Association of nutritional parameters and survival in parenteral nutrition-supported (PN) gastrointestinal cancer patients.

10078 Background: PN is a major tool in managing nutritional challenges in cancer patients. However, a clear set of clinical and biochemical indices to determine PN application in cancer patients has not been developed. We assessed the association between PN related nutritional parameters and survival in a large group of gastrointestinal (GI) cancer patients. Methods: 1197 consecutive GI cancer patients who received PN support between 08/01/08 – 08/01/13 were reviewed. Height, weight, plasma glucose (baseline and within 48 hours after PN initiation), surgical history, and pharmacy data including PN contents (dextrose, amino acids, and fat) and non-PN dextrose or fat in drug administration were recorded. Body mass index (BMI), Ideal body weight (IBW), PN and non-PN Calorie, and nitrogen were calculated for analysis. Data were entered into a multivariate analysis controlling for age, gender, cancer site, and medical comorbidities. Results: Median BMI was 25.4. 70% of the patients had unsteady weight ( > 2.5% change) before PN initiation. The magnitude of weight change was inversely related to survival (HR 1.02), P < 0.001). Patients with BMI > 25 and < 7.5% weight change prior to PN initiation had the most favorable survival. Glycemic instability (maximum plasma glucose variation > 100mg/dL) was independently related to shorter survival (HR 1.53, P < 0.001). Total calorie by IBW (kcal/kg/day) (HR 0.97, P < 0.001), non-PN calorie % (HR 1.04, P < 0.001), and calorie to nitrogen ratio (kcal:g) (HR 1.02, P < 0.001) were all independently associated with overall survival. Conclusions: Lower BMI, weight instability, and glycemic instability were adversely associated with survival. Higher total PN calorie and amino acid support were associated with better survival. Higher non-PN calorie % was adversely related to survival. Future studies must focus on developing a set of indices incorporating independent prognostic clinical and biochemical factors in determining PN application and monitoring in cancer patients. Optimum calorie and amino acids in PN support for cancer patients also require further investigation.

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Optimal Modified Frailty Index Cutoff in Older Gastrointestinal Cancer Patients

The American Surgeon ◽

10.1177/000313481708300837 ◽

2017 ◽

Vol 83 (8) ◽

pp. 860-865 ◽

Cited By ~ 2

Author(s):

Mary Garland ◽

Fang-Chi Hsu ◽

Perry Shen ◽

Clancy J. Clark

Keyword(s):

Cancer Patients ◽

Cross Validation ◽

Frailty Index ◽

Postoperative Outcomes ◽

Cancer Site ◽

Optimal Cutoff ◽

Major Morbidity ◽

Gi Cancer ◽

Modified Frailty Index ◽

Fold Cross Validation

The newly characterized modified frailty index (mFI) is a robust predictor of postoperative outcomes for surgical patients. The present study investigates the optimal cutoff for mFI specifically in older gastrointestinal (GI) cancer patients undergoing surgery. All patients more than 60 years old who underwent surgery for a GI malignancy (esophagus, stomach, colon, rectum, pancreas, liver, and bile duct) were identified in the 2005 to 2012 National Surgical Quality Improvement Program, Participant Use Data File (NSQIP PUF). Patients undergoing emergency procedures, of American Society of Anesthesiologists (ASA) five status, or diagnosed with preoperative sepsis were excluded. Logistic regression modeling and 10-fold cross validation were used to identify an optimal mFI cutoff. A total of 41,455 patients (mean age 72, 47.4% female) met the eligibility criteria. Among them, 19.0 per cent (n = 7891) developed a major postoperative complication and 2.8 per cent (n = 1150) died within 30 days. A random sampling by a cancer site was performed to create 90 per cent training and 10 per cent test sample datasets. Using 10-fold cross validation, logistical regression models evaluated the association between mFI and endpoints of 30-day mortality and major morbidity at various cutoffs. Optimal cutoffs for 30-day mortality and major morbidity were mFI ≥ 0.1 and ≥0.2, respectively. After adjusting for age, sex, ASA, albumin ≥3g/dl, and body mass index ≥ 30 kg/m2, mFI ≥ 0.1 was associated with increased mortality (odds ratio (OR) 1.49, 1.30–1.71 95% confidence interval (CI), P < 0.001) and mFI ≥ 0.2 was associated with increased morbidity (OR 1.52, 1.39–1.65 95% CI, P < 0.001). For older GI cancer patients, a very low mFI was a predictor of poor postoperative outcomes with an optimal cutoff of two or more mFI characteristics.

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The Relationship between Nutritional Parameters and Thrombosis Risk in Cancer Patients

Nutrition and Cancer ◽

10.1080/01635581.2021.1952631 ◽

2021 ◽

pp. 1-6

Author(s):

Merve Sari ◽

Yusuf Ilhan ◽

Sema Sezgin Goksu ◽

Osman Kostek ◽

Ali Murat Tatli ◽

...

Keyword(s):

Cancer Patients ◽

Nutritional Parameters ◽

Thrombosis Risk ◽

The Relationship

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A Machine Learning Model Approach to Risk-Stratify Gastrointestinal (GI) Cancer Patients for Hospitalization and Mortality Outcomes

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2021.04.019 ◽

2021 ◽

Author(s):

Kaitlin M. Christopherson ◽

Prajnan Das ◽

Christopher Berlind ◽

W. David Lindsay ◽

Christopher Ahern ◽

...

Keyword(s):

Machine Learning ◽

Cancer Patients ◽

Learning Model ◽

Gi Cancer ◽

Machine Learning Model ◽

Model Approach

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Questionnaire-based detection of immune-related adverse events in cancer patients treated with PD-1/PD-L1 immune checkpoint inhibitors

BMC Cancer ◽

10.1186/s12885-021-08006-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Luisa Maria Griewing ◽

Claudia Schweizer ◽

Philipp Schubert ◽

Sandra Rutzner ◽

Markus Eckstein ◽

...

Keyword(s):

Adverse Events ◽

Cancer Patients ◽

Weight Change ◽

Immune Checkpoint ◽

Detection Rate ◽

Immune Checkpoint Inhibitors ◽

Checkpoint Inhibitors ◽

Patient Questionnaire ◽

Organ Specific ◽

Tumor Entities

Abstract Background Immune checkpoint inhibitors (ICI) have become standard treatment in different tumor entities. However, safe treatment with ICI targeting the PD-1/PD-L1 axis requires early detection of immune-related adverse events (irAE). There exist different questionnaires of drug manufacturers for the detection of irAE that have not been validated so far. Methods The prospective non-interventional ST-ICI trial studied treatment with PD-1/PD-L1 ICI alone or combined with radiotherapy. In the current analysis, the detection rate of self-reported irAE with a patient questionnaire containing 41 different questions was compared to clinician-reported irAE. Results Between April 2017 and August 2019, a total of 104 patients were prospectively enrolled. NSCLC (44%) and HNSCC (42%) were the most frequent tumor entities. A total of 784 questionnaires were collected. A total of 29 irAE were reported by clinicians. The most frequent irAE was hypothyroidism (9%), followed by skin reactions (5%), hepatitis (4%), diarrhea (3%), and pneumonitis (3%). Questions that became significantly more often positive at time points of clinician-reported irAE were “weight change”, “difficulty to grip things”, “bloody or mucous stool” and “insomnia”. Self-reported organ-specific questions detected at least 50% of clinician-reported irAE of gastrointestinal, lung, endocrine, and skin irAE. It was not possible to detect hepatic irAE with the questionnaire. Conclusion Questionnaires can help to detect gastrointestinal, lung, endocrine, or skin irAE, but not hepatic irAE. Questions on “weight change” and “insomnia” may help to increase the detection rate of irAE, besides organ-specific questions. These results are a valuable contribution to the future development of a specific and practicable questionnaire for early self-reported detection of irAE during ICI therapy in cancer patients. Trial registration ClinicalTrials.gov, NCT03453892. Registered on 05 March 2018.

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Ion Chromatography Based Urine Amino Acid Profiling Applied for Diagnosis of Gastric Cancer

Gastroenterology Research and Practice ◽

10.1155/2012/474907 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8 ◽

Cited By ~ 11

Author(s):

Jing Fan ◽

Jing Hong ◽

Jun-Duo Hu ◽

Jin-Lian Chen

Keyword(s):

Gastric Cancer ◽

Amino Acids ◽

Amino Acid ◽

Advanced Gastric Cancer ◽

Free Amino Acid ◽

Cancer Patients ◽

Free Amino ◽

Amino Acid Profile ◽

Healthy Adults ◽

Group D

Aim. Amino acid metabolism in cancer patients differs from that in healthy people. In the study, we performed urine-free amino acid profile of gastric cancer at different stages and health subjects to explore potential biomarkers for diagnosing or screening gastric cancer.Methods. Forty three urine samples were collected from inpatients and healthy adults who were divided into 4 groups. Healthy adults were in group A (n=15), early gastric cancer inpatients in group B (n=7), and advanced gastric cancer inpatients in group C (n=16); in addition, two healthy adults and three advanced gastric cancer inpatients were in group D (n=5) to test models. We performed urine amino acids profile of each group by applying ion chromatography (IC) technique and analyzed urine amino acids according to chromatogram of amino acids standard solution. The data we obtained were processed with statistical analysis. A diagnostic model was constructed to discriminate gastric cancer from healthy individuals and another diagnostic model for clinical staging by principal component analysis. Differentiation performance was validated by the area under the curve (AUC) of receiver-operating characteristic (ROC) curves.Results. The urine-free amino acid profile of gastric cancer patients changed to a certain degree compared with that of healthy adults. Compared with healthy adult group, the levels of valine, isoleucine, and leucine increased (P<0.05), but the levels of histidine and methionine decreased (P<0.05), and aspartate decreased significantly (P<0.01). The urine amino acid profile was also different between early and advanced gastric cancer groups. Compared with early gastric cancer, the levels of isoleucine and valine decreased in advanced gastric cancer (P<0.05). A diagnosis model constructed for gastric cancer with AUC value of 0.936 tested by group D showed that 4 samples could coincide with it. Another diagnosis model for clinical staging with an AUC value of 0.902 tested by 3 advanced gastric cancer inpatients of group D showed that all could coincide with the model.Conclusions. The noticeable differences of urine-free amino acid profiles between gastric cancer patients and healthy adults indicate that such amino acids as valine, isoleucine, leucine, methionine, histidine and aspartate are important metabolites in cell multiplication and gene expression during tumor growth and metastatic process. The study suggests that urine-free amino acid profiling is of potential value for screening or diagnosing gastric cancer.

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Comparison of Weight Change in Head and Neck Cancer Patients with and without Enteral Nutrition during Radiation Therapy

Journal of the American Dietetic Association ◽

10.1016/s0002-8223(96)00430-0 ◽

1996 ◽

Vol 96 (9) ◽

pp. A34

Author(s):

T. Nash

Keyword(s):

Radiation Therapy ◽

Head And Neck Cancer ◽

Enteral Nutrition ◽

Head And Neck ◽

Cancer Patients ◽

Neck Cancer ◽

Weight Change

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LB031 ASSOCIATION BETWEEN HYDRATION VOLUME AND BODY WEIGHT CHANGE IN TERMINALLY ILL CANCER PATIENTS WITH ABDOMINAL MALIGNANCIES

Clinical Nutrition Supplements ◽

10.1016/s1744-1161(10)70543-3 ◽

2010 ◽

Vol 5 (2) ◽

pp. 207

Author(s):

N. Mori ◽

S. Mita ◽

M. Asano ◽

T. Watanabe ◽

A. Ishikawa

Keyword(s):

Body Weight ◽

Cancer Patients ◽

Weight Change ◽

Terminally Ill ◽

Body Weight Change ◽

Terminally Ill Cancer Patients

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Impact of cancer on emergency department outcomes.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e18618 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e18618-e18618

Author(s):

Alexander S. Qian ◽

Edmund M. Qiao ◽

Vinit Nalawade ◽

Rohith S. Voora ◽

Nikhil V. Kotha ◽

...

Keyword(s):

Emergency Department ◽

Risk Stratification ◽

Hospital Mortality ◽

Hospital Admission ◽

Cancer Patients ◽

Metastatic Cancer ◽

Inpatient Admission ◽

Cancer Site ◽

Patients With Cancer ◽

Increased Risk

e18618 Background: Cancer patients frequently utilize the Emergency Department (ED) for a variety of diagnoses, both related and unrelated to their cancer. Patients with cancer have unique risks related to their cancer and treatment which could influence ED-related outcomes. A better understanding of these risks could help improve risk-stratification for these patients and help inform future interventions. This study sought to define the increased risks cancer patients face for inpatient admission and hospital mortality among cancer patients presenting to the ED. Methods: From the National Emergency Department Sample (NEDS) we identified patients with and without a diagnosis of cancer presenting to the ED between 2016 and 2018. We used International Classification of Diseases, version 10 (ICD10-CM) codes to identify patients with cancer, and to identify patient’s presenting diagnosis. Multivariable mixed-effects logistic regression models assessed the influence of cancer diagnoses on two endpoints: hospital admission from the ED, and inpatient hospital mortality. Results: There were 340 million weighted ED visits, of which 8.3 million (2.3%) occurred in patients with a cancer diagnosis. Compared to non-cancer patients, patients with cancer had an increased risk of inpatient admission (64.7% vs. 14.8%; p < 0.0001) and hospital mortality (4.6% vs. 0.5%; p < 0.0001). Factors associated with both an increased risk of hospitalization and death included older age, male gender, lower income level, discharge quarter, and receipt of care in a teaching hospital. We identified the top 15 most common presenting diagnoses among cancer patients, and among each of these diagnoses, cancer patients had increased risks of hospitalization (odds ratio [OR] range 2.0-13.2; all p < 0.05) and death (OR range 2.1-14.4; all p < 0.05) compared to non-cancer patients with the same diagnosis. Within the cancer patient cohort, cancer site was the most robust individual predictor associated with risk of hospitalization or death, with highest risk among patients with metastatic cancer, liver and lung cancers compared to the reference group of prostate cancer patients. Conclusions: Cancer patients presenting to the ED have high risks for hospital admission and death when compared to patients without cancer. Cancer patients represent a distinct population and may benefit from cancer-specific risk stratification or focused interventions tailored to improve outcomes in the ED setting.

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Impact of cancer on the risk of unplanned 30-day readmissions.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.6581 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 6581-6581

Author(s):

Alexander Qian ◽

Edmund Qiao ◽

Vinit Nalawade ◽

Nikhil V. Kotha ◽

Rohith S. Voora ◽

...

Keyword(s):

Cancer Patients ◽

Cancer Diagnosis ◽

Hospital Admissions ◽

Reference Group ◽

Cancer Site ◽

Cancer Type ◽

Logistic Regression Models ◽

Increased Risk ◽

Initial Hospitalization ◽

The Impact

6581 Background: Hospital readmission are associated with unfavorable patient outcomes and increased costs to the healthcare system. Devising interventions to reduce risks of readmission requires understanding patients at highest risk. Cancer patients represent a unique population with distinct risk factors. The purpose of this study was to define the impact of a cancer diagnosis on the risks of unplanned 30-day readmissions. Methods: We identified non-procedural hospital admissions between January through November 2017 from the National Readmission Database (NRD). We included patients with and without a cancer diagnosis who were admitted for non-procedural causes. We evaluated the impact of cancer on the risk of 30-day unplanned readmissions using multivariable mixed-effects logistic regression models. Results: Out of 18,996,625 weighted admissions, 1,685,099 (8.9%) had record of a cancer diagnosis. A cancer diagnosis was associated with an increased risk of readmission compared to non-cancer patients (23.5% vs. 13.6%, p < 0.001). However, among readmissions, cancer patients were less likely to have a preventable readmission (6.5% vs. 12.1%, p < 0.001). When considering the 10 most common causes of initial hospitalization, cancer was associated with an increased risk of readmission for each of these 10 causes (OR range 1.1-2.7, all p < 0.05) compared to non-cancer patients admitted for the same causes. Compared to patients aged 45-64, a younger age was associated with increased risk for cancer patients (OR 1.29, 95%CI [1.24-1.34]) but decreased risk for non-cancer patients (OR 0.65, 95%CI [0.64-0.66]). Among cancer patients, cancer site was the most robust individual predictor for readmission with liver (OR 1.47, 95%CI [1.39-1.55]), pancreas (OR 1.36, 95%CI [1.29-1.44]), and non-Hodgkin’s lymphoma (OR 1.35, 95%CI [1.29-1.42]) having the highest risk compared to the reference group of prostate cancer patients. Conclusions: Cancer patients have a higher risk of 30-day readmission, with increased risks among younger cancer patients, and with individual risks varying by cancer type. Future risk stratification approaches should consider cancer patients as an independent group with unique risks of readmission.

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