Do most newly diagnosed advanced NSCLC patients need nutritional intervention?

9108 Background: Depletion of nutritional reserves and significant weight loss are commonly noted in patients (pts) with non-small cell lung cancer (NSCLC). The Patient Generated Subjective Global Assessment (PG-SGA) is a nutritional screening tool for cancer pts, recommended by the Oncology Network of Dietitians of Canada and the American Dietetic Association. The PG-SGA categorizes total scores into 4 ranges for nutritional triage: 0–1 requires no intervention, 2–3 requires education, 4 - 8 requires intervention by a dietitian, and =9 requires urgent symptom control and nutrition intervention. (Ottery, 2000). Methods: We determined the prevalence of malnutrition in 92 newly diagnosed advanced NSCLC pts (stages 3 / 4) in an outpatient clinic who had completed a baseline PG-SGA. We also investigated the association between CRP (an inflammatory marker which correlates with poor prognosis) and the PG-SGA. PG-SGA score was based on the sum of 4 subscales: symptoms, weight history, food intake and functional status. Results: 92 pts (M 48, F 44) aged 65 ±11 years were studied. 21 (23%) pts had a PG-SGA score of 0–3, 23 (25%) 4–8, and 48 (52%) of 9 or greater. The most common symptoms accounting for a high PG-SGA score were: no appetite 37 (40%), pain 27 (29%), constipation 26 (28%), feeling full 24 (26%), dry mouth 22 (24%) and taste changes 19 (21%). 51 (55%) pts lost 0–4.9% of their body weight in the past month, 17 (19%) had a weight loss of 5–9.9% and 24 (26%) had a weight loss =10 %. In pts with a PG-SGA score of 0–3 the median CRP was 7.0 mg/L (range: 0.7–66.0), in those with a score of 4–8 the median CRP was 41.8 mg/L (0.8–266.1) and in those with a score of =9 the median CRP was 18.5 mg/L (0.3–219.0) (p=0.02). Conclusion: At time of diagnosis, 77% of advanced NSCLC pts were in need of nutritional intervention; 52% required urgent intervention. The PG-SGA is a simple screening tool which should be incorporated into patient care in outpatient oncology clinics. No significant financial relationships to disclose.

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Experience of weight loss and its burden in patients with non-small cell lung cancer: Results of an online survey.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.26_suppl.71 ◽

2016 ◽

Vol 34 (26_suppl) ◽

pp. 71-71 ◽

Cited By ~ 1

Author(s):

Ana Maria Rodriguez ◽

Elizabeth M Duus ◽

John Friend

Keyword(s):

Quality Of Life ◽

Lung Cancer ◽

Weight Loss ◽

Body Weight ◽

Advanced Nsclc ◽

Small Cell ◽

Small Cell Lung ◽

Appetite Loss ◽

Nsclc Patients

71 Background: The main objectives of this study were to characterize and compare the burden of non-small cell lung cancer (NSCLC) patients who reported considerable weight loss ( ≥ 5% of their body weight in the past 6 months or ≥ 2% for a BMI less than 20 kg/m2) to those who did not. Methods: 95 advanced NSCLC patients were surveyed from the online patient-powered community PatientsLikeMe. Self-reported demographic and clinical characteristics were recorded. Appetite, distress and concerns, health-related quality of life (QLQ-C15-PAL) and anorexia-cachexia symptoms/concerns (FAACT A/CS) were summarized. The results obtained between patients who lost considerable weight and those who did not were compared, using a two-tailed t-test or a Kruskal-Wallis test. Patients with weight loss were additionally asked open-ended questions on burden and concerns. Results: 35 (37%) patients were classified as having considerable weight loss at the time of the survey and 60 (63%) where classified without. Most patients were female (81%), American (81%), and mean age was 59 years. 61% of patients indicated not receiving either chemotherapy or radiotherapy at the time of the survey. Patients with weight loss reported significantly (p < 0.05) lower overall quality of life (55.2 vs. 66.9), worsened anorexia-cachexia symptoms/concerns (30.7 vs. 36.0), and higher symptomology, specifically fatigue (64.8 vs. 49.1), nausea (19.5 vs. 9.2), and appetite loss (41.0 vs. 23.9) – than patients without weight loss. In addition, significantly more patients who lost weight reported moderate/high distress levels than patients who did not (71% vs. 38%). For patients with weight loss, change in food taste, fatigue, and decrease in appetite were the most frequently reported symptoms with the greatest impact on their lives. Conclusions: Our results support that weight loss negatively affects cancer patients’ quality of life and is associated with more distress and symptoms—particularly fatigue, and appetite loss. Weight loss-related symptoms also significantly impact their lives. Interventions targeted at maintaining/increasing body weight may help to improve well-being and reduce key symptoms in advanced NSCLC patients with considerable weight loss.

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Body weight response with anamorelin in advanced non-small cell lung cancer (NSCLC) patients with anorexia/cachexia: Pooled analysis of two phase III trials.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.10097 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 10097-10097 ◽

Cited By ~ 2

Author(s):

David Christopher Currow ◽

Jennifer S. Temel ◽

Amy Pickar Abernethy ◽

John Friend ◽

Ruben Giorgino

Keyword(s):

Weight Loss ◽

Body Weight ◽

Advanced Nsclc ◽

Pooled Analysis ◽

Phase Iii ◽

P Value ◽

Double Blind ◽

Entire Study ◽

Ghrelin Receptor ◽

Nsclc Patients

10097 Background: Anorexia/cachexia commonly occurs in patients with advanced NSCLC and is associated with increased morbidity and mortality. In two randomized, double-blind, placebo-controlled phase 3 trials in NSCLC patients with cachexia, the ghrelin receptor agonist anamorelin was well tolerated and significantly increased body weight, lean and fat mass, and anorexia/cachexia symptom burden over 12 weeks compared to placebo (Temel J. Lancet Oncol. 2016). Since an involuntary weight loss of ≥ 5% is an established diagnostic criterion for cancer anorexia/cachexia, an analysis was conducted to assess the proportion of patients with ≥ 5% increase in body weight. Methods: NSCLC patients [ROMANA 1 (NCT01387269; N = 484) and ROMANA 2 (NCT01387282; N = 495)] with stage III/IV disease and cachexia (BMI < 20 kg/m2 or ≥ 5% weight loss during prior 6 months) were randomized 2:1 to receive 100 mg once daily oral anamorelin or placebo up to 12 weeks. A pooled analysis was conducted post-hoc in the modified intent-to-treat population (N = 829) to measure the proportion of patients with ≥ 5% increase in body weight at the end of study (or last observation carried forward since week 6 or 9). Results: The percentage of patients with ≥ 5% increase in body weight at the end of study was significantly higher in the anamorelin arm (N = 188/552, 34.1%) compared to placebo (N = 37/277; 13.4%). Among patients with BMI < 20kg/m2 at baseline (N = 182), 47.3% (N = 53/112) of anamorelin patients had a weight increase of ≥ 5% compared to 17.4% (N = 12/69) in the placebo arm. In both cases the nominal p-value was lower than 0.0001. Conclusions: Data from two published large pivotal studies in advanced NSCLC patients with anorexia/cachexia suggest that anamorelin treatment effect size on body weight is clinically relevant, as shown by the higher response rate achieved when the stringent cut-off of ≥ 5% weight gain was applied. The proportion of patients with BMI < 20kg/m2 that benefited from anamorelin treatment was greater than the proportion of patients who benefited in the entire study sample, suggesting that patients with more advanced cachexia may still benefit from anamorelin treatment. Clinical trial information: ROMANA 1: NCT01387269; ROMANA 2: NCT01387282.

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Effect of early nutrition intervention on advanced nasopharyngeal carcinoma patients receiving chemoradiotherapy.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e17504 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e17504-e17504

Author(s):

Lingbin Meng ◽

Xiaochun Xu ◽

Xin Jiang ◽

Tarek Mekhail

Keyword(s):

Weight Loss ◽

Nasopharyngeal Carcinoma ◽

Nutritional Status ◽

Nutritional Intervention ◽

Nutrition Intervention ◽

Lower Percentage ◽

Early Group ◽

Early Nutrition ◽

Treatment Tolerance ◽

Late Group

e17504 Background: Patients with nasopharyngeal carcinoma (NPC) frequently developed the problem of malnutrition at the time of diagnosis. Chemoradiotherapy (CRT) can even worsen the situation. Therefore, nutritional intervention should be applied to prevent CRT-associated weight loss and interruption of CRT. However, it is still controversial if early nutritional intervention is beneficial to NPC patients with CRT. This study is to investigate the influence of early nutritional intervention on advanced NPC patients with CRT by evaluating the nutritional status and CRT treatment tolerance. Methods: A cohort of 78 stage III-IV nasopharyngeal carcinoma patients was divided into early (n = 46) and late (n = 32) nutrition intervention groups. The early group of patients received nutritional support at the beginning of CRT, whereas the late group received such a support until development of the side effects, like 50% required oral dietary intake or > 10% weight loss. The data were collected and statistically analyzed. Results: There was no significant difference in baseline clinical characteristics between these two groups, suggesting that no selection bias occurred. Both groups of patients had weight loss at the end of CRT and 3 months thereafter. However, at the later time point, the early group started to regain their weight, while the late group continued to lose weight. At both time points, the early group had a lower percentage of weight loss than the late group. Similar results were also obtained for BMI, albumin, and pre-albumin levels (All p< 0.05). Besides, the early group showed a lower rate of advanced mucositis, a lower percentage of patients with more than 3 days RT breaks, fewer days of RT delayed for toxicity, and a lower percentage of patients with unplanned hospitalizations (All p< 0.05). A linear correlation was also found between the percentage of weight loss and the number of days of RT delayed. Conclusions: Early nutritional intervention provides beneficial outcomes to NPC patients by maintaining their nutritional status and enhancing CRT treatment tolerance. Our results also indicated early nutrition intervention may reduce the hospital cost and improve patients’ life quality.

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P1.01-44 Outcome of Uncommon EGFR Mutation Positive Newly Diagnosed Advanced NSCLC Patients: A Single-Centre Retrospective Analysis

Journal of Thoracic Oncology ◽

10.1016/j.jtho.2018.08.600 ◽

2018 ◽

Vol 13 (10) ◽

pp. S477

Author(s):

S. Kate ◽

A. Choughule ◽

A. Joshi ◽

V. Noronha ◽

V. Patil ◽

...

Keyword(s):

Retrospective Analysis ◽

Egfr Mutation ◽

Advanced Nsclc ◽

Newly Diagnosed ◽

Single Centre ◽

Nsclc Patients

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Anlotinib Hydrochloride Combined With EGFR-Tyrosine Kinase Inhibitor (TKI) in Treating Advanced NSCLC Patients With Acquired Resistance to EGFR-TKI

Case Medical Research ◽

10.31525/ct1-nct04007835 ◽

2019 ◽

Author(s):

Keyword(s):

Tyrosine Kinase ◽

Tyrosine Kinase Inhibitor ◽

Advanced Nsclc ◽

Kinase Inhibitor ◽

Acquired Resistance ◽

Egfr Tyrosine Kinase Inhibitor ◽

Egfr Tyrosine Kinase ◽

Nsclc Patients ◽

Egfr Tki

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Nutritional Intervention May Improve Body Mass Index of Malnourished Hospitalized Psychiatric Patients – A Preliminary Observation

Current Topics in Nutraceutical Research ◽

10.37290/ctnr2641-452x.18:256-259 ◽

2019 ◽

Vol 18 (3) ◽

pp. 256-259

Author(s):

Hou Y.C. ◽

Hsieh Y.L. ◽

Tzeng I.S. ◽

Kuo C.Y.

Keyword(s):

Body Weight ◽

Psychiatric Patients ◽

Psychiatric Hospitals ◽

Nutritional Intervention ◽

Nutrition Intervention ◽

Calorie Intake ◽

Psychiatric Ward ◽

Increased Risk ◽

Total Calorie ◽

Total Calorie Intake

Malnutrition is an important issue in hospitalized patients. Poor nutrition may lead to increased risk of morbidity and death, impaired mental and physical conditions, apathy, depression, self-neglect, increased risk of medical complications, increased risk of pressure ulcers, reduced immune response, delayed wound healing, longer hospital stays, and reduced quality of life. However, few studies have investigated malnutrition in psychiatric patients. Psychiatric patients are known to have an increased risk of malnutrition, but psychiatric hospitals rarely conduct physical examinations and nutritional assessments. In this preliminary study, patients from a psychiatric ward of the Taipei Tzu Chi Hospital were chosen using the Malnutrition Universal Screening Tool. We used the before-and-after analysis to test the effect of a nutrition intervention on the selected parameters. We found that patients who had an impaired nutritional status showed significant increases in body weight (mean: 43.6 ± 7.5 vs. 46.5 ± 8.2 kg; P < 0.001), BMI (mean: 16.8 ± 2.0 vs. 17.9 ± 2.1 kg/m2; P < 0.001), and total calorie intake (mean: 1128 ± 230 vs. 1378 ± 320 Kcal; P < 0.001). Nutritional intervention significantly improved body weight, BMI, and total calorie intake. Nutritional intervention may help prevent malnutrition and improve the management of psychiatric patients.

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