Preoperative nutritional counselling in patients undergoing oesophagectomy

2021 ◽  
pp. 175045892110060
Author(s):  
M AlleaBelle Gongola ◽  
Rebecca J Reif ◽  
Peggy C Cosgrove ◽  
Kevin W Sexton ◽  
Katy A Marino ◽  
...  
Keyword(s):  
Weight Loss ◽  
High Risk ◽  
Length Of Stay ◽  
Cancer Patients ◽  
Clinical Outcomes ◽  
Oesophageal Cancer ◽  
Feeding Tube ◽  
Nutritional Counselling

Background Patients undergoing surgery for oesophageal cancer are at high risk of malnutrition due to pathology and neoadjuvent therapy. This study sought to determine if oesophageal cancer patients undergoing oesophagectomy achieve superior clinical outcomes when preoperative nutritional counselling is performed. Methods Oesophageal cancer patients undergoing oesophagectomy were retrospectively divided into cohorts based on those who received ( n = 48) and did not receive ( n = 58) preoperative nutritional counselling. We compared weight loss, length of stay, 30-day readmission related to nutrition or feeding tube problems, and 90-day mortality. Results Per cent weight loss was less in patients who received preoperative nutritional counselling. There was a trend toward decreased mean length of stay and there were fewer readmissions for feeding tube-related complications in patients who received counselling. Conclusions Nutritional counselling before surgery may lead to decreased weight loss and reduced readmissions for feeding tube-related complications in patients with oesophageal cancer undergoing oesophagectomy.

Prognostic value of nutritional status for esophageal cancer patients undergoing neoadjuvant therapy and resection.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 133-133 ◽  
Author(s):  
Sabrina D Saeed ◽  
Jacques Fontaine ◽  
Luis Pena ◽  
Sarah E. Hoffe ◽  
Jessica Frakes ◽  
...  
Keyword(s):  
Weight Loss ◽  
Esophageal Cancer ◽  
Neoadjuvant Therapy ◽  
Cancer Patients ◽  
Prognostic Value ◽  
Feeding Tube ◽  
Tube Placement ◽  
Significant Weight Loss ◽  
Increased Risk ◽  
The Impact

133 Background: Malnutrition, linked to decreased patient tolerance to chemotherapy and increased rates of therapy-related toxicity, negatively affects cancer prognosis. Esophageal carcinomas (EC) frequently present with dysphagia and significant weight loss which may be exacerbated by neoadjuvant chemoradiation, placing EC patients at an increased risk of malnutrition. We therefore aim to assess the prognostic value of pre-operative malnutrition for esophageal cancer patients undergoing neoadjuvant therapy (NAT). Methods: Query of our institution’s IRB approved database of 1113 EC patients (pts) identified 725 individuals who underwent NAT followed by resection from 1994-2018. Seventy-six pts were considered to be at higher nutritional risk during NAT, as indicated by significant weight loss and enteral feeding tube requirement (ETF+), while 644 did not receive pre-operative feeding tube placement (ETF–). Clinicopathologic characteristics, post-operative outcomes, and survival were compared between ETF+ and ETF– using various statistical methods. Results: Of the included pts, 83% were male with a median age of 64.5 (28-86) years. Between ETF+ (n = 76) and ETF– (n = 644), pt characteristics were balanced in terms of initial stage, age, histology and tumor location. A higher percentage of ETF+ pts had > 5% weight loss before NAT (32 vs. 6%; p < .01). ETF+ was associated with a significantly worse median survival (27 vs. 77 m; p < .01), but not with increased post-operative length of hospital stay (p = .69), complications (p = .20) or tumor recurrence (p = .89). Although completion of chemotherapy (p = .46) and radiation (p = .49) were comparable between ETF+ and ETF–, tumor response was worse in the ETF+ group (71 vs. 60% non-complete response; p = .02). Conclusions: Our results suggest that baseline malnutrition is a risk factor for poor survival and negatively impacts the efficacy of neoadjuvant therapy in EC patients. Poor response to NAT in malnourished patients may stem from impaired immune function. Future prospective studies should evaluate other parameters for nutritional assessment to further assess the impact of malnutrition on tumor regression and survival after NAT.

Cachexia in treatment-naïve gynecological cancer patients: Prevalence, predictors, and clinical associations.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e17576-e17576
Author(s):  
Niamh O'Donoghue ◽  
Charlie Sullivan ◽  
Claire Thompson ◽  
Feras Abu Saadeh ◽  
Waseem Kamran ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Weight Loss ◽  
Length Of Stay ◽  
Functional Status ◽  
Cancer Patients ◽  
Gynaecological Cancer ◽  
Composition Analysis ◽  
Gynaecological Malignancy ◽  
The Impact

e17576 Background: Cancer cachexia is associated with considerable morbidity and mortality, yet its prevalence in gynaecological malignancy is unknown. Prevalence of cachexia in de novo gynaecological cancer patients and the impact of cachexia on clinical parameters and patient-reported outcomes were investigated. Methods: A prospective, exploratory study of newly diagnosed gynaecological cancer patients was conducted at St. James’s Hospital, the largest treatment provider for gynaecological malignancy in the Republic of Ireland. Patients recently diagnosed with a gynaecological cancer were eligible. Demographics, oncological history, Clavien Dindo Classification and length of stay were collected from participants’ medical record. A questionnaire completed by participants on 3 consecutive days collected data on height, weight, weight history, recent dietary intake, nutritional impact symptoms and functional status. Cachexia was defined using the criteria established in 2011 (Fearon and Strasser et al, 2011). Participants’ staging computed tomography scans were utilised for body composition analysis. Descriptive statistics, Mann Whitney U tests and Chi-square were used to summarise and identify significant associations between variables. Logistic regression was used to model predictors of cachexia. The European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Core Questionnaire in conjunction with EORTC gynaecological cancer-specific modules assessed quality of life. Results: A total of 94 participants were recruited. All five gynaecological cancers were represented. Prevalence of cachexia was 21.4% and was highest in patients with cervical cancer. Any weight loss in the previous month was predictive of developing cachexia. Low albumin and anorexia were associated with cachexia, although neither reached significance. Median post-operative length of stay for cachectic patients was 5 days (range 1-57) compared to 4 days (range 0-27) for non-cachectic patients (p = 0.682). 60% of cachectic patients had some post-operative complication. Cachectic patients were more symptomatic and had lower functional status in all quality of life categories, with the exception of emotional function. Conclusions: As prevalence of cachexia in this population is at least 22%, we strongly recommend screening for cachexia at all clinical assessments. Although weight loss and body mass index can identify the majority of cachectic patients, skeletal muscle mass index should also be included where possible. Its incorporation into standard radiology assessment of cancer patients would be optimal. Further research is warranted in a larger population to fully elucidate the predictors of cachexia. Quality of life is a useful means to monitor symptoms and functional status which may contribute to or exacerbate cachexia.

scholarly journals Gastrointestinal symptoms and weight loss in cancer patients receiving chemotherapy

2012 ◽  
Vol 109 (5) ◽  
pp. 894-897 ◽  
Author(s):  
Karla Sánchez-Lara ◽  
Emilio Ugalde-Morales ◽  
Daniel Motola-Kuba ◽  
Dan Green
Keyword(s):  
Quality Of Life ◽  
Lung Cancer ◽  
Weight Loss ◽  
High Risk ◽  
Cancer Patients ◽  
Gastrointestinal Symptoms ◽  
Tumour Site ◽  
Lung Cancer Patients ◽  
Gi Symptoms

Cancer patients receiving chemotherapy have a high risk of malnutrition secondary to the disease and treatment, and 40–80 % of cancer patients suffer from different degrees of malnutrition, depending on tumour subtype, location, staging and treatment strategy. Malnutrition in cancer patients affects the patient's overall condition, and it increases the number of complications, the adverse effects of chemotherapy and reduces the quality of life. The aim of the present study was to evaluate weight-loss prevalence depending on the tumour site and the gastrointestinal (GI) symptoms of oncology patients receiving chemotherapy. We included 191 cancer patients receiving chemotherapy. Files of all patients were reviewed to identify symptoms that might potentially influence weight loss. The nutritional status of all patients was also determined. The cancer sites in the patients were as follows: breast (31·9 %); non-colorectal GI (18·3 %); colorectal (10·4 %); lung (5·8 %); haematological (13·1 %); others (20·5 %). Of these patients, 58 % experienced some degree of weight loss, and its prevalence was higher among the non-colorectal GI and lung cancer patients. Common symptoms included nausea (59·6 %), anorexia (46 %) and constipation (31·9 %). A higher proportion of patients with ≥ 5 % weight loss experienced anorexia, nausea and vomiting (OR 9·5, 2·15 and 6·1, respectively). In conclusion, these results indicate that GI symptoms can influence weight loss in cancer patients, and they should be included in early nutritional evaluations.

scholarly journals Cost impact analysis of Enhanced Recovery After Surgery program implementation in Alberta colon cancer patients

2016 ◽  
Vol 23 (3) ◽  
pp. 221 ◽  
Author(s):  
G. Nelson ◽  
L.N. Kiyang ◽  
A. Chuck ◽  
N.X. Thanh ◽  
L.M. Gramlich
Keyword(s):  
Colon Cancer ◽  
Length Of Stay ◽  
Cancer Patients ◽  
Clinical Outcomes ◽  
Program Implementation ◽  
Impact Analysis ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Guideline Implementation ◽  
Cost Savings

Background The Enhanced Recovery After Surgery (ERAS) colorectal guideline has been implemented widely across Alberta. Our study examined the clinical and cost impacts of eras on colon cancer patients across the province.Methods We first used both summary statistics and multivariate regression methods to compare, before and after guideline implementation, clinical outcomes (length of stay, complications, readmissions) in consecutive elective colorectal patients 18 or more years of age and in colon cancer and non-cancer patients treated at the Peter Lougheed Centre and the Grey Nuns Hospital between February 2013 and December 2014. We then used the differences in clinical outcomes for colon cancer patients, together with the average cost per hospital day, to estimate cost impacts.Results The analysis considered 790 patients (398 cancer and 392 non-cancer patients). Mean guideline compliance increased to 60% in cancer patients and 57% in non-cancer patients after ERAS implementation from 37% overall before ERAS implementation. From pre- to post-ERAS, mean length of stay declined to 8.4 ± 5 days from 9.5 ± 7 days in cancer patients, and to 6.4 ± 4 days from 8.8 ± 5.5 days in non-cancer patients (p = 0.0012 and p = 0.0041 respectively). Complications declined significantly in the renal, hepatic, pancreatic, and gastrointestinal groups (difference in proportions: 13% in cancer patients; p < 0.05). No significant change in the risk of readmission was observed. The net cost savings attributable to ERAS implementation ranged from $1,096 to $2,771 per cancer patient and from $3,388 to $7,103 per non-cancer patient.Conclusions Implementation of eras not only resulted in clinical outcome improvements, but also had a significant beneficial impact on scarce health system resources. The effect for cancer patients was different from that for noncancer patients, representing an opportunity for further refinement and study.

scholarly journals Oesophageal cancer magnitude and presentation in Ethiopia 2012–2017

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0242807
Author(s):  
Abigiya Wondimagegnehu ◽  
Selamawit Hirpa ◽  
Samson Wakuma Abaya ◽  
Muluken Gizaw ◽  
Sefonias Getachew ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Oesophageal Cancer ◽  
Data Extraction ◽  
Clinical Care ◽  
Feeding Tube ◽  
Current Status ◽  
Number Of Patients ◽  
Referral Hospitals ◽  
Data Extraction Tool ◽  
Document Review

The aim of this study was to assess the magnitude, socio-demographic, and clinical characteristics of oesophageal cancer patients in selected referral hospitals of Ethiopia. A retrospective document review was employed in ten referral hospitals in different regions of Ethiopia. A structured data extraction tool was used to extract data from clinical care records of all clinically and pathologically confirmed oesophageal cancer patients who were diagnosed and treated in those hospitals from 2012 to 2017. During the study period, a total of 777 oesophageal cancer cases were identified, and the median age of these patients was 55 years, with an interquartile range of 19. More than half (55.1%, n = 428) of the cases were males, and the majority of them were reported from Oromia (49.9%, n = 388) and Somali (25.9%, n = 202) regional states. The highest numbers of oesophageal cancer cases were recorded in 2016 (23.8%, n = 185), while the lowest were in 2012 (12.6%, n = 98). Eighty per cent of oesophageal cancer cases were diagnosed in later stages of the disease. More than one-fourth (27.0%, n = 210) of patients had surgical procedures where the majority (74.3%, n = 156) required insertion of a feeding tube followed by transhiatal oesophagectomy (10.9%, n = 23). Of the 118 patients for which there was histology data, squamous cell carcinoma (56.7%, n = 67) and adenocarcinoma (36.4%, n = 43) were the predominant histologic type. One-fourth (25.0%, n = 194) of the patients were alive, and more than two-thirds (71.7%, n = 557) of the patients’ current status was unknown at the time of the review. In these referral hospitals of Ethiopia, many oesophageal cancer patients presented during later stages of the disease and needed palliative care measures. The number of patients seen in Oromia and Somali hospitals by far exceeded hospitals of the other regions, thus postulating possibly unique risk factors in those geographic areas.

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