Malnutrition Predicts Clinical Outcome in Patients with Neuroendocrine Neoplasia

Abstract

Malnutrition is a common problem in oncological diseases, influencing treatment outcomes, treatment complications, quality of life and survival. The potential role of malnutrition has not yet been studied systematically in neuroendocrine neoplasms (NEN), which, due to their growing prevalence and additional therapeutic options, provide an increasing clinical challenge to diagnosis and management. The aim of this cross-sectional observational study, which included a long-term follow-up, was therefore to define the prevalence of malnutrition in 203 patients with NEN using various methodological approaches, and to analyse the short- and long-term outcome of malnourished patients. A detailed subgroup analysis was also performed to define risk factors for poorer outcome. When applying malnutrition screening scores, 21-25% of the NEN patients were at risk of or demonstrated manifest malnutrition. This was confirmed by anthropometric measurements, by determination of serum surrogate parameters such as albumin as well as by bioelectrical impedance analysis (BIA), particularly phase angle α. The length of hospital stay was significantly longer in malnourished NEN patients, while long-term overall survival was highly significantly reduced. Patients with high-grade (G3) neuroendocrine carcinomas, progressive disease and undergoing chemotherapy were at particular risk of malnutrition associated with a poorer outcome. Multivariate analysis confirmed the important and highly significant role of malnutrition as an independent prognostic factor for NEN besides proliferative capacity (G3 NEC). Malnutrition is therefore an underrecognized problem in NEN patients which should systematically be diagnosed by widely available standard methods such as Nutritional Risk Screening (NRS), serum albumin assessment and BIA, and treated to improve both short- and long-term outcomes.

Bone Metabolism and Vitamin D Implication in Gastroenteropancreatic Neuroendocrine Tumors

“…Bone health is strictly connected with nutritional status, which has been reported to be altered in 14% to 25% of NET patients [64][65][66]. Particularly, patients with high-grade (G3) NET, progressive disease, and who are undergoing chemotherapy are at high risk of malnutrition (57.9%, 39.5%, and 42.3% respectively) [64].…”

The management of neuroendocrine tumours: A nutritional viewpoint

“…One of the most used tool to assess malnutrition is the malabsorption universal screening tool (MUST) (BAPEN 2015). However, the assessment of malnutrition in patients with GEP-NETs has been only reported in a single very recent study to date (Maasberg et al 2017).…”

Nutritional experiences in head and neck cancer patients

“…Specialised nutrition competencies and skills are needed to make early detections of patients in need of nutritional support and to assess and initiate relevant nutritional support. Hospital stays are longer and costs per hospitalisation are higher in malnourished cancer patients, thus actions that may delay or prevent hospital admissions during treatment are desired (Maasberg et al, ; Planas et al, ; Pressoir et al, ). Updated international clinical guidelines on nutritional support in cancer patients recommend that dietitians play a central role in the multidisciplinary team responsible for the supportive care of HNC patients (Arends, Bachmann, et al, ; Thompson et al, ).…”