Nutritional Status Of Cancer Patients Research Articles

Bioimpedentiometry parameters used as indicators of frailty and malnutrition: association between G8 score and Phase angle (PHA) in elderly cancer patients.

Since the incidence of cancer increases with age, in older cancer patients important information may be missed without a Comprehensive Geriatric Assessment (CGA). On the other side, CGA is a time-consuming and complex instrument, sothat Geriatric 8 (G8) has been proposed as a more feasible screening tool to identify patients who could benefit from a CGAevaluation. G8 consists of 8 questions (patient age + 7 items derived from the Mini Nutritional Assessment questionnaire). A G8 score ≤ 14 is considered associated with frailty and risk of malnutrition. Another screening test is Bioelectrical Impedance Analysis (Bioimpedentiometry, BIA), which enables to evaluate the nutritional status through a specific parameter known as Phase angle (PhA). This study is aimed at assessing the ability of G8 alone or in combination with PhA to detect elderly cancer patients at higher risk for malnutrition who cannot undergo immediate anticancer treatments. A total of 289 cancer patients (168 men and 121 women) aged ≥ 70years old were enrolled and performed both G8 test, body mass index (BMI) and BIA assessments. A concurrent G8 score ≤ 14 and PhA < 5 defined subjects most exposed to the risk of malnutrition. An association between BMI and G8 (p < 0.001, OR 1.54) and a clinically significant relationship between G8 and PhA (p = 0.013) were observed. G8 can be used to identify patients at risk for malnutrition who would benefit from comprehensive CGA. The concurrent use of G8 and BIA presents a higher power in discriminating subjects at higher risk of malnutrition than a single test. This study suggests the need for routine assessment of nutritional status in cancer patients using combinations of methods, in order to implement strategies for individually-tailored care before starting any treatment.

Prognostic value of pre-therapeutic nutritional risk factors in elderly patients with locally advanced esophageal squamous cell carcinoma receiving definitive chemoradiotherapy or radiotherapy

BackgroundThe nutritional status of cancer patients is a crucial factor in determining their prognosis. The objective of this study was to investigate and compare the prognostic value of pretreatment nutrition-related indicators in elderly esophageal squamous cell carcinoma (ESCC). Risk stratification was performed according to independent risk factors and a new nutritional prognostic index was constructed.MethodsWe retrospectively reviewed 460 older locally advanced ESCC patients receiving definitive chemoradiotherapy (dCRT) or radiotherapy (dRT). This study included five pre- therapeutic nutrition-related indicators. The optimal cut-off values for these indices were calculated from the Receiver Operating Curve (ROC). Univariate and multivariate COX analyses were employed to determine the association between each indicator and clinical outcomes. The predictive ability of each independently nutrition-related prognostic indicator was assessed using the time-dependent ROC (time-ROC) and C-index.ResultsMultivariate analyses indicated that the geriatric nutrition risk index (GNRI), body mass index (BMI), the controlling nutritional status (CONUT) score, and platelet-albumin ratio (PAR) could independently predict overall survival (OS) and progression-free survival (PFS) in elderly patients with ESCC (all p < 0.05), except for prognostic nutritional index (PNI). Based on four independently nutrition-related prognostic indicators, we developed pre-therapeutic nutritional prognostic score (PTNPS) and new nutritional prognostic index (NNPI). No-risk (PTNPS = 0–1 point), moderate-risk (PTNPS = 2 points), and high-risk (PTNPS = 3–4 points) groups had 5-year OS rates of 42.3%, 22.9%, and 8.8%, respectively (p < 0.001), and 5-year PFS rates of 44.4%, 26.5%, and 11.3%, respectively (p < 0.001). The Kaplan–Meier curves showed that the mortality of elderly ESCC patients in the high-risk group was higher than that in the low-risk group according to the NNPI.Analysis of time-AUC and C-index revealed that the NNPI (C-index: 0.663) had the greatest predictive power on the prognosis in older ESCC patients.ConclusionsIn elderly ESCC patients, the GNRI, BMI, CONUT score, and PAR can be used as objective assessment measures for the risk of nutrition-related death. Compared to the other four indexes, the NNPI has the greatest prognostic value for prognosis, and elderly patients with a higher nutritional risk have a poor prognosis, which is helpful in guiding early clinical nutrition intervention.

Relationship of Inflammatory Parameters and Nutritional Status in Cancer Patients.

Chronic inflammation and cytokine storm can cause uncontrolled events in cancer. Pro-inflammatory molecules released by malignant cells send signals to the brain, liver, and neuroendocrine cells, interfering with appetite and promoting anorexia. Malnutrition in cancer patients is associated with increased treatment toxicity, reduced physical efficiency, and decreased survival. Therefore, early recognition of malnutrition could improve quality of life, treatment compliance, and survival. The aim of the study was to explore the relationship between inflammatory parameters with disease stage and nutritional status in patients with solid cancers. We screened 77 consecutive patients from 3 clinical Institutions in Sicily, Italy, with solid tumors who were either in follow-up after curative treatment or being treated for metastatic disease using the Mini Nutritional Assessment (MNA) questionnaire. Inflammatory parameters, including interleukin 6 (IL6), C-reactive protein (CRP), β2-microglobulin, ferritin, and transferrin were evaluated. A statistically significant difference was found in mean values of IL6, CRP, β2-microglobulin, ferritin, and transferrin between patients without evidence of disease and metastatic patients. Among the metastatic group, there was a significant difference in mean values of these inflammatory parameters between patients with malnutrition and those with normal nutritional status. The difference in average IL6, CRP, β2-microglobulin, and ferritin between patients at risk of malnutrition and those with normal nutritional status was also significant. However, the difference between patients at risk of malnutrition and those with malnutrition was not significant. IL6, CRP, transferrin, ferritin, and β2-microglobulin are functional inflammatory parameters that indicate risk of malnutrition and support the MNA screening test to identify patients with solid tumors who require nutritional support.

Clinical nutrition in surgical oncology: Young AIOM-AIRO-SICO multidisciplinary national survey on behalf of NutriOnc research group.

Malnutrition is a common condition in cancer patients which is usually associated with functional limitations, as well as increased morbidity and mortality. Based on the support of the young sections of Italian Association of Medical Oncology (AIOM), Italian Association of Radiotherapy and Clinical Oncology (AIRO) and Italian Society of Surgical Oncology (SICO) merged into the NutriOnc Research Group, we performed a multidisciplinary national survey with the aim to define the awareness of nutritional issues among healthcare professionals delivering anticancer care. The questionnaire was organized in four sections, as follows: Knowledge and practices regarding Nutritional Management of cancer patients; Timing of screening and assessment of Nutritional Status; Nutritional Treatment and prescription criteria; Immunonutrition and educational topics. The modules focused on esophagogastric, hepato-bilio-pancreatic and colorectal malignancies. Overall, 215 physicians completed the survey. As regards the management of Nutritional Status of cancer patients, many responders adopted the ERAS program (49.3%), while a consistent number of professionals did not follow a specific validated nutritional care protocol (41.8%), mainly due to lack of educational courses (14.5%) and financial support (15.3%). Nearly all the included institutions had a multidisciplinary team (92%) to finalize the treatment decision-making. Cancer patients routinely underwent nutritional screening according to 57.2% of interviewed physicians. The timing of nutritional assessment was at diagnosis (37.8%), before surgery (25.9%), after surgery (16.7%), before radiochemotherapy (13.5%) and after radiochemotherapy (7%). Most of the responders reported that nutritional status was assessed throughout the duration of cancer treatments (55.6%). An important gap between current delivery and need of nutritional assessment persists. The development of specific and defined care protocols and the adherence to these tools may be the key to improving nutritional support management in clinical practice.

Phase Angle, Handgrip Strength, and Other Indicators of Nutritional Status in Cancer Patients Undergoing Different Nutritional Strategies: A Systematic Review and Meta-Analysis.

Malnutrition in cancer patients is one of the most influential factors in the evolution and mortality of such patients. To reduce the incidence of malnutrition, it is necessary to establish a correct nutritional intervention. For this purpose, precise tools and indicators must be developed to determine the patient's condition. The main objective of this systematic review and meta-analysis was to analyze the relationship between different nutritional strategies, phase angle (PA), and handgrip strength in patients with cancer, with the secondary objectives being the modification of other indicators of nutritional status, such as weight and body mass index (BMI). A systematic review of randomized clinical trials was carried out in March 2023 in the databases PubMed, Web of Science, Cochrane, and Scopus. As a risk-of-bias tool, RoB 2.0 was utilized. A total of 8 studies with a total of 606 participants were included in the analysis. A significant increase in PA was observed after the different nutritional strategies (SMD: 0.43; 95% CI: 0.10 to 0.77; p = 0.01; I2 = 65.63%), also detecting a significant increase in handgrip strength (SMD: 0.27, 95% CI: 0.08 to 0.47; p = 0.01; I2 = 30.70%). A significant increase in PA and handgrip were observed in cancer patients subjected to different nutritional strategies. These results suggest that these indicators could be used in the nutritional and functional assessment of the patients.

The Effect of an Educational-Supportive Intervention on the Perceived Stress and Nutritional Status of Breast Cancer Patients Undergoing Chemotherapy

Background: Managing stress and improving the nutritional status of cancer patients can lead to better physical and mental conditions, more desirable treatment outcomes, and improved feelings and engagement in the treatment process. Objectives: This study sought to examine the effect of an educational-supportive intervention on the perceived stress and nutritional status of breast cancer patients undergoing chemotherapy. Methods: This quasi-experimental study was conducted on 80 women with breast cancer admitted to Khatam Al-Anbia (PBUH) and Ali Ibn Abi Talib (AS) hospitals affiliated with Zahedan University of Medical Sciences in 2022. Participants were selected using convenience sampling and randomly divided into 2 intervention and control groups. In the intervention group, participants attended 4 training sessions focusing on the patients’ common problems, proper nutrition, and prescribed treatment. The training session was performed at the patient’s bedside and lasted 45 - 60 minutes. In the control group, patients received no intervention except for hospital routine training. Data were collected from both groups before and 6 weeks after the intervention using the Perceived Stress Scale and patient-generated subjective global assessment (PG-SGA). Data were analyzed using SPSS version 22 using the paired-samples t test, independent samples t test, and chi-square test. Data analysis was performed at a significance level of less than 0.05 (P &lt; 0.05). Results: The mean perceived stress scores were changed from 52.250 ± 2.284 to 32.125 ± 7.390 in the intervention group and 51.475 ± 2.773 to 48.425 ± 2.011 in the control group. The mean perceived stress scores were significantly higher in the intervention group than in the control group (P &lt; 0.001). Moreover, the mean scores of the nutritional status were changed from 7.005 ± 41.40 to 1.94 ± 19.95 in the intervention group and 7.561 ± 40.58 to 5.177 ± 49.65 in the control group. The mean nutritional status scores were significantly higher in the intervention group than in the control group (P &lt; 0.001). Conclusions: Given the positive effect of the educational-supportive intervention on reducing stress and improving nutritional status, these interventions can be incorporated into training and care programs to improve nutritional status and reduce stress in patients with breast cancer.

Is virtual nutritional counseling efficacious for cancer patients during the COVID-19 pandemic?

This study investigates the outcomes of virtual nutritional counseling (VNC) for oncology patients during the Covid-19 pandemic. Our study evaluated the nutritional status data of cancer patients at the baseline and after VNC. An oncology dietitian evaluated the patients by video calling each patient via WhatsApp and sent an individual nutrition diet plan and recommendations via e-mail. Patient-Generated Subjective Global Assessment (PG-SGA) was used as a screening and evaluation tool to assess nutritional status. A total of 157 patients with a mean age of 55.8 ± 14.7 (r = 19–89) were included in the study. Researchers detected at least one nutrition-related sign in 77.7% of patients. After the VNC and based on the final PG-SGA assessments, 62.2% of the patients whose baseline PG-SGA Score-B improved to Score-A, 12.5% with a baseline PG-SGA Score-C improved to Score-A and 54.2% with a baseline Score-C improved to a Score-B (χ2 = 55,000, P < 0.001). Based on the number of VNCs, the improvement in malnutrition status following two sessions and three or more sessions was found to be 17.6% and 35.7%, respectively (P < 0.001). Our results confirm that VNC can improve the nutritional status of cancer patients. Hence, nutritional counseling should be an integral part of oncological treatment.

The relationship between nutritional status before chemotherapy with nutritional status after chemotherapy in locoregionally advanced nasopharyngeal carcinoma patients

Background: Malnutrition in nasopharyngeal carcinoma (NPC) patients is caused by various factors such as tumor localization, metabolic derangement, and side effects of therapy. Poor nutritional status in cancer patients is associated with serious clinical consequences such as poor quality of life, higher treatment toxicity, and poor prognosis. The purpose of this study was to determine the effect of nutritional status before chemotherapy on the nutritional status after chemotherapy in non-metastatic advance-stage NPC patients. Methods: This study was an observational study with a cross sectional design using secondary data involving non-metastatic advanced-stage NPC patients undergoing chemotherapy at dr. Kariadi Hospital Semarang in January 2020 – June 2022. The sampling technique used was consecutive sampling. Nutritional status was measured by malnutrition criteria according to the American Society for Parenteral and Enteral Nutrition (ASPEN). Statistical analysis was performed with Chi-Square and McNemar analysis test. Results: Total sample of this study was 55 subjects. The results of this study were there was a relationship between nutritional status before chemotherapy and nutritional status after chemotherapy in non-metastatic advanced-stage NPC patients (P&lt;0.05). All subjects were malnourished before chemotherapy, with 12.7% moderately malnourished and 87.3% severely malnourished. All subjects were malnourished after chemotherapy, with 41.8% moderately malnourished and 58.2% severely malnourished, decreased nutritional status of post-chemotherapy non-metastatic advanced NPC patients was related to the length of chemotherapy (p&lt;0.05), but not related to comorbidities, age, and stage of chemotherapy (p&gt;0.05). Conclusion: There is a relationship between nutritional status before chemotherapy and nutritional status after chemotherapy in non-metastatic advanced-stage NPC patients.

Malnutrion In Patient Cancer

Nutrition is an important part on the implementation of cancer, both in patients who are undergoing therapy, restoration of the therapy, in a State of remission or to prevent a recurrence. Nutritional status in cancer patients is known to correlate with response therapy, prognosis and quality of life. More or less 30-87% of cancer patients experiencing malnutrition before undergoing therapy. The incidence of malnutrition vary depending on the origin of cancer, for example in patients with pancreatic cancer and gaster are experiencing malnutrition to 85%, 66% in lung cancer, and 35% in breast cancer. One of the problems of nutrients that need attention in cancer patients is the kaheksia. The malnutrition common in advance because the nutrition component of the intake not as recommended.

The dietary risk factors on cancer patients receiving chemotherapy and correlation between serum vitamin D and B12 levels, depression and anxiety status.

Objective: the aim of this study is to evaluate the relationship between serum vitamin D and B12 levels, nutritional levels, depression, and anxiety in adult cancer patients before and after chemotherapy. Methods: a case-controlled study was carried out on 44 patients who were diagnosed with cancer and applied to the Chemotherapy Unit for treatment (patient group, PG) and 44 volunteer individuals (control group, CG) with similar characteristics to the age and gender-matched patient group but with no diagnosis of cancer. Results: the average age of individuals in PG is 52.50 ± 12.21 years and for those in CG is 52.84 ± 10.98 years. Serum D and B12 levels in the first cure in individuals in PG are higher than in the last treatment (p > 0.05). It was determined that vitamin C taken with a daily diet reduces the risk of cancer (OR: 0.920, 95 % CI: 0.899-0.942, p = 0.042). No correlation was found between depression and anxiety scores of both groups and serum vitamin D and B12 levels (p > 0.05). It was determined that the Beck Anxiety Inventory (BAI) score increased with decrease in body mass index (BMI) (β = 0.311, p = 0.040) and serum vitamin B12 level (β = -0.406, p = 0.006). In addition, it was found that the increase in the Patient-Generated Subjective Global Assessment (PG-SGA) score, which reflects the nutritional status of cancer patients, worsened the level of anxiety (β = 0.389, p = 0.009). Conclusions: as stated in the findings of the study, chemotherapy treatment mediated the development of anxiety in cancer patients by changing the vitamin B12 levels and anthropometric characteristics with its negative effect on nutritional status. It should be ensured that cancer patients treated with chemotherapy follow a healthy and balanced diet plan that is suitable for their needs and has adequate vitamin and mineral content.

Application of bioelectrical impedance analysis in monitoring patients with head and neck cancer after surgical intervention.

It is estimated that about 60% of patients with head and neck cancer (HNC) show poor nutritional status, and approximately 80% lose weight during treatment. The impact of surgical procedures on the risk of further weight loss, severe malnutrition and cachexia is a significant clinical problem that determines the higher incidence of postoperative complications, reduced effectiveness of the treatment used, longer hospitalization time, poor quality of life and higher mortality among patients. Bioelectrical impedance analysis (BIA) is currently recognized as a useful method of assessing the body composition and therefore the nutritional status of cancer patients. The aim of this study is to investigate whether measured and calculated parameters of BIA change shortly after surgery and could reflect the health of cells and body composition changes. We enrolled 54 patients (males) with advanced HNC in this observational study. We collected detailed anthropometric and BIA derived data. The Subjective Global Assessment (SGA) was used to assess the nutrition. In the assessment performed one week after the surgery, compared to the condition on the day of surgery, the patients had significantly lower values of nutritional status (weight; body mass index - BMI; SGA), body composition (free fat mass - FFM; intracellular fluid - ICF; total body water - TBW). Other changes include a significant increase in fat mass (FM) or extracellular fluid (ECF). Moreover, a significant reduction of phase angle (PA, one of the most important BIA derived prognostic factors) was also noted. Apart from the baseline assessment of the body composition and diagnosing nutritional disorders, it seems, that BIA should be considered also in the monitoring of HNC patients undergoing surgery.

Exploration of phase angle used to construct PG-SGA nutritional assessment and prediction model for malignant tumor patients

Objective: To explore the value of phase angle (PA) in constructing a predictive model of nutrition evaluation for tumor patients. Methods: A retrospective analysis was performed on 1 129 patients with malignant tumors hospitalized in the Cancer Center of Changzhi People's Hospital from June 2020 to February 2021. PA values of six parts of the body were measured by the body composition analyzer, including: left arm (LA), right arm (RA), left leg (LL), right leg (RL), the trunk (TR), and the whole body (WB). Patients' body mass index (BMI) was calculated and patient-generated subjective global assessment (PG-SGA) was assessed. The differences of PA values of six parts were compared and their correlations with BMI and PG-SGA in combination with age, gender and tumor disease types were analyzed, binary classification regression on BMI and PG-SGA was performed, and the functions of the best prediction model was fitted. Decision tree, random forest, Akaike information criterion in a Stepwise Algorithm (stepAIC) and generalized likelihood ratio test were used to select appropriate variables, and the logit logistic regression model was used to fit the data. Results: Comparing the PA values of six parts in pairs, it was found that the PA values of LA and RA, LL and RL, and TR and WB were linearly correlated and the coefficient was close to 1 (P<0.001). Binary classification regression was performed for BMI and PG-SGA, respectively. In order to make the data have clinical significance, 18.5 kg/m(2) was used as the classification point for BMI, 4 and 9 were used as the classification points for PG-SGA score, and the models of A, B and C were obtained. Suitable variables including PA-LA, PA-TR and tumor disease types were used as variables to fit BMI classification; BMI, PA-LA and age were used as variables to fit the PG-SGA model with 9 as the classification point. PA-LA, PA-TR, BMI, age and tumor disease types were used as variables to fit the PG-SGA model with 4 as the classification point. In this study, the predicted values of models A, B and C obtained by R-studio were imported into SPSS 26.0 software, and the cut-off values of classification were obtained by the receiver operating characteristic (ROC) curve. The ROC analytic results showed that the best cut-off values of Model A, B and C were 0.155, 0.793 and 0.295. Model A recommended when the probability is >0.155, a patient's nutritiond tatus should be classified as BMI < 18.5 kg/m(2) group. Model B recommended that PG-SGA<9 group be classified as the probability is >0.793. Model C recommended that PG-SGA < 4 group should be classified when probability is >0.295. Conclusions: The PG-SGA classification prediction model is simple to operate, and the nutritional status of patients can be roughly divided into three groups: normal or suspected malnutrition group (PG-SGA<4), moderate malnutrition group (4≤PG-SGA<9), and severe malnutrition group (PG-SGA≥9). This model can more efficiently predict the nutritional status of cancer patients, greatly simplify the nutritional assessment process, and better guide the standardized treatment of clinical malnutrition.

The Role of Standardized Phase Angle in the Assessment of Nutritional Status and Clinical Outcomes in Cancer Patients: A Systematic Review of the Literature.

Compared with the phase angle (PA), the predictive ability of the standardized phase angle (SPA) in assessing nutritional status and clinical outcomes in cancer patients remains uncertain. This review aimed to assess (1) the relationship between SPA and nutritional status and clinical outcomes (including complications and survival) in cancer patients; (2) the predictive ability of SPA alone and in comparison with the predictive ability of PA; and (3) the cut-off value of SPA in cancer patients. Studies that addressed the relationship of SPA use to nutritional status, complications, and survival in cancer patients were searched and identified from six electronic databases (PubMed, Medline, CINAHL, Embase, Web of Science, and the Cochrane Library). The included studies were considered to meet the following criteria: English studies with original data that reflected the effects of SPA on nutritional status and clinical outcomes (including complications and survival) and reported a cut-off value of SPA in cancer patients aged ≥18. Thirteen studies that included a total of 2787 participants were evaluated. Five studies assessed the relationship between SPA and nutritional status, and four of them reported a positive relationship between SPA and nutritional status in cancer patients, even considering SPA as a predictor. Twelve studies assessed the relationship between SPA and clinical outcomes in cancer patients. Two-thirds of the studies that evaluated complications reported the predictive ability of SPA; 30% of survival studies reported a positive relationship, 40% reported SPA as a predictor, and 30% reported no relationship. The standard cut-off value for SPA has not yet been determined. Data from the selected studies suggest that SPA might be a predictor of nutritional status. Further studies are needed to determine the value of SPA in predicting nutritional status and clinical outcomes in cancer patients.

Findings from Positron Emission Tomography-Computed Tomography with 18F-Fluorodeoxyglucose Uncover a Potential Marker of Nutritional Status in Cancer Patients: A Cross-Sectional Pilot Study

Background Cancer patients often have altered nutritional status and periodically undergo imaging tests. We hypothesized that standard uptake values (SUV) by positron emission tomography-computed tomography (PET/CT) with 18 F-fluorodeoxyglucose (18F-FDG) could be associated with the nutritional status of cancer patients. Materials and Methods Adult cancer patients who underwent clinical evaluation and PET/CT with 18 F-FDG on the same day were included in a cross-sectional pilot study. The focus was on evaluating 18 F-FDG findings with regard to nutritional status, with an emphasis on liver SUVmean and tumor SUVmax. Results A total of 179 patients were evaluated. One hundred and three (57.5%) were classified as well-nourished, 54 (30.1%) as suspected/moderately malnourished, and 22 (12.2%) as severely malnourished. The median hepatic SUVmean was 2.29, with 1.87 corresponding to the 10th percentile. There was a significant difference between the severely malnourished (2.02) and well-nourished or suspected/moderately malnourished (2.36) patients. Severely malnourished patients were more likely to have a SUVmean < 1.87 (p = .035). The tumor SUVmax also was significantly higher in severely malnourished patients (p = .003). Conclusion Cancer patients with severe malnutrition have lower values of hepatic SUVmean and higher values of tumor SUVmax in PET/CT with 18F-FDG when compared to well-nourished patients.

Relationship between Preoperative Nutritional Status and Clinical Outcomes in Patients with Head and Neck Cancer

The nutritional status in cancer patients is related to cancer survival and surgical outcome. The objective of this study was to examine the relationship between preoperative prognostic nutritional index (PNI) and post-operative clinical outcomes in head and neck cancer (HNC) patients. A total of 1282 head and neck cancer patients receiving surgical resection in Changhua Christian Hospital between 1 January 2010 and 30 August 2021 were recruited in the final analysis after undergoing propensity score matching analysis. The logistic regression model was used to assess the association of the PNI group with overall and various complications. The patients in the high PNI group had a significant lower incidence of overall complications, medical complications, and pulmonary complications; but not significant surgical complications. The high PNI group had lower mortality risk. The results in this study revealed that PNI score was a significant independent predictor of postoperative complications in HNC patients undergoing surgical resection. We recommend preoperative testing and evaluation of HNC patients to identify low PNI and high-risk groups for postoperative surveillance.

A large, multi-centre prospective study demonstrating high prevalence of malnutrition associated with reduced survival in ambulatory systemic anti-cancer therapy patients.

The nutritional status of cancer patients is highly variable, and known to impact on clinical outcomes. To date, no large study evaluating the nutritional status of Irish cancer patients has been reported. The aim of this study was to describe the nutritional status, using gold standard methods, of a large cohort of ambulatory oncology patients receiving Systemic Anti-Cancer Therapy and to assess the impact of abnormal body composition phenotypes on survival. A prospective study in adults undergoing Systemic Anti-Cancer Therapy for solid tumours enrolled patients between 2012 and 2016. Baseline details were collected incorporating demographics, cancer pathology, lifestyle, body composition (by computed tomography (CT), and inflammatory status. Skeletal muscle index (SMI) and mean muscle attenuation (MA) were obtained from CT images and categorised to low muscle mass and low MA using previously published sex specific cut points. Survival was monitored for a median of 25 months [IQR:10-46 months]. Survival analyses were conducted using multivariate Cox Proportional Hazards Models. Of 1015 patients recruited, 940 patients with an evaluable CT were included in this analysis. Median age was 64 years [IQR 55-71] and 56% were male. Colorectal cancer (28%) and gastro-oesophageal (16%) were the most common diagnoses and 58% of patients had stage IV disease. Despite 56% being overweight or obese (BMI >25kg/m2), 52% were weight losing and 17% had lost >10% body weight. Cancer Cachexia (CC) was present in 42%, 39% had low muscle mass (MM) (sarcopenia) and 45% had low MA. Overall, 73% of patients exhibited an abnormal body composition (BC) phenotype (≥1 of CC, low MM/MA). Overall survival was significantly lower in those with abnormal BC phenotype, independent of site, stage, sex, ECOG and mGPS (HR: 1.416 [95% CI: 1.069-1.875], p=0.015). Malnutrition and abnormal body composition phenotypes are common in cancer, but are often masked by adiposity. Appropriate screening and diagnostic tools should consider this co-presentation of overweight and obesity, alongside muscle depletion. Given that abnormal body composition phenotypes detectable only via CT are associated with reduced survival, these should be more widely employed to identify patients at risk of poor prognosis, and allow potentially more effective, early intervention.

Nutrition Status of Cancer Patients Attending Oncology Unit at Birat Medical College

Introduction: Malnutrition is a major problem in cancer patients which results in high morbidity and mortality. There are lack of comprehensive centers providing nutritional support to cancer patients in eastern region of Nepal. Objective: The objective of this study was to analyze the malnutrition status of cancer patients at Birat Medical College. It aimed to calculate the prevalence of malnutrition in cancer patients. Methodology: This descriptive cross sectional observational study of six months duration was conductedfrom 15th January 2021 to 15th July 2021 in the department of Oncology at Birat Medical College Teaching Hospital.All the histologically proven cancer patients during the study period were taken as study population whose body mass index were calculated. The relevant data were maintained inexcel sheet and analysis was done with the help of statistical software SPSS version22. Results: A total of 70 cases attended oncology unit during the study duration at Birat Medical College. The mean age of the cases were60 years (range 21-85) with the proportion of female patients almost equal(53%) to that of males. There was total 28 (40%) malnutrition cases out of which 22% were overweight,17% were underweight and only 1% obese. During the study period total 50% of the malnutrition cases were alive and 50% cases expired due to disease progression. Conclusion: Malnutrition is a major concern worldwide and even in cancer patients of Nepal. There is a need of comprehensive cancer center providing nutritional support to cancer patients in eastern region of Nepal.

291P Assessment of nutritional status in cancer patients using patient generated subjective global assessment screening tool

Malnutrition is one of the most frequent disorders in cancer patients which accounts for 50-90%. This high prevalence of malnutrition is very concerning as it is associated with reduced treatment efficacy, functional status, quality of life and survival. The prevalence of malnutrition varies with tumor type, site and the stage of the disease. The highest prevalence of cancer patients with nutritional deficits is seen in those with tumors of the gastrointestinal tract and lung.

Effect of Integrated Nurse-Guided Psychological Intervention on Nutritional Status of Head and Neck Cancers (HNC) Patients Undergoing Radiotherapy: A Randomized Controlled Study

<h3>Purpose/Objective(s)</h3> Malnutrition is common in HNC patients and was considered as a poor prognostic factor of radiotherapy (RT). Studies have shown that psychological intervention may improve the nutritional status of cancer patients during treatment. We hypothesize that the compliance with nutritional advice and nutrition status of HNC patients during RT can be improved by integration of nurse-guided psychological intervention into clinical nutrition management. <h3>Materials/Methods</h3> From October 2020 to February 2021, a total of 70 HNC patients who received postoperative radio(chemo)therapy in our department were randomly divided into two groups. Compared with patients in control group, patients in study group received psychological intervention under the guidance of nurses (at least once a week) on the basis of routine nutritional support. Anxiety (SAS scale), depression (SDS scale), nutritional status (PG-SGA score, body weight, BMI, albumin, and hemoglobin) and treatment dependence scale (treatment dependence scale) of patients were collected before radiotherapy (within 1 week), during radiotherapy (at the 20th treatment), at the end of radiotherapy, and 3 months after radiotherapy, respectively. <h3>Results</h3> There were no significant differences in anxiety and depression scores, nutritional status, and treatment dependence between the two groups before RT. In study group, the scores of anxiety and depression decreased significantly after RT than before RT (SAS: 52.46 ± 7.23 vs 60.05 ± 6.54, <i>p</i> =0.032; SDS: 50.66 ± 6.92 vs 59.55 ± 5.98, <i>p</i> = 0.037), while there was no significant difference in the scores before and after RT in control group (SAS, 60.22 ± 6.97 vs 59.91 ± 6.69, <i>p</i> = 0.648; SDS, 59.26 ± 6.01 vs 58.62 ± 8.33, <i>p</i> = 0.675). The nutritional status of the study group during and after radiotherapy were significantly better than those of the control group (body weight (kg), 62.33 ± 4.27 vs 60.24 ± 4.76, <i>p</i> = 0.037, BMI (kg/m²), 20.24 ± 3.72 vs 20.33 ± 2.25, <i>p</i> = 0.043; Alb (g/L), 35.41 ± 4.36 vs 34.27 ± 4.19, <i>p</i> = 0.028; Hb (g/L), 130.60 ± 15.63 vs 122.43 ± 13.98, <i>p</i> = 0.041). During RT, the compliance with nutritional advice was better in study group than in control group (3.56 ± 0.63 vs 1.42 ± 0.28, <i>p</i> = 0.013). <h3>Conclusion</h3> The integration of psychological intervention under the guidance of nurses into clinical management can relieve anxiety and depression in HNC patients undergoing RT, and improve the nutritional status and therapeutic compliancy of patients.

Predictive value of the preoperative prognostic nutritional index for postoperative progression in patients with pancreatic neuroendocrine neoplasms.

ObjectiveThe preoperative nutritional status of cancer patients is closely related to prognosis. The prognostic nutritional index (PNI) has been shown to predict the prognosis of a variety of tumors, but its study in pancreatic neuroendocrine neoplasms (pNENs) is lacking. The aim of the present study is to investigate the predictive value of the preoperative PNI for postoperative progression in patients with pNENs.MethodsThe medical records of 181 patients with pNENs, who underwent surgery, were retrospectively analyzed. A time-dependent receiver operating characteristic (ROC) curve was plotted to determine the optimal cut-off value of the preoperative PNI. Correlations between the preoperative PNI and clinicopathological parameters were analyzed using multiple linear regression. A Kaplan-Meier curve was applied to assess the progression-free survival (PFS) rate, which was tested using a log rank. Univariate and multivariate Cox proportional risk regression models were used to analyze the predictive value of the preoperative PNI on prognosis.ResultsThe optimal cut-off value of the preoperative PNI was 48.275. The patients were divided into a high PNI group (PNI > 48.275, n = 92) and a low PNI group (PNI ≤ 48.275, n = 89). The proportion of patients with tumor progression after surgery was significantly higher in the low PNI group compared with that in the high PNI group (P = 0.004). The Kaplan-Meier curve showed that the PFS rate after surgery was significantly lower in the low PNI group compared with that in the high PNI group (P = 0.026). The preoperative PNI was an independent predictor of PFS (HR: 2.727, 95% CI: 1.174∼6.333, P = 0.020).ConclusionThe preoperative PNI has a predictive value for postoperative progression in patients with pNENs.