Nutritional support in pancreatic cancer

Caccialanza, Riccardo; Lobascio, Federica; Brugnatelli, Silvia; Pedrazzoli, Paolo

doi:10.1002/cncr.32713

Cited by 8 publications

(5 citation statements)

References 15 publications

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“…Considering the prevalence up to 85% [87], its known and peculiar pathophysiological mechanisms, and the remarkable prognostic relevance, the proper management of pancreatic cancer malnutrition is, undoubtedly, of paramount importance and deserves specific approaches [88].…”

Section: From a Solitary Management To A Shared Perspective: The "Nutritional Oncology Board"mentioning

confidence: 99%

Clinical Implications of Malnutrition in the Management of Patients with Pancreatic Cancer: Introducing the Concept of the Nutritional Oncology Board

et al. 2021

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Pancreatic cancer represents a very challenging disease, with an increasing incidence and an extremely poor prognosis. Peculiar features of this tumor entity are represented by pancreatic exocrine insufficiency and an early and intense nutritional imbalance, leading to the highly prevalent and multifactorial syndrome known as cancer cachexia. Recently, also the concept of sarcopenic obesity has emerged, making the concept of pancreatic cancer malnutrition even more multifaceted and complex. Overall, these nutritional derangements play a pivotal role in contributing to the dismal course of this malignancy. However, their relevance is often underrated and their assessment is rarely applied in clinical daily practice with relevant negative impact for patients’ outcome in neoadjuvant, surgical, and metastatic settings. The proper detection and management of pancreatic cancer-related malnutrition syndromes are of primary importance and deserve a specific and multidisciplinary (clinical nutrition, oncology, etc.) approach to improve survival, but also the quality of life. In this context, the introduction of a “Nutritional Oncology Board” in routine daily practice, aimed at assessing an early systematic screening of patients and at implementing nutritional support from the time of disease diagnosis onward seems to be the right path to take.

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Section: From a Solitary Management To A Shared Perspective: The "Nutritional Oncology Board"mentioning

confidence: 99%

Clinical Implications of Malnutrition in the Management of Patients with Pancreatic Cancer: Introducing the Concept of the Nutritional Oncology Board

et al. 2021

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“…In this clinical setting, the assessment of patients’ general conditions and supportive care needs holds a crucial role, in order to make chemotherapy possible and tolerable, thus prolonging survival ( 20 ). As the prevalence of nutritional derangements in patients with pancreatic cancer is among the highest in solid tumors, a multidisciplinary nutritional management is receiving increasing attention as it may be crucial to optimize treatment tolerance and efficacy, but it is not yet part of the routine care ( 21 ).…”

Section: Discussionmentioning

confidence: 99%

Pancreatic Enzyme Replacement Therapy in Patients Undergoing First-Line Gemcitabine Plus nab-paclitaxel for Advanced Pancreatic Adenocarcinoma

et al. 2021

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BackgroundThe clinical consequences of pancreatic exocrine insufficiency and its treatment in advanced pancreatic ductal adenocarcinoma (PDAC) are poorly investigated. This retrospective study aims at investigating the pancreatic enzyme replacement therapy (PERT) use and its impact on survival and maldigestion-related symptoms in advanced PDAC patients undergoing chemotherapy.MethodsA retrospective analysis was conducted on advanced PDAC patients, treated with first-line gemcitabine plus nab-paclitaxel at two academic institutions (March 2015-October 2018). Data were correlated with overall survival (OS) using Cox regression model. Kaplan-Meier curves were compared using Log-Rank test.ResultsData from 110 patients were gathered. PERT was administered in 55 patients (50%). No significant differences in baseline characteristics with those who did not receive PERT were found. Median OS for the entire group was 12 months (95% CI 9-15). At multivariate analysis, previous surgical resection of the primary tumor, (HR 2.67, p=0.11), weight gain after 3 months (HR 1.68, p=0.07) and PERT (HR 2.85, p ≤ 0.001) were independent predictors of OS. Patients who received PERT reported an improvement of maldigestion-related symptoms at 3 months more frequently than patients who did not (85.2% vs 14.8%, p ≤ 0.0001).ConclusionPERT is associated with significantly prolonged survival and maldigestion-related symptoms alleviation in advanced PDAC patients.

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“…Highlighting this potential, 2 of 4 patients in our study with less than 80% app compliance presented back to the hospital with significant complications including post-operative pancreatic hemorrhage and sepsis, respectively. Implementation of monitoring and counseling has the potential to extend the reach of dietitians amongst a population who many believe should receive universal nutritional screening [48,49]. While more research is necessary, nutrition monitoring mobile apps have potential for both the pre-habilitation and post-operative setting for cancer patients and other patients receiving complex surgeries.…”

Section: Discussionmentioning

confidence: 99%

Pilot trial of remote monitoring to prevent malnutrition after hepatopancreatobiliary surgery

et al. 2021

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Background Patients undergoing hepatopancreatobiliary (HPB) surgery, such patients with pancreatic, periampullary, and liver cancer, are at high risk for malnutrition. Malnutrition increases surgical complications and reduces overall survival. Despite its severity, there are limited interventions addressing malnutrition after HPB surgery. The aim of this pilot trial was to examine feasibility, acceptability, usability, and preliminary efficacy of a remote nutrition monitoring intervention after HPB surgery. Methods Participants received tailored nutritional counseling before and after surgery at 2 and 4 weeks after hospital discharge. Participants also recorded nutritional intake daily for 30 days, and these data were reviewed remotely by registered dietitians before nutritional counseling visits. Descriptive statistics were used to describe study outcomes. Results All 26 patients approached to participate consented to the trial before HPB surgery. Seven were excluded after consent for failing to meet eligibility criteria (e.g., did not receive surgery). Nineteen participants (52.6% female, median age = 65 years) remained eligible for remote monitoring post-surgery. Nineteen used the mobile app food diary, 79% of participants recorded food intake for greater than 80% of study days, 95% met with the dietitian for all visits, and 89% were highly satisfied with the intervention. Among participants with complete data, the average percent caloric goal obtained was 82.4% (IQR: 21.7). Conclusions This intervention was feasible and acceptable to patients undergoing HPB surgery. Preliminary efficacy data showed most participants were able to meet calorie intake goals. Future studies should examine intervention efficacy in a larger, randomized controlled trial. Trial registration Clinicaltrials.gov. Registered 16 September 2019, https://clinicaltrials.gov/ct2/show/NCT04091165.

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Nutritional support in pancreatic cancer

Cited by 8 publications

References 15 publications

Clinical Implications of Malnutrition in the Management of Patients with Pancreatic Cancer: Introducing the Concept of the Nutritional Oncology Board

Clinical Implications of Malnutrition in the Management of Patients with Pancreatic Cancer: Introducing the Concept of the Nutritional Oncology Board

Pancreatic Enzyme Replacement Therapy in Patients Undergoing First-Line Gemcitabine Plus nab-paclitaxel for Advanced Pancreatic Adenocarcinoma

Pilot trial of remote monitoring to prevent malnutrition after hepatopancreatobiliary surgery

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