Nutritional support during the hospital stay reduces mortality in patients with different types of cancers: secondary analysis of a prospective randomized trial.

Hematologic Neoplasms Humans Length of Stay Nutritional Support Prospective Studies Quality of Life
cancer malnutrition nutrition outcomes randomized trial

Journal

Annals of oncology : official journal of the European Society for Medical Oncology
ISSN: 1569-8041
Titre abrégé: Ann Oncol
Pays: England
ID NLM: 9007735

Informations de publication

Date de publication:
08 2021
Historique:
received: 09 03 2021
revised: 29 04 2021
accepted: 14 05 2021
pubmed: 23 5 2021
medline: 14 8 2021
entrez: 22 5 2021
Statut: ppublish

Résumé

Nutritional support in patients with cancer aims at improving quality of life. Whether use of nutritional support is also effective in improving clinical outcomes requires further study. In this preplanned secondary analysis of patients with cancer included in a prospective, randomized-controlled, Swiss, multicenter trial (EFFORT), we compared protocol-guided individualized nutritional support (intervention group) to standard hospital food (control group) regarding mortality at 30-day (primary endpoint) and other clinical outcomes. We analyzed 506 patients with a main admission diagnosis of cancer, including lung cancer (n = 113), gastrointestinal tumors (n = 84), hematological malignancies (n = 108) and other types of cancer (n = 201). Nutritional risk based on Nutritional Risk Screening (NRS 2002) was an independent predictor for mortality over 180 days with an (age-, sex-, center-, type of cancer-, tumor activity- and treatment-) adjusted hazard ratio of 1.29 (95% CI 1.09-1.54; P = 0.004) per point increase in NRS. 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 = 0.027). Interaction tests did not show significant differences in mortality across the cancer type subgroups. Nutritional support also significantly improved functional outcomes and quality of life measures. Compared to usual hospital nutrition without nutrition support, individualized nutritional support reduced the risk of mortality and improved functional and quality of life outcomes in cancer patients with increased nutritional risk. These data further support the inclusion of nutritional care in cancer management guidelines.

Sections du résumé

BACKGROUND
Nutritional support in patients with cancer aims at improving quality of life. Whether use of nutritional support is also effective in improving clinical outcomes requires further study.
PATIENTS AND METHODS
In this preplanned secondary analysis of patients with cancer included in a prospective, randomized-controlled, Swiss, multicenter trial (EFFORT), we compared protocol-guided individualized nutritional support (intervention group) to standard hospital food (control group) regarding mortality at 30-day (primary endpoint) and other clinical outcomes.
RESULTS
We analyzed 506 patients with a main admission diagnosis of cancer, including lung cancer (n = 113), gastrointestinal tumors (n = 84), hematological malignancies (n = 108) and other types of cancer (n = 201). Nutritional risk based on Nutritional Risk Screening (NRS 2002) was an independent predictor for mortality over 180 days with an (age-, sex-, center-, type of cancer-, tumor activity- and treatment-) adjusted hazard ratio of 1.29 (95% CI 1.09-1.54; P = 0.004) per point increase in NRS. 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 = 0.027). Interaction tests did not show significant differences in mortality across the cancer type subgroups. Nutritional support also significantly improved functional outcomes and quality of life measures.
CONCLUSIONS
Compared to usual hospital nutrition without nutrition support, individualized nutritional support reduced the risk of mortality and improved functional and quality of life outcomes in cancer patients with increased nutritional risk. These data further support the inclusion of nutritional care in cancer management guidelines.

Identifiants

DOI: 10.1016/j.annonc.2021.05.793 PMID: 34022376
pubmed: 34022376
pii: S0923-7534(21)01993-1
doi: 10.1016/j.annonc.2021.05.793
pii:
doi:

Types de publication

Journal Article Multicenter Study Randomized Controlled Trial Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

1025-1033

Commentaires et corrections

Type : CommentIn
Type : CommentIn
Type : CommentIn
Type : CommentIn

Informations de copyright

Copyright © 2021 European Society for Medical Oncology. Published by Elsevier Ltd. All rights reserved.

Déclaration de conflit d'intérêts

Disclosure The Institution of PS has previously received unrestricted grant money unrelated to this project from Nestlé Health Science and Abbott Nutrition. The institution of ZS received speaking honoraria and research support from Nestlé Health Science, Abbott Nutrition and Fresenius Kabi. All other authors have declared no conflicts of interest.

Auteurs

L Bargetzi (L)

Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Basel, Switzerland.

C Brack (C)

Medical Faculty of the University of Basel, Basel, Switzerland.

J Herrmann (J)

Medical Faculty of the University of Basel, Basel, Switzerland.

A Bargetzi (A)

Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Basel, Switzerland.

L Hersberger (L)

Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Basel, Switzerland.

M Bargetzi (M)

Medical Faculty of the University of Basel, Basel, Switzerland; Division of Oncology, Hematology and Transfusion Medicine, Kantonsspital Aarau, Aarau, Switzerland.

N Kaegi-Braun (N)

Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland.

P Tribolet (P)

Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland.

F Gomes (F)

Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; The New York Academy of Sciences, New York, USA.

C Hoess (C)

Internal Medicine, Kantonsspital Muensterlingen, Muensterlingen, Switzerland.

V Pavlicek (V)

Internal Medicine, Kantonsspital Muensterlingen, Muensterlingen, Switzerland.

S Bilz (S)

Internal Medicine & Endocrinology/Diabetes, Kantonsspital St.Gallen, St.Gallen, Switzerland.

S Sigrist (S)

Internal Medicine & Endocrinology/Diabetes, Kantonsspital St.Gallen, St.Gallen, Switzerland.

M Brändle (M)

Internal Medicine & Endocrinology/Diabetes, Kantonsspital St.Gallen, St.Gallen, Switzerland.

C Henzen (C)

Internal Medicine, Kantonsspital Luzern, Luzern, Switzerland.

R Thomann (R)

Internal Medicine, Buergerspital Solothurn, Solothurn, Switzerland.

J Rutishauser (J)

Internal Medicine, Kantonsspital Baselland, Liestal, Switzerland.

D Aujesky (D)

Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

N Rodondi (N)

Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.

J Donzé (J)

Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Division of General Internal Medicine, Brigham and Women's Hospital, Boston, USA.

A Laviano (A)

Department of Translational and Precision Medicine, Sapienza University, Rome, Italy.

Z Stanga (Z)

Division of Diabetes, Endocrinology, Nutritional Medicine & Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

B Mueller (B)

Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Basel, Switzerland.

P Schuetz (P)

Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Basel, Switzerland. Electronic address: schuetzph@gmail.com.

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Classifications MeSH

questionsmedicales.fr › Hémopathies et maladies lymphatiques › Hémopathies › Tumeurs hématologiques › Nutritional support during the hospital stay...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Nutritional support during the hospital stay...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Soins aux patients › Hospitalisation › Durée du séjour › Nutritional support during the hospital stay...
questionsmedicales.fr › Thérapeutique › Thérapie nutritionnelle › Soutien nutritionnel › Nutritional support during the hospital stay...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études prospectives › Nutritional support during the hospital stay...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Mesures épidémiologiques › Démographie › État de santé › Qualité de vie › Nutritional support during the hospital stay...