  
pp. 6-13 ◽  
Author(s):  
Maurice Pérol ◽  
Katherine B. Winfree ◽  
Gebra Cuyun Carter ◽  
Zhanglin Lin Cui ◽  
Lee Bowman ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Symptom Burden ◽  
Small Cell ◽  
Exploratory Analysis ◽  
Phase Iii ◽  
Small Cell Lung

scholarly journals P3.15-29 Defining the Symptom Burden of Non-Small Cell Lung Cancer

2018 ◽  
Vol 13 (10) ◽  
pp. S1001-S1002
Author(s):  
M. Whisenant ◽  
L. Williams ◽  
V. Vaghani ◽  
Q. Shi ◽  
A. Garcia Gonzalez ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Symptom Burden ◽  
Small Cell ◽  
Small Cell Lung

Hydrazine sulfate influence on nutritional status and survival in non-small-cell lung cancer.

1990 ◽  
Vol 8 (1) ◽  
pp. 9-15 ◽  
Author(s):  
R T Chlebowski ◽  
L Bulcavage ◽  
M Grosvenor ◽  
E Oktay ◽  
J B Block ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Nutritional Status ◽  
Small Cell Lung Cancer ◽  
Median Survival ◽  
Cell Lung Cancer ◽  
Combination Chemotherapy ◽  
Objective Response ◽  
Small Cell ◽  
Small Cell Lung ◽  
Hydrazine Sulfate

This randomized, prospective, placebo-controlled clinical trial compares the influence on nutritional status and survival of hydrazine sulfate with placebo addition to cisplatin-containing combination chemotherapy in patients with unresectable non-small-cell lung cancer (NSCLC). The trial consisted of 65 patients with advanced, unresectable NSCLC who had had no prior chemotherapy, were at least partially ambulatory (Eastern Cooperative Oncology Group [ECOG] performance status [PS] level 0-2), and who had adequate hematologic, renal, and hepatic function. All patients received the same defined combination chemotherapy (cisplatin, vinblastine, and bleomycin) and the same defined dietary counseling with the addition of either three times daily oral hydrazine sulfate (60 mg) or placebo capsules. Hydrazine sulfate compared with placebo addition to chemotherapy resulted in significantly greater caloric intake and albumin maintenance (P less than .05). Considering all patients, survival was greater for the hydrazine sulfate compared with placebo group (median survival, 292 v 187 days), but the difference did not achieve statistical significance. In favorable PS patients (PS 0-1), survival was significantly prolonged (median survival, 328 days v 209 days; P less than .05) for hydrazine sulfate compared with placebo addition. In a multifactor analysis, PS, weight loss, and liver involvement were the final variables. Objective response frequency and toxicity were comparable on both arms. Hydrazine sulfate may favorably influence nutritional status and clinical outcome of patients with NSCLC. Further definitive studies of hydrazine sulfate addition to therapeutic regimens in NSCLC are warranted.

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