Nutritional status and symptom burden in advanced non-small cell lung cancer: results of the dietetic assessment and intervention in lung cancer (DAIL) trial

Abstract

IntroductionEuropean Society for Clinical Nutrition and Metabolism guidelines recommend that patients with cancer should be screened for malnutrition at diagnosis. The dietetic assessment and intervention in lung cancer study investigated the nutritional status of patients with non-small cell lung cancer (NSCLC) and the need for dietetic intervention.MethodsIn this observational cohort pilot study, patients with stage 3b and 4 NSCLC were assessed prior to starting first line systemic anticancer therapy (SACT) with a range of measurements and questionnaires. We report the outcomes related to the Patient Generated Subjective Global Assessment tool (PG-SGA),Results96 patients were consented between April 2017 and August 2019. The PG-SGA identified that 78% of patients required specialist nutritional advice; with 52% patients having a critical need for dietetic input and symptom management. Results were dominated by symptom scores. As a screening test, one or more symptoms or recent weight loss history had a sensitivity of 88% (95% CI 78.44% to 94.36%) and specificity of 95.24% (95% CI 76.18% to 99.88%) for need for dietetic intervention.ConclusionA large proportion of patients with NSCLC have a high symptom burden and are at risk of malnutrition prior to starting SACT and would benefit from dietetic review. It is imperative that oncologists and healthcare professionals discuss weight loss history and symptoms with lung cancer patients to correct nutritional deficiencies and resolve symptoms prior to starting treatment.

Hypoalbuminaemia as a Prognostic Biomarker of First-Line Treatment Resistance in Metastatic Non-small Cell Lung Cancer

“…Interventions to optimise physical functional and nutritional status may be employed based on the needs of the patient (18, [43][44][45][46]. Patients with metastatic NSCLC often have multiple pre-existing comorbidities and a high cancer-symptom burden (47). In our cohort, 64 (16%) had pre-treatment PS2+, which is consistent with that seen in previous real-world studies (48).…”

“…Overall, this is a patient group who were likely to require intensive, specialist, multi-modal intervention to maximise their fitness. For example, recent data has suggested that half of the patients with metastatic NSCLC who are fit for SACT meet the criteria for the critical need to see a dietician (47).…”

Effect of Megestrol Acetate Combined With Oral Nutrition Supplement in Malnourished Lung Cancer Patients: A Single-Center Prospective Cohort Study

“…Nutrition risk score 2002 (NRS2002) and PG-SGA are recommended for nutritional risk screening and nutritional assessment in cancer patients ( 9 – 12 ). Dietetic assessment and intervention in lung cancer (DAIL) trial revealed that PG-SGA identified 78% of patients required specialist nutritional advice, with 52% patients having a critical need for dietetic input and symptom management ( 16 ). Higher malnutrition risk and elevated inflammatory status in patients with lung cancer were associated with poor overall survival independently ( 17 ).…”

“…Toxicities induced by the study treatment were negligible and comparable between Arm1 and Arm 2 (Table 6). for dietetic input and symptom management (16). Higher malnutrition risk and elevated inflammatory status in patients with lung cancer were associated with poor overall survival independently (17).…”

Early dietitian referral in lung cancer: use of machine learning

“…Cancer associated malnutrition has resulted in greater challenges when delivering chemotherapy 4–7. Assessing nutritional status early is, therefore, vital in patients with advanced lung cancer 8 9…”