Prevalence, risk factors and clinical implications of malnutrition in French Comprehensive Cancer Centres

M Pressoir, S Desné, D Berchery, G Rossignol, B Poiree, M Meslier, S Traversier, M Vittot, M Simon, J P Gekiere, J Meuric, F Serot, M N Falewee, I Rodrigues, P Senesse, M P Vasson, F Chelle, B Maget, S Antoun, P Bachmann, M Pressoir, S Desné, D Berchery, G Rossignol, B Poiree, M Meslier, S Traversier, M Vittot, M Simon, J P Gekiere, J Meuric, F Serot, M N Falewee, I Rodrigues, P Senesse, M P Vasson, F Chelle, B Maget, S Antoun, P Bachmann

Abstract

Background: This epidemiological observational study aimed at determining the prevalence of malnutrition in non-selected adults with cancer, to identify risk factors of malnutrition and correlate the results with length of stay and 2-month mortality.

Methods: This prospective multicentre 1-day study conducted in 17 French Comprehensive Cancer Centres included 1545 patients. Body mass index (BMI), weight loss (WL) in the past 6 months and age were routinely recorded according to the French national recommendations for hospitalised patients; malnutrition was rated as absent, moderate or severe according to the level of WL and BMI. Age, sex, tumour site, type of hospitalisation and treatment, disease stage, World Health Organisation performance status (PS) and antibiotic therapy were the potential malnutrition risk factors tested. Follow-up at 2 months allowed to determine the correlation with length of stay and mortality.

Results: Malnutrition was reported in 30.9% of patients, and was rated as severe in 12.2%. In multivariate analysis, only pre-existing obesity (BMI> or =30), PS > or =2 and head-and-neck or upper digestive cancers were associated with increased risk of malnutrition. Antibiotics use was significantly higher in malnourished patients (35.5 vs 22.8%; P<0.001). Severe malnutrition was independently associated with mortality. The median length of stay was 19.3+/-19.4 days for malnourished patients vs 13.3+/-19.4 days for others (P<0.0001).

Conclusion: In French Comprehensive Cancer Centres, one out of three cancer patients are malnourished and this was associated with a longer length of stay. Pre-existing obesity could be identified as a new risk factor for malnutrition in our cancer patient population perhaps because of a misidentification or a delay in nutrition support in this category of patients.

References

    1. Andreyev HJ, Norman AR, Oates J, Cunningham D (1998) Why do patients with weight loss have a worse outcome when undergoing chemotherapy for gastrointestinal malignancies? Eur J Cancer 34: 503–509
    1. Arends J, Bodoky G, Bozzetti F, Fearon K, Muscaritoli M, Selga G, van Bokhorst-de van der Schueren MA, von Meyenfeldt M, Zürcher G, Fietkau R, Aulbert E, Frick B, Holm M, Kneba M, Mestrom HJ, Zander A (2006) ESPEN Guidelines on enteral nutrition: non-surgical oncology. Clin Nutr 25: 245–259
    1. Bozzetti F (2009) Screening the nutritional status in oncology: a preliminary report on 1000 outpatients. SCRINIO Working Group. Support Care Cancer 17: 279–284
    1. Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ (2003) Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med 348: 1625–1638
    1. Chumlea WC, Roche AF, Steinbaugh ML (1985) Estimating stature from knee height for persons 60 to 90 years of age. J Am Geriatr Soc 33: 116–120
    1. Claudot F, Fresson J, Coudane H, Guillemin F, Demore B, Alla F (2008) [Research in clinical epidemiology: which rules should be applied?]. Rev Epidemiol Sante Publique 56: 63–70
    1. Cleveland RJ, Eng SM, Abrahamson PE, Britton JA, Teitelbaum SL, Neugut AI, Gammon MD (2007) Weight gain prior to diagnosis and survival from breast cancer. Cancer Epidemiol Biomarkers Prev 16: 1803–1811
    1. Correia MI, Waitzberg DL (2003) The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr 22: 235–239
    1. Dewys WD, Begg C, Lavin PT, Band PR, Bennett JM, Bertino JR, Cohen MH, Douglass Jr HO, Engstrom PF, Ezdinli EZ, Horton J, Johnson GJ, Moertel CG, Oken MM, Perlia C, Rosenbaum C, Silverstein MN, Skeel RT, Sponzo RW, Tormey DC (1980) Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern Cooperative Oncology Group. Am J Med 69: 491–497
    1. Dignam JJ, Polite BN, Yothers G, Raich P, Colangelo L, O’Connell MJ, Wolmark N (2006) Body mass index and outcomes in patients who receive adjuvant chemotherapy for colon cancer. J Natl Cancer Inst 98: 1647–1654
    1. Griggs JJ, Sorbero ME, Lyman GH (2005) Undertreatment of obese women receiving breast cancer chemotherapy. Arch Intern Med 165: 1267–1273
    1. Izawa S, Enoki H, Hirakawa Y, Masuda Y, Iwata M, Hasegawa J, Iguchi A, Kuzuya M (2007) Lack of body weight measurement is associated with mortality and hospitalization in community-dwelling frail elderly. Clin Nutr 26: 764–770
    1. Johansen N, Kondrup J, Plum LM, Bak L, Norregaard P, Bunch E, Baernthsen H, Andersen JR, Larsen IH, Martinsen A (2004) Effect of nutritional support on clinical outcome in patients at nutritional risk. Clin Nutr 23: 539–550
    1. Kruizenga HM, Van Tulder MW, Seidell JC, Thijs A, Ader HJ, Van Bokhorst-de van der Schueren MA (2005) Effectiveness and cost-effectiveness of early screening and treatment of malnourished patients. Am J Clin Nutr 82: 1082–1089
    1. Kruizenga HM, Wierdsma NJ, van Bokhorst-de van der Schueren MA, Haollander HJ, Jonkers-Schuitema CF, van der Heijden E, Melis GC, van Staveren WA (2003) Screening of nutritional status in the Netherlands. Clin Nutr 22: 147–152
    1. Landi F, Onder G, Gambassi G, Pedone C, Carbonin P, Bernabei R (2000) Body mass index and mortality among hospitalized patients. Arch Intern Med 160: 2641–2644
    1. Li D, Morris JS, Liu J, Hassan MM, Day RS, Bondy ML, Abbruzzese JL (2009) Body mass index and risk, age of onset, and survival in patients with pancreatic cancer. JAMA 301: 2553–2562
    1. Majed B, Moreau T, Senouci K, Salmon RJ, Fourquet A, Asselain B (2008) Is obesity an independent prognosis factor in woman breast cancer? Breast Cancer Res Treat 111: 329–342
    1. McTiernan A (2005) Obesity and cancer: the risks, science, and potential management strategies. Oncology 19: 871–881
    1. Nitenberg G, Raynard B (2000) Nutritional support of the cancer patient: issues and dilemmas. Crit Rev Oncol Hematol 34: 137–168
    1. Norman K, Pichard C, Lochs H, Pirlich M (2008) Prognostic impact of disease-related malnutrition. Clin Nutr 27: 5–15
    1. Nourissat A, Mille D, Delaroche G, Jacquin JP, Vergnon JM, Fournel P, Seffert P, Porcheron J, Michaud P, Merrouche Y, Chauvin F (2007) Estimation of the risk for nutritional state degradation in patients with cancer: development of a screening tool based on results from a cross-sectional survey. Ann Oncol 18: 1882–1886
    1. Pirlich M, Schutz T, Norman K, Gastell S, Lubke HJ, Bischoff SC, Bolder U, Frieling T, Güldenzoph H, Hahn K, Jauch KW, Schindler K, Stein J, Volkert D, Weimann A, Werner H, Wolf C, Zürcher G, Bauer P, Lochs H (2006) The German hospital malnutrition study. Clin Nutr 25: 563–572
    1. Prado CM, Lieffers JR, McCargar LJ, Reiman T, Sawyer MB, Martin L, Baracos VE (2008) Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol 9: 629–635
    1. Prado CM, Baracos VE, McCargar LJ, Mourtzakis M, Mulder KE, Reiman T, Butts CA, Scarfe AG, Sawyer MB (2007) Body Composition as an independent determinant of 5-fluorouracil-based chemotherapy toxicity. Clin Cancer Res 13: 3264–3268
    1. Ross PJ, Ashley S, Norton A, Priest K, Waters JS, Eisen T, Smith IE, O’Brien ME (2004) Do patients with weight loss have a worse outcome when undergoing chemotherapy for lung cancers? Br J Cancer 90: 1905–1911
    1. Schneider SM, Veyres P, Pivot X, Soummer AM, Jambou P, Filippi J, van Obberghen E, Hébuterne X (2004) Malnutrition is an independent factor associated with nosocomial infections. Br J Nutr 92: 105–111
    1. Segura A, Pardo J, Jara C, Zugazabeitia L, Carulla J, de Las Peñas R, García-Cabrera E, Luz Azuara M, Casadó J, Gómez-Candela C (2005) An epidemiological evaluation of the prevalence of malnutrition in Spanish patients with locally advanced or metastatic cancer. Clin Nutr 24: 801–814
    1. Tucker HN, Miguel SG (1996) Cost containment through nutrition intervention. Nutr Rev 54: 111–121
    1. van Kruijsdijk RC, van der Wall E, Visseren FL (2009) Obesity and cancer: the role of dysfunctional adipose tissue. Cancer Epidemiol Biomarkers Prev 18: 2569–2578

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit