Nutritional support during the hospital stay is cost-effective for preventing adverse outcomes in patients with cancer

Schüetz, Philipp; Sulo, Suela; Walzer, Stefan; Krenberger, Sebastian; Brunton, Cory

doi:10.3389/fonc.2022.916073

Cited by 5 publications

(4 citation statements)

References 29 publications

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“…Altogether, the results of the PreMiO [ 6 ] and NUTRIONCO studies highlight the importance of a timely and careful evaluation of nutritional risk in cancer patients, in particular those with non-metastatic disease, through early screenings and continuous application of supportive treatments. Strategies to limit or prevent cancer cachexia and improve nutritional status include support for cancer patients at nutritional risk with oral nutritional supplements, specific nutrients, and enteral or parenteral nutrition [ 46 ], i.e., relatively low-cost interventions that have not only clinical, but also financial benefits, with proven cost-effectiveness [ 47 ]. Other early strategies are based on the clinical management of symptoms that impede proper food intake (e.g., pain, depression, nausea, vomiting).…”

Section: Discussionmentioning

confidence: 99%

The Impact of NUTRItional Status at First Medical Oncology Visit on Clinical Outcomes: The NUTRIONCO Study

Muscaritoli

Modena

Valerio

et al. 2023

Cancers

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Malnutrition affects up to 75% of cancer patients and results from a combination of anorexia and metabolic dysregulation. Metabolic and nutritional abnormalities in cancer patients can lead to cachexia, a multifactorial syndrome characterized by involuntary loss of skeletal muscle mass, systemic inflammation and increased protein catabolism. Cancer cachexia negatively affects patients’ outcomes, response to anticancer treatments, quality of life, and survival. However, risk of malnutrition, and cachexia are still under-recognized in cancer patients. The Prevalence of Malnutrition in Oncology (PreMiO) study revealed that 51% of patients already had nutritional deficiencies at their first medical oncology visit. Here, we report the results of the subsequent retrospective, observational NUTRItional status at first medical oncology visit ON Clinical Outcomes (NUTRIONCO) study, aimed at assessing the impact of baseline nutritional and non-nutritional variables collected in the PreMiO study on the clinical outcomes of the same patients followed up from August 2019 to October 2021. We have highlighted a statistically significant association between baseline variables and patient death, rehospitalization, treatment toxicity, and disease progression at follow-up. We found a higher overall survival probability in the well-nourished general study population vs. malnourished patients (p < 0.001). Of major interest is the fact that patient stratification revealed that malnutrition decreased survival probability in non-metastatic patients but not in metastatic patients (p < 0.001). Multivariate analysis confirmed that baseline malnutrition (p = 0.004) and VAS score for appetite loss (p = 0.0104), in addition to albumin < 35 g/L (p < 0.0001) and neutrophil/lymphocyte ratio > 3 (p = 0.0007), were independently associated with the death of non-metastatic patients at follow-up. These findings highlight the importance of proactive, early management of malnutrition and cachexia in cancer patients, and in particular, in non-metastatic patients, from the perspective of a substantial improvement of their clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

The Impact of NUTRItional Status at First Medical Oncology Visit on Clinical Outcomes: The NUTRIONCO Study

Muscaritoli

Modena

Valerio

et al. 2023

Cancers

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“… 26 To date, there is evidence that an individualised nutritional support reduces the risk of mortality and improves QoL in patients with cancer at malnutritional risk. 27 Moreover, nutritional support for oncology patients is a low-cost intervention compared with other cares 28 and it does not require additional costs for the healthcare system. 29 However, the impact on survival still requires confirmation as reliable real-world data are lacking.…”

Section: Discussionmentioning

confidence: 99%

Multicentric, observational, longitudinal study for the evaluation of nutritional management implications in newly diagnosed Italian cancer patients: the Italian Registry of Malnutrition in Oncology (IRMO)

Bosetti,

Casirati,

Da Prat

et al. 2023

BMJ Open

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BackgroundMalnutrition is a frequent problem in oncology and is associated with reduced response to cancer treatments, increased drug-related toxicity, higher rates of clinical complications, reduced quality of life (QoL) and worse prognosis. Guidelines on clinical nutrition in oncology emphasise the usefulness of early assessment of nutritional status for a prompt identification of malnutrition and the implementation of effective interventions, but no real-world clinical data are available on the adequate management of nutritional support in patients with cancer in Italy.Methods and analysisThis is an observational, longitudinal, multicentre registry of patients with a new diagnosis of cancer or metastatic disease, candidates for active treatment. They will be identified in at least 15 Italian oncological centres, members of the Alliance Against Cancer Working Group ‘Survivorship Care and Nutritional Support’. At least 1500 patients with cancer are expected to be enrolled each year. Detailed clinical and nutritional data will be collected by oncologists and clinical nutritionists during the visits foreseen in the clinical practice, through an ad hoc developed digital platform (e-Nutracare). The effects of malnutrition and nutritional support—at diagnosis and during follow-up—on overall survival and progression-free survival, as well as on patients’ symptoms and QoL, will be investigated.Ethics and disseminationThe study protocol was approved by the Ethics Committee of the Fondazione IRCCS Policlinico San Matteo, Pavia, Italy and from the Ethics Committees of all other participating centres. An informed consent will be obtained from each patient enrolled in the study. Study findings will be disseminated through peer-reviewed journals, conferences and patients with cancer or professional associations. The registry will allow a better monitoring of the nutritional status of patients with cancer, promoting adequate and sustainable nutritional support, with the ultimate goal of improving the care and prognosis of these patients.

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“…Estudios que evalúan costos médicos asociados a enfermedades relacionadas con desnutrición estiman un gasto anual de $9.500 -$15.500 millones de dólares en EE.UU. y > €31 mil millones de euros en Europa (14,15).…”

Section: Costos De La Desnutriciónunclassified

“…Estudios apuntan que pacientes desnutridos tienen un tiempo promedio de internación hospitalaria mayor (3,4 días) que los pacientes bien nutridos, con un costo de internación hospitalaria aumentado. Por lo tanto, el soporte nutricional intrahospitalario para pacientes desnutridos o con riesgo nutricional es una intervención de bajo costo con beneficios clínicos y económicos (15,24).…”

Section: Desnutrición Relacionada Con Enfermedadunclassified

Food insecurity risk situations such as conflict, disasters and pandemics

Kfouri Filho

2024

an.ranf

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Disease-related malnutrition is a reality among hospitalized patients and a recurrent problem due to the lack of diagnosis and actions to treat and even avoid it. The global population is constantly exposed to situations of risk for malnutrition with hunger coexisting in all continents, in different percentages and with greater emphasis in the countries of Africa, South Asia and Latin America. Food insecurity risk situations such as conflict, disasters and pandemics are frequent and further worsen the condition of people already in crisis. Living with hunger promotes a greater vulnerability to malnutrition and the double burden of poor nutrition coexisting with obesity. Both situations, the lack or excess of nutrients, cause susceptibility to diseases or complications of pre-existing comorbidities, which increases the risk of hospitalization, infections, lenght of hospitalization, health costs, disabilities and mortality. It is extremely important to implement validated tools to identify, as soon as possible, patients at risk or with malnutrition to estabilish nutritional support actions and the follow-up of these patients during hospitalization and post-discharge, within the ethical aspects for each situation, in order to provide benefits without maleficence, avoiding complications, readmissions and with a good cost-effectiveness ratio in the care of the inpatient hospitalization. Keywords: malnutrition; food insecurity; nutritional screening; disease-related malnutrition; human rights; sarcopenia

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Nutritional support during the hospital stay is cost-effective for preventing adverse outcomes in patients with cancer

Cited by 5 publications

References 29 publications

The Impact of NUTRItional Status at First Medical Oncology Visit on Clinical Outcomes: The NUTRIONCO Study

The Impact of NUTRItional Status at First Medical Oncology Visit on Clinical Outcomes: The NUTRIONCO Study

Multicentric, observational, longitudinal study for the evaluation of nutritional management implications in newly diagnosed Italian cancer patients: the Italian Registry of Malnutrition in Oncology (IRMO)

Food insecurity risk situations such as conflict, disasters and pandemics

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