- Email: [email protected]
PP098-MON CANCER AND THE USE OF NUTRITIONAL SUPPLEMENTS
S158 Pearsons correlation and individual logistic regression were used to test for associations. Results: The prevalence of weight loss 5% was 31.2% (median weight loss 7.9%, range 5.0 18.7%). The majority of patients (66.7%) lost 5% weight after treatment at a median time point of week 3 post completion of treatment. The prevalence of EN was 12.5% with 7 (58.3%) starting during radiotherapy and 5 (41.7%) after radiotherapy. PG-SGA was available for 68 (71%) patients at start of RT with 58 (85%) wellnourished and 10 (15%) with mild to moderate malnutrition. Patients receiving concurrent chemotherapy were more likely to have 5% weight loss (40 vs 0%, p < 0.001). The odds ratio of 5% weight loss was 2.5 times higher for NSCLC patients with disease stage 3 (95% CI 1.36, 4.50, p = 0.003). Only PG-SGA score was associated with starting EN (r = 0.27, p = 0.03). Conclusion: Clinically significant weight loss is prevalent in lung cancer patients receiving radiotherapy and is associated with concurrent chemotherapy and disease stage 3. Identification of factors associated with weight loss assists with early identification and intervention in patients at high nutritional risk. Disclosure of Interest: None Declared
PP096-MON EFFECT OF PRETREATMENT WITH L-ARGININE ON INTESTINAL MUCOSITIS INDUCED BY 5-FU IN MICE P.C.L. Leoc´ adio1 , M.M. Antunes1 , J. Alvarez-Leite2 , L.G. Teixeira1 , A.J. Leonel1 , D.C.C. Machado3 , S.V. Generoso4 , V.N. Cardoso5 , M.I.T.D. Correia6 . 1 Universidade Federal de MInas Gerais, Belo Horizonte, 2 Biochemistry, 3 Pathology, 4 Nutrition, 5 Pharmacy, 6 Surgery, Universidade Federal de MInas Gerais, Belo Horizonte, Brazil Rationale: Mucositis is a side effect of chemotherapy treatment, affecting approximately 40% of patients. This is characterized by inflammation that affects the gastrointestinal tract, increasing permeability as well as causing abdominal pain, nausea, vomiting and diarrhea, which worsen the nutritional status. Therefore, it is important to assess potential novel treatment options that may positively impact the outcome of such complication. Beneficial effects of L-arginine on immune response and bowel function have been reported. Methods: The aim of this study was to evaluate the effect of a 2% L-arginine water supplementation pretreatment on mucositis induced by 5-FU (single dose of 200 mg/kg body weight) in Swiss male mice. We evaluated the effect of L-arginine on weight, morphology and inflammatory score of the small intestine (from 0 to 12), cell infiltrate (enzymatic assay of MPO, NAG and EPO) and intestinal permeability. Statistical significance was set at p < 0.05 Results: Intestinal length improvement was observed, as well as partial recovery of the mucosal architecture, intermediate reduction of inflammatory score (5-FU:12 and 10; ARG 5-FU:8 and 8; for duodenum and proximal jejunum, respectively) and neutrophil infiltration, in addition to improvement of intestinal permeability. However, weight loss after the administration of 5-FU was seen ( 1.34±0.21 g/mice, mean±SD) and arginine supplementation did not prevent it ( 2.32±0.31 g/mice, mean±SD).
Poster presentations Conclusion: L-arginine is able to partially improve intestinal mucositis, promoting mucosal recovery, reduction of inflammation and improvement of intestinal permeability. Disclosure of Interest: None Declared
PP097-MON INFLUENCE OF IMMUNONUTRITION IN THE SURGICAL CANCER PATIENT REGARDING ALBUMIN LEVELS AND ANTROPOMETRY L.G. Barbosa1 , H.B. Abreu1 , R.C. Fortes1 , B.A. Toscano1 , G.D. Ceniccola1 , J.T. Junior2 . 1 Clinical nutrition, SES DF, 2 Clinical nutrition, FANEP, Brasilia, Brazil Rationale: Malnutrition can occur in 60% to 80% of the cancer patients. Evidences are that immunonutrition may promote beneficial effects in surgical cancer patients. [1] Objective: To evaluate the effects of immunonutrition in patients with cancer in the perioperative period. Methods: Patients with cancer, 20 years or older, both sexes, were randomized into three groups receiving at least 600 ml daily by oral or enteral immunomodulatory diet with glutamine, l-arginine, medium chain triglyceride, (IM1) and l-arginine, nucleotides and w-3 fatty acids, EPA and DHA (IM2), or standard diet (SD) in perioperative surgical oncology. We measured anthropometry (weight, body mass index, triceps skinfold thickness TSF), plasmatic albumin and length of stay. Results: A sample of 22 patients revealed that male was more prevalent, with 72.7% and an average age of 58.5 years. Malnutrition was found in 86.3% of the cases and gastric was the most prevalent type of cancer with 36%. As anthropometric variables, only the SD group showed significant reduction of Triceps Skin Fold (p 0.034) and Arm circumference (p 0.036). It was also verified significant reduction of albumin in the IM1 and IM2 groups (p 0.020 e p 0.014) Conclusion: It was observed in this study that immunonutrition was able to maintain some anthropometric parameters and there was a trend to minimize the loss of muscle mass and adipose tissue. Was also seen that plasmatic albumin levels had better results with placebo. Nevertheless, more randomized controlled trials with larger patient population, with deeper evaluation of the inflammatory state, are needed to establish a more consistent view of this scenario. References [1] Cerantola Y, Hubner M, Grass F, Demartines N, Schafer M. Immunonutrition in gastrintestinal surgery. Br J Surg. 2011; 98:37 48. Disclosure of Interest: None Declared
PP098-MON CANCER AND THE USE OF NUTRITIONAL SUPPLEMENTS L. Otten1 , M. Freudenreich2 , N. Stob¨ aus2 , S. Paffhausen1 , 2 1 K. Norman . Institut f. Ern¨ ahrungswissenschaften, Universit¨ at Potsdam, Potsdam, 2 Medizinische Klinik f¨ ur Gastroenterologie, Infektiologie und Rheumatologie, Charit´ e Universit¨ atsmedizin, Berlin, Germany Rationale: The aim of this prospective study is to assess the prevalence of nutritional supplement (NS) intake by cancer patients in Germany.
Nutrition and cancer II Methods: Data from 405 patients (189 male) with varying cancer diagnoses were evaluated in an interim analysis. The prevalence and type of NS, as well as reason for and general attitude towards supplementation were recorded with a questionnaire. Further information regarding diagnosis, therapy, education, lifestyle, and smoking status was also collected. Results: 52.8% of patients indicated a change in dietary habits since diagnosis with cancer. 40.1% of these patients reported an increased consumption of healthy foods, while only 2.7% followed a specific cancer diet. Patients living by themselves changed their eating habits more often than those not living alone. Altogether, 42.2% of patients consumed NS, of which45.9% first began use after the diagnosis. Supplementation from men was significantly more prevalent after cancer diagnosis. 41.8% were opposed to NS use, assuming sufficient nutrient supply from the diet. 43.7% approved use in the case of increased requirement or a deficiency. Most commonly consumed were particularteas (37.9%), enriched or specific juices (24.3%), multivitamins (22.2%), plant-based supplements or other natural remedies (20.8%), selen (13.0%), vitamin B complexes (10.8%), preparations to strengthen the immune system (10.2%), vitamin C (10.2%), zinc (10.3%), omega-3 fatty acids (9.3%), iron (8.3%) and vitamin E (3.8%). The main reasons for use included improving immune defense (46.3%), preventing nutritional deficiency (31.4%), cancer treatment (27.7%), and improving quality of life (26.6%). Conclusion: Nearly half of the questioned patients regularly consumed NS. Supplementation by cancer patients should always be assessed in order to prevent possible interactions, deficiency or overdose. Disclosure of Interest: None Declared
PP099-MON POTENTIAL IMPACTS ON NUTRITIONAL MANAGEMENT IN CANCER: COMPLEMENTARY AND ALTERNATIVE THERAPY USAGE IN A SCOTTISH PAEDIATRIC COHORT R. Revuelta Iniesta1 , M.L. Wilson2 , K. White3 , L. Stewart2 , J.M. McKenzie1 , D.C. Wilson2 . 1 Dietetics, Nutrition and Biological Science, Queen Margaret University, 2 Child Life and Health, University of Edinburgh, 3 Department of Heamatology and Oncology, Royal Hospital for Sick Children, Edinburgh, United Kingdom Rationale: To determine the usage of Complementary and alternative therapy (CAT) in the paediatric oncology population of SE Scotland and to establish both the reasons for its use and perceived benefits. Methods: A retrospective cohort survey was performed using a previously piloted questionnaire, which was distributed between 2006 2009. Eligibility criteria included children aged <18 years, diagnosed with a first time cancer or Langerhams Cell Histiocytosis and managed by the SE Scotland paediatric service. Demographic and clinical data were collected and descriptive statistics were employed to establish frequencies. Univariate associations were established by means of c2 -test. Results: 169 families were approached and 74 (43.7%) returned completed questionnaires. Of these, 41 (55.4%) reported having used CAT whilst their children were receiving conventional cancer treatment. Higher socioeconomic status was significantly associated with an increased use of CAT
S159 (c2 (2) = 46.718, p < 0.001). Of the biological CAT, the most popular were vitamin and mineral supplements (n = 22; 52.6%) followed by fish oils (n = 12; 29.2%) and herbal remedies (n = 11; 26.8%). 72% of families perceived CAT to be beneficial and the most common reasons for CAT use were to improve quality of life (n = 15; 36.5%) and to reduce both stress and side effects (n = 10; 24.4%) Conclusion: The use of CAT is highly prevalent in this cohort. Although, this is the largest retrospective study in the UK, more epidemiological and high quality interventional studies are required to provide clinicians with evidence based guidance on the safety and efficacy of different CAT, particularly the effects of biological based therapies and their potential interactions with conventional treatments Disclosure of Interest: R. Revuelta Iniesta Grant/Research Support: Fergus Maclay Leukaemia Trust, M. Wilson: None Declared, K. White: None Declared, L. Stewart: None Declared, J. McKenzie: None Declared, D. Wilson: None Declared
PP100-MON NUTRITIONAL MANAGEMENT IN PATIENTS WITH ACUTE MALIGNANT BOWEL OBSTRUCTION (AMBO) R. Burgos1 , and Spanish NADYA-SENPE Group and ESPEN Acute Intestinal Failure Special Interest Group. 1 Nutritional Support Unit, University Hospital Vall d’Hebron, Barcelona, Spain Rationale: AMBO is associated with advanced gynecological (GC) and colorectal cancers (CRC). Survival of AMBO patients has improved over recent years. The prevalence of malnutrition at diagnosis can be increased, but nutritional support (NS) is often delayed until the diagnosis and staging of the neoplastic disease is completed, and this could be a negative prognostic factor. Aims: To stablish the standard care in patients with AMBO and to analyze factors implicated in the decision-making process with regard to NS. Methods: A national survey was designed with 2 questions about the hospital and 10 questions about management of AMBO as an initial presentation in advanced intra-abdominal malignancy. The survey was e-mailed to the members of the Spanish NADYA-SENPE group. Results: We received 19 surveys from 17 hospitals (response rate 30% of hospitals, 80% third level hospitals, 70% more than 500 beds) The initial management with suspected CRC was non-surgical in 80% and in GC AMBO 60%. The aims for emergency surgery was decompression and exploration in 50% of hospitals in AMBO for CRC, whereas in GC included cytoreduction. Parenteral nutrition (PN) was considered in 40% of hospitals initially only if diagnosis and staging of the disease were established, and patient were under consideration for oncologic treatment. In both cases, PN was considered when patients were malnourished or had fasted for more than 7 d. Factors implicated in decision-making process were: possibilities for oncologic treatment, malnutrition, and consideration of re-evaluable decision. 90% of hospitals withdraw PN if patients were only candidate for palliative care. Conclusion: There is an heterogeneity in the initial treatment in AMBO patients. PN is often delayed until diagnosis is established or awaits resolution with medical treatment. This study could be a start for a European wide questionnaire in order to develop clear guidelines in NS of patients with AMBO. Disclosure of Interest: None Declared
PP096-MON EFFECT OF PRETREATMENT WITH L-ARGININE ON INTESTINAL MUCOSITIS INDUCED BY 5-FU IN MICE P.C.L. Leoc´ adio1 , M.M. Antunes1 , J. Alvarez-Leite2 , L.G. Teixeira1 , A.J. Leonel1 , D.C.C. Machado3 , S.V. Generoso4 , V.N. Cardoso5 , M.I.T.D. Correia6 . 1 Universidade Federal de MInas Gerais, Belo Horizonte, 2 Biochemistry, 3 Pathology, 4 Nutrition, 5 Pharmacy, 6 Surgery, Universidade Federal de MInas Gerais, Belo Horizonte, Brazil Rationale: Mucositis is a side effect of chemotherapy treatment, affecting approximately 40% of patients. This is characterized by inflammation that affects the gastrointestinal tract, increasing permeability as well as causing abdominal pain, nausea, vomiting and diarrhea, which worsen the nutritional status. Therefore, it is important to assess potential novel treatment options that may positively impact the outcome of such complication. Beneficial effects of L-arginine on immune response and bowel function have been reported. Methods: The aim of this study was to evaluate the effect of a 2% L-arginine water supplementation pretreatment on mucositis induced by 5-FU (single dose of 200 mg/kg body weight) in Swiss male mice. We evaluated the effect of L-arginine on weight, morphology and inflammatory score of the small intestine (from 0 to 12), cell infiltrate (enzymatic assay of MPO, NAG and EPO) and intestinal permeability. Statistical significance was set at p < 0.05 Results: Intestinal length improvement was observed, as well as partial recovery of the mucosal architecture, intermediate reduction of inflammatory score (5-FU:12 and 10; ARG 5-FU:8 and 8; for duodenum and proximal jejunum, respectively) and neutrophil infiltration, in addition to improvement of intestinal permeability. However, weight loss after the administration of 5-FU was seen ( 1.34±0.21 g/mice, mean±SD) and arginine supplementation did not prevent it ( 2.32±0.31 g/mice, mean±SD).
Poster presentations Conclusion: L-arginine is able to partially improve intestinal mucositis, promoting mucosal recovery, reduction of inflammation and improvement of intestinal permeability. Disclosure of Interest: None Declared
PP097-MON INFLUENCE OF IMMUNONUTRITION IN THE SURGICAL CANCER PATIENT REGARDING ALBUMIN LEVELS AND ANTROPOMETRY L.G. Barbosa1 , H.B. Abreu1 , R.C. Fortes1 , B.A. Toscano1 , G.D. Ceniccola1 , J.T. Junior2 . 1 Clinical nutrition, SES DF, 2 Clinical nutrition, FANEP, Brasilia, Brazil Rationale: Malnutrition can occur in 60% to 80% of the cancer patients. Evidences are that immunonutrition may promote beneficial effects in surgical cancer patients. [1] Objective: To evaluate the effects of immunonutrition in patients with cancer in the perioperative period. Methods: Patients with cancer, 20 years or older, both sexes, were randomized into three groups receiving at least 600 ml daily by oral or enteral immunomodulatory diet with glutamine, l-arginine, medium chain triglyceride, (IM1) and l-arginine, nucleotides and w-3 fatty acids, EPA and DHA (IM2), or standard diet (SD) in perioperative surgical oncology. We measured anthropometry (weight, body mass index, triceps skinfold thickness TSF), plasmatic albumin and length of stay. Results: A sample of 22 patients revealed that male was more prevalent, with 72.7% and an average age of 58.5 years. Malnutrition was found in 86.3% of the cases and gastric was the most prevalent type of cancer with 36%. As anthropometric variables, only the SD group showed significant reduction of Triceps Skin Fold (p 0.034) and Arm circumference (p 0.036). It was also verified significant reduction of albumin in the IM1 and IM2 groups (p 0.020 e p 0.014) Conclusion: It was observed in this study that immunonutrition was able to maintain some anthropometric parameters and there was a trend to minimize the loss of muscle mass and adipose tissue. Was also seen that plasmatic albumin levels had better results with placebo. Nevertheless, more randomized controlled trials with larger patient population, with deeper evaluation of the inflammatory state, are needed to establish a more consistent view of this scenario. References [1] Cerantola Y, Hubner M, Grass F, Demartines N, Schafer M. Immunonutrition in gastrintestinal surgery. Br J Surg. 2011; 98:37 48. Disclosure of Interest: None Declared
PP098-MON CANCER AND THE USE OF NUTRITIONAL SUPPLEMENTS L. Otten1 , M. Freudenreich2 , N. Stob¨ aus2 , S. Paffhausen1 , 2 1 K. Norman . Institut f. Ern¨ ahrungswissenschaften, Universit¨ at Potsdam, Potsdam, 2 Medizinische Klinik f¨ ur Gastroenterologie, Infektiologie und Rheumatologie, Charit´ e Universit¨ atsmedizin, Berlin, Germany Rationale: The aim of this prospective study is to assess the prevalence of nutritional supplement (NS) intake by cancer patients in Germany.
Nutrition and cancer II Methods: Data from 405 patients (189 male) with varying cancer diagnoses were evaluated in an interim analysis. The prevalence and type of NS, as well as reason for and general attitude towards supplementation were recorded with a questionnaire. Further information regarding diagnosis, therapy, education, lifestyle, and smoking status was also collected. Results: 52.8% of patients indicated a change in dietary habits since diagnosis with cancer. 40.1% of these patients reported an increased consumption of healthy foods, while only 2.7% followed a specific cancer diet. Patients living by themselves changed their eating habits more often than those not living alone. Altogether, 42.2% of patients consumed NS, of which45.9% first began use after the diagnosis. Supplementation from men was significantly more prevalent after cancer diagnosis. 41.8% were opposed to NS use, assuming sufficient nutrient supply from the diet. 43.7% approved use in the case of increased requirement or a deficiency. Most commonly consumed were particularteas (37.9%), enriched or specific juices (24.3%), multivitamins (22.2%), plant-based supplements or other natural remedies (20.8%), selen (13.0%), vitamin B complexes (10.8%), preparations to strengthen the immune system (10.2%), vitamin C (10.2%), zinc (10.3%), omega-3 fatty acids (9.3%), iron (8.3%) and vitamin E (3.8%). The main reasons for use included improving immune defense (46.3%), preventing nutritional deficiency (31.4%), cancer treatment (27.7%), and improving quality of life (26.6%). Conclusion: Nearly half of the questioned patients regularly consumed NS. Supplementation by cancer patients should always be assessed in order to prevent possible interactions, deficiency or overdose. Disclosure of Interest: None Declared
PP099-MON POTENTIAL IMPACTS ON NUTRITIONAL MANAGEMENT IN CANCER: COMPLEMENTARY AND ALTERNATIVE THERAPY USAGE IN A SCOTTISH PAEDIATRIC COHORT R. Revuelta Iniesta1 , M.L. Wilson2 , K. White3 , L. Stewart2 , J.M. McKenzie1 , D.C. Wilson2 . 1 Dietetics, Nutrition and Biological Science, Queen Margaret University, 2 Child Life and Health, University of Edinburgh, 3 Department of Heamatology and Oncology, Royal Hospital for Sick Children, Edinburgh, United Kingdom Rationale: To determine the usage of Complementary and alternative therapy (CAT) in the paediatric oncology population of SE Scotland and to establish both the reasons for its use and perceived benefits. Methods: A retrospective cohort survey was performed using a previously piloted questionnaire, which was distributed between 2006 2009. Eligibility criteria included children aged <18 years, diagnosed with a first time cancer or Langerhams Cell Histiocytosis and managed by the SE Scotland paediatric service. Demographic and clinical data were collected and descriptive statistics were employed to establish frequencies. Univariate associations were established by means of c2 -test. Results: 169 families were approached and 74 (43.7%) returned completed questionnaires. Of these, 41 (55.4%) reported having used CAT whilst their children were receiving conventional cancer treatment. Higher socioeconomic status was significantly associated with an increased use of CAT
S159 (c2 (2) = 46.718, p < 0.001). Of the biological CAT, the most popular were vitamin and mineral supplements (n = 22; 52.6%) followed by fish oils (n = 12; 29.2%) and herbal remedies (n = 11; 26.8%). 72% of families perceived CAT to be beneficial and the most common reasons for CAT use were to improve quality of life (n = 15; 36.5%) and to reduce both stress and side effects (n = 10; 24.4%) Conclusion: The use of CAT is highly prevalent in this cohort. Although, this is the largest retrospective study in the UK, more epidemiological and high quality interventional studies are required to provide clinicians with evidence based guidance on the safety and efficacy of different CAT, particularly the effects of biological based therapies and their potential interactions with conventional treatments Disclosure of Interest: R. Revuelta Iniesta Grant/Research Support: Fergus Maclay Leukaemia Trust, M. Wilson: None Declared, K. White: None Declared, L. Stewart: None Declared, J. McKenzie: None Declared, D. Wilson: None Declared
PP100-MON NUTRITIONAL MANAGEMENT IN PATIENTS WITH ACUTE MALIGNANT BOWEL OBSTRUCTION (AMBO) R. Burgos1 , and Spanish NADYA-SENPE Group and ESPEN Acute Intestinal Failure Special Interest Group. 1 Nutritional Support Unit, University Hospital Vall d’Hebron, Barcelona, Spain Rationale: AMBO is associated with advanced gynecological (GC) and colorectal cancers (CRC). Survival of AMBO patients has improved over recent years. The prevalence of malnutrition at diagnosis can be increased, but nutritional support (NS) is often delayed until the diagnosis and staging of the neoplastic disease is completed, and this could be a negative prognostic factor. Aims: To stablish the standard care in patients with AMBO and to analyze factors implicated in the decision-making process with regard to NS. Methods: A national survey was designed with 2 questions about the hospital and 10 questions about management of AMBO as an initial presentation in advanced intra-abdominal malignancy. The survey was e-mailed to the members of the Spanish NADYA-SENPE group. Results: We received 19 surveys from 17 hospitals (response rate 30% of hospitals, 80% third level hospitals, 70% more than 500 beds) The initial management with suspected CRC was non-surgical in 80% and in GC AMBO 60%. The aims for emergency surgery was decompression and exploration in 50% of hospitals in AMBO for CRC, whereas in GC included cytoreduction. Parenteral nutrition (PN) was considered in 40% of hospitals initially only if diagnosis and staging of the disease were established, and patient were under consideration for oncologic treatment. In both cases, PN was considered when patients were malnourished or had fasted for more than 7 d. Factors implicated in decision-making process were: possibilities for oncologic treatment, malnutrition, and consideration of re-evaluable decision. 90% of hospitals withdraw PN if patients were only candidate for palliative care. Conclusion: There is an heterogeneity in the initial treatment in AMBO patients. PN is often delayed until diagnosis is established or awaits resolution with medical treatment. This study could be a start for a European wide questionnaire in order to develop clear guidelines in NS of patients with AMBO. Disclosure of Interest: None Declared