Among 506 hospitalized patients with cancer at risk of malnutrition, individualized nutritional support reduced the risk of mortality compared to consumption of standard hospital food. The findings from a preplanned secondary analysis of the prospective, randomized, multicenter EFFORT trial, conducted in Switzerland, were published by Bargetzi et al in Annals of Oncology.
Nutritional Issues in Patients With Cancer
Malnutrition affects around 30% of patients with solid tumors and hematologic malignancies. It is associated with higher mortality, impaired functional status, and longer hospital stays. The clinical presentation of malnutrition in patients with cancer may vary from loss of appetite and/or weight, to loss of muscle mass with sarcopenia, to severe tumor cachexia.
Several factors put patients with cancer at high malnutrition risk, including tumor-derived cytokine release (causing loss of appetite and anorexia) and side effects of cancer treatment interfering with appetite and normal food intake. When admitted to the hospital, patients with cancer are at high risk for further deterioration of nutritional status due to fasting for diagnostic studies, treatment side effects, and overall suboptimal nutritional management.
Different screening tools are recommended, including the Nutritional Risk Screening system (NRS 2002). The study authors pointed out that there is relatively little evidence regarding this recommendation for the population of hospitalized patients with cancer, as previous data have been somewhat inconclusive. While some studies looking at patients with colorectal cancer found improved outcomes associated with nutritional support interventions, other studies have not provided evidence in favor of using nutritional interventions. Whether malnutrition is indeed a modifiable risk factor and improved by nutritional interventions has therefore been questioned.
Secondary Analysis of EFFORT
In the preplanned secondary analysis of patients with cancer included in the EFFORT study (Effect of early nutritional support on Frailty, Functional Outcomes and Recovery of malnourished medical inpatients Trial), the Swiss investigators compared protocol-guided individualized nutritional support (intervention group) to standard hospital food (control group) regarding mortality at 30 days (primary endpoint) and other clinical outcomes.
The study investigators analyzed 506 patients at nutritional risk admitted to the hospital with a diagnosis of lung cancer (n = 113), gastrointestinal cancer (n = 84), hematologic malignancies (n = 108), and other types of cancer (n = 201). Nutritional risk based on NRS 2002 was an independent predictor for mortality over 180 days with an age-, sex-, center-, cancer type–, tumor activity–, and treatment-adjusted hazard ratio of 1.29 (95% confidence interval [CI] = 1.09–1.54, P = .004) per point increase in NRS 2002 score.
In the 30-day follow-up period, 50 patients (19.9%) died in the control group compared to 36 (14.1%) in the intervention group, resulting in an adjusted odds ratio of 0.57 (95% CI = 0.35–0.94, P = .027).
Interaction tests did not show significant differences in mortality across cancer type subgroups. Nutritional support also significantly improved functional outcomes and quality-of-life measures.
The study team concluded that nutritional risk in patients with cancer was an independent prognostic indicator regarding 6-month mortality. In patients with cancer and increased nutritional risk, individualized nutritional support reduced mortality and improved functional and quality-of-life outcomes.
The authors commented that their findings support malnutrition screening upon hospital admission followed by an individualized nutritional support strategy in this vulnerable patient population. The study data strengthen the evidence in favor of inclusion of nutritional care in the multidisciplinary management of patients with cancer and in relevant guidelines.
Disclosure: This work was supported by grants from the Swiss National Science Foundation and the Forschungsrat of the Kantonsspital Aarau. For full disclosures of the study authors, visit annalsofoncology.org.
