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CACHEXIA AND MALNUTRITION IN CANCER PATIENTS: INFLAMMATION INDEXES EVALUATION AND NUTRITIONAL INTERVENTION
2
SINPE conference abstracts / Nutrition 65 (2019) 110580
off value for VAT was 44. Median OS was 30.97 months. At univariate analysis, older age (HR 2.46, p=0.013), primary tumor resection (HR 0.40, p=0.029), VAT>=44 (HR 2.85, p=0.011) and metastasectomy (HR 0.22, p=0.005), were significantly associated with OS (Table 2 and Figure1). By multivariate analysis, only VAT>=44 (HR2.64; p=0.030) was significantly associated with OS (Table 2). This exploratory study supported the prognostic role of VAT evaluation in patients with MCRC. In particular, high VAT was predictor of worse outcome. Further investigations are needed to confirm these preliminary data.
VENOUS ACCESS DEVICE RELATED COMPLICATIONS IN ONCOLOGIC PATIENTS ENROLLED ON HOME PARENTERAL NUTRITION E. Agnello *, A. Devecchi, M. Fadda, A. De Francesco della Salute e della Scienza di Torino, Torino, Italy Citta Oncologic patients with important anorexia or alterated digestive tract function, for obstruction or malabsorption, may benefit by Home Parenteral Nutrition. Aim: to evaluate the incidence of venous access related complications in cancer patients undergoing HPN. We included 195 patients enrolled on HPNon the basis of ESPEN guidelines, in 2015- 2016. Incidence of complications were expressed as events per 1000 HPN days, calculated from the HPN start date until the discontinuation of home infusions or the removal of the VAD or the death of the patient. The VADs used were peripherally inserted central catheters (PICCs), subcutaneous implanted port, tunneled central catheters (TCCs) or non tunneled central catheters (NTCCs). 111 males, 84 females; median age 65 years(27-94). Median HPN duration was 106 days. A total of 208 VADs were studied: 67% PICCs, 21% ports, 9% TCCs and 3% NTCCs. Both thrombosis and tip migrations occurred only in PICCs, while infections happened in PICCs, ports and TCCs. The overall incidence of VAD related complications per 1000 HPN days was 0,73(0,27 in TCCs, 0,70 in PICCs, 1,25 in ports and null in NTCCs). HPN results to be a supportive therapy with low rate of VADs related complications. Infections are the most frequent complication and may occur in all kind of devices. Cotogni P. Catheter-related complications in cancer patients on home parenteral nutrition: a prospective study of over 51,000 catheter days. JPEN J Parenter Enteral Nutr. 2013;37(3):375-83 Vashi PG. A longitudinal study investigating quality of life and nutritional outcomes in advanced cancer patients receiving home parenteral nutrition.BMC Cancer.2014;14:593
INTESTINAL FAILURE ASSOCIATED LIVER DISEASE IN ADULT PATIENTS: A ONE-YEAR PROSPECTIVE STUDY A.S. Sasdelli *, M. Guidetti, C. Pazzeschi, L. Pironi Center for Chronic Intestinal Failure, Department of Medical and Surgical Science, University of Bologna, Bologna, Italy Intestinal Failure Associated Liver Disease (IFALD) results from liver injury due to factors related to intestinal failure (IF) and/or to home parenteral nutrition (HPN), and no other evident cause. The epidemiology of IFALD depends on the criteria used for the diagnosis. The aim of the study was to assess the prevalence and the incidence of IFALD in the first 12 months of HPN in adult patients. 18 adult patients (13 Females; age 46§16 years; short bowel syndrome, 72%) who started HPN between Jan 2016 and December 2017 (T0) were enrolled in the study: 13 completed the 12-month follow-up (T12), 5 are ongoing. Biochemical liver function tests were collected at T0, 6-months (T6) and T12; liver ultrasound (US) was performed at T0 and T12. IFALDcriteria diagnosis: IFALD-Cholestasis: two of ɣglutamyltransferase, alkaline phosphatase and conjugated bilirubin 1.5 upper normal level for 6 months; IFALD-Steatosis: echogenicity at US; IFALD-Fibrosis: FIB-4 index. Statistic: descriptive analysis. Prevalence at T0, T6, T12, respectively: Cholestasis, 50%, 22%, 15%; Steatosis, 69%, 71%, 71%; Fibrosis, 16%, 27%, 0%. Incidence between T0 at T12: Cholestasis, 0%; Steatosis, 50%; Fibrosis, 0%. Our results indicate that IFALD can be present at the beginning of HPN, IFALD-cholestasis and IFALD-fibrosis may disappear during the first period of HPN, whereas IFALD-steatosis remains. This would suggest that at
starting HPN, liver may be affected by the metabolic alterations of the acute IF, that subside when turning in chronic IF.
DIAGNOSIS OF SARCOPENIA WITH COMPUTED TOMOGRAPHY AND BIOELECTRICAL IMPEDANCE VECTOR ANALYSIS IN CANCER PATIENTS A. Casirati *,1, G. Vandoni 1, S. Della Valle 1, E. Scioscioli 1, G. Greco 2, M. Platania 4, L. Mariani 3, C. Gavazzi 1 1 Fondazione IRCCS Istituto Nazionale dei Tumori, Clinical Nutrition Unit, Milano, Italy 2 Fondazione IRCCS Istituto Nazionale dei Tumori, Department of Radiology, Milano, Italy 3 Fondazione IRCCS Isituto Nazionale dei Tumori, Clinical Epidemiology and trial Organization Unit, Milano, Italy 4 Fondazione IRCCS Isituto Nazionale dei Tumori, Medical Oncology and Hematology Department, Milano, Italy Sarcopenia is a predictor of poorer prognosis in cancer patients. Emerging data suggest the association between computed tomography (CT)-defined body composition and clinical outcomes. The aim of the study was to compare imaging method with conventional diagnostic criteria to identify malnutrition and altered body composition (BC) in oncological patients. In a prospective study, patients with a new diagnosis of advanced solid tumors were enrolled before starting chemotherapy. Anthropometric, BC and systemic inflammation measurements were collected: weight loss (WL), in the previous 6 months, body mass index (BMI), skeletal muscle index (SMI) by CT, fat-free mass index (FFMI) by bioelectrical impedance vector analysis (BIVA) and neutrophil-to-lymphocyte ratio (NLR). As cutoff point for sarcopenia, SMI<38.5-52.4cm2/m2 and FFMI<15-17kg/m2 were used for female and male patients respectively. Statistical analysis was performed with McNemar’s test. Data are given as means§SD. 60 patients were assessed: 37M/23F; average age 59§13years; 37(62%) upper gastrointestinal, 10 lung, 9 colorectal, 1 breast, 3 other cancers. According to CT criteria, 41 patients (68%) were sarcopenic, of those 31(76%) reported a WL10%. Using BIVA, only 13 patients (22%) had pathologic FFMI, of those 12 (92%) reported a WL10%. CT identified a higher prevalence of sarcopenia than BIVA (p<0.0001). Among sarcopenic patients, 22(54%) had NLR4. Our preliminary results suggest that CT seems to be a more sensitive method for identifing sarcopenic patients, while BIVA is more specific. Further studies are required to confirm these data and to identify the best methods for monitoring BC during nutritional intervention.
CACHEXIA AND MALNUTRITION IN CANCER PATIENTS: INFLAMMATION INDEXES EVALUATION AND NUTRITIONAL INTERVENTION M. Borghi *,1, M. Bartoletti 2, D. Basile 2, C.A. Bertuzzi 1, S. Bodecchi 3, L. Bortot 2, F. Brescia 1, C. Corvaja 2, V. Fanotto 2, M. Favarato 1, S.K. Garattini 2, L. Gerratana 2, C. Lisanti 2, G. Pelizzari 2, F. Puglisi 2, V. Solfrini 4, F. Valoriani 5, F. Fabiani 1 1 Anesthesia and Intensive Care Unit, IRCCS CRO National Cancer Institute, Aviano, Italy 2 Unit of Medical Oncology and Cancer Prevention, IRCCS CRO National Cancer Institute, Aviano, Italy 3 Multidisciplinary Internist Unit, Azienda USL-IRCCS, Reggio Emilia, Italy 4 Sanitary Direction, IRCCS CRO National Cancer Institute, Aviano, Italy 5 Department of Metabolism Disease and Clinical Nutrition, Polyclinic Hospital, Modena, Italy Cancer patients (CP) typically experiment cachexia and malnutrition due to cancer type and systemic inflammation, that may cause greater treatment toxicities, impacting on prognosis, response to treatment, hospitalization and quality of life. We retrospectively analyzed consecutive data of 190 CP treated from February 2017 to July 2018 at the Anesthesia and Intensive Care Unit of National Cancer Institute, Aviano. At nutritional assessment we
SINPE conference abstracts / Nutrition 65 (2019) 110580
evaluated the rate of weight loss (WL) compared to self-reported usual weight (UW) and at 6 and 1 months before the visit, performed by an expert physician and a certified dietitian. We explored the association of WL10% with inflammation biomarkers, total protein, albumin, diagnosis and nutritional intervention through chi-squared or Kruskal-Wallis test, as statistically appropriate (Tab.2). Patients’ characteristics were summarized through descriptive analysis (Tab.1). Noteworthy 48% of CP was 65 years old, 20% had BMI<18.49; 21% had BMI25, 51% of them had a WL10%. About 63%, 44% and 13% of patients had a WL10% from UW, at 6 months and at 1 month, respectively. Moreover, 57% received oral supplementation after nutritional counseling. Conversely, 31% received artificial nutrition. Interestingly, WL10% from UW was associated with neutrophils-to-lymphocytes ratio (P=0.049) (Fig.1), cholesterol level (P=0.016) (Fig.2) and cancer type both from UW (P=0.003) (Fig.3) and at 6 months (P=0.007) before evaluation. A trend was observed with artificial nutrition (P=0.067). Prevention and treatment of cachexia still remain a critical need in CP. Therefore, integrating nutritional supportive care to oncologic treatments is crucial.
3
Fig. 2. Association of Total Cholesterol and %WL from UW.
Table 1 Patients' characteristics.
Fig. 3. Association of Diagnosis and %WL from UW.
Table 2 Association with %WL UW.
TAILORED NUTRITIONAL SUPPORT AS A PREDICTIVE FACTOR FOR SURVIVAL IN HEAD AND NECK CANCER PATIENTS UNDERGOING TREATMENTS I. Trestini *,1, L. Carbognin 2,3, I. Sperduti 4, C. Bonaiuto 1, L. Tondulli 1, S. Pilotto 1, G. Tortora 5, M. Milella 1, E. Bria 5 1 Department of Oncology, University of Verona Hospital, Verona, Italy 2 University of Verona, Verona, Italy 3 Division of Gynecologic Oncology, Department of Woman and Child Cattolica del Sacro Cuore, Fondazione Policlinico Health, Universita Universitario A. Gemelli IRCCS, Roma, Italy 4 Biostatistics, Regina Elena National Cancer Institute, Roma, Italy 5 Medical Oncology, Fondazione Policlinico Universitario A. Gemelli Cattolica del Sacro Cuore, Roma, Italy IRCCS, Universita
Fig. 1. Association of NLR with %WL from UW.
The purpose of the present study was to explore the prognostic relevance of tailored nutritional intervention in patients affected by head and neck (HNC) undergoing chemotherapy and/or radiotherapy. We retrospectively analysed data from patients affected by HNC (stage II-IV), diagnosed between April 2010 and August 2016 at the AOUI of Verona and undergoing chemotherapy and/or radiotherapy. Descriptive statistics was adopted. Clinical, pathological and nutritional data were correlated with Overall Survival (OS) using a Cox model. Overall data from 87 patients were gathered. Forty-one patients (47.1%) received an individualized nutritional intervention, including tailored nutritional counselling by a skilled dietitian, in addition to oral nutritional supplements, addressing the patients’ needs, and 46 patients (52.9%) did not receive that, without significant differences for baseline clinical and pathological characteristics. At the multivariate analysis, the independent significant predictors of OS were the response or stable disease after the first line treatment (HR 4.62,p<0.0001), the Performance Status (ECOG)<1 (HR 2.06, p=0.037), the nutritional intervention (HR 3.72, p<0.0001), and the BMI 25 at baseline (HR 2.85, p=0.006). Particularly, the 3-year OS
SINPE conference abstracts / Nutrition 65 (2019) 110580
off value for VAT was 44. Median OS was 30.97 months. At univariate analysis, older age (HR 2.46, p=0.013), primary tumor resection (HR 0.40, p=0.029), VAT>=44 (HR 2.85, p=0.011) and metastasectomy (HR 0.22, p=0.005), were significantly associated with OS (Table 2 and Figure1). By multivariate analysis, only VAT>=44 (HR2.64; p=0.030) was significantly associated with OS (Table 2). This exploratory study supported the prognostic role of VAT evaluation in patients with MCRC. In particular, high VAT was predictor of worse outcome. Further investigations are needed to confirm these preliminary data.
VENOUS ACCESS DEVICE RELATED COMPLICATIONS IN ONCOLOGIC PATIENTS ENROLLED ON HOME PARENTERAL NUTRITION E. Agnello *, A. Devecchi, M. Fadda, A. De Francesco della Salute e della Scienza di Torino, Torino, Italy Citta Oncologic patients with important anorexia or alterated digestive tract function, for obstruction or malabsorption, may benefit by Home Parenteral Nutrition. Aim: to evaluate the incidence of venous access related complications in cancer patients undergoing HPN. We included 195 patients enrolled on HPNon the basis of ESPEN guidelines, in 2015- 2016. Incidence of complications were expressed as events per 1000 HPN days, calculated from the HPN start date until the discontinuation of home infusions or the removal of the VAD or the death of the patient. The VADs used were peripherally inserted central catheters (PICCs), subcutaneous implanted port, tunneled central catheters (TCCs) or non tunneled central catheters (NTCCs). 111 males, 84 females; median age 65 years(27-94). Median HPN duration was 106 days. A total of 208 VADs were studied: 67% PICCs, 21% ports, 9% TCCs and 3% NTCCs. Both thrombosis and tip migrations occurred only in PICCs, while infections happened in PICCs, ports and TCCs. The overall incidence of VAD related complications per 1000 HPN days was 0,73(0,27 in TCCs, 0,70 in PICCs, 1,25 in ports and null in NTCCs). HPN results to be a supportive therapy with low rate of VADs related complications. Infections are the most frequent complication and may occur in all kind of devices. Cotogni P. Catheter-related complications in cancer patients on home parenteral nutrition: a prospective study of over 51,000 catheter days. JPEN J Parenter Enteral Nutr. 2013;37(3):375-83 Vashi PG. A longitudinal study investigating quality of life and nutritional outcomes in advanced cancer patients receiving home parenteral nutrition.BMC Cancer.2014;14:593
INTESTINAL FAILURE ASSOCIATED LIVER DISEASE IN ADULT PATIENTS: A ONE-YEAR PROSPECTIVE STUDY A.S. Sasdelli *, M. Guidetti, C. Pazzeschi, L. Pironi Center for Chronic Intestinal Failure, Department of Medical and Surgical Science, University of Bologna, Bologna, Italy Intestinal Failure Associated Liver Disease (IFALD) results from liver injury due to factors related to intestinal failure (IF) and/or to home parenteral nutrition (HPN), and no other evident cause. The epidemiology of IFALD depends on the criteria used for the diagnosis. The aim of the study was to assess the prevalence and the incidence of IFALD in the first 12 months of HPN in adult patients. 18 adult patients (13 Females; age 46§16 years; short bowel syndrome, 72%) who started HPN between Jan 2016 and December 2017 (T0) were enrolled in the study: 13 completed the 12-month follow-up (T12), 5 are ongoing. Biochemical liver function tests were collected at T0, 6-months (T6) and T12; liver ultrasound (US) was performed at T0 and T12. IFALDcriteria diagnosis: IFALD-Cholestasis: two of ɣglutamyltransferase, alkaline phosphatase and conjugated bilirubin 1.5 upper normal level for 6 months; IFALD-Steatosis: echogenicity at US; IFALD-Fibrosis: FIB-4 index. Statistic: descriptive analysis. Prevalence at T0, T6, T12, respectively: Cholestasis, 50%, 22%, 15%; Steatosis, 69%, 71%, 71%; Fibrosis, 16%, 27%, 0%. Incidence between T0 at T12: Cholestasis, 0%; Steatosis, 50%; Fibrosis, 0%. Our results indicate that IFALD can be present at the beginning of HPN, IFALD-cholestasis and IFALD-fibrosis may disappear during the first period of HPN, whereas IFALD-steatosis remains. This would suggest that at
starting HPN, liver may be affected by the metabolic alterations of the acute IF, that subside when turning in chronic IF.
DIAGNOSIS OF SARCOPENIA WITH COMPUTED TOMOGRAPHY AND BIOELECTRICAL IMPEDANCE VECTOR ANALYSIS IN CANCER PATIENTS A. Casirati *,1, G. Vandoni 1, S. Della Valle 1, E. Scioscioli 1, G. Greco 2, M. Platania 4, L. Mariani 3, C. Gavazzi 1 1 Fondazione IRCCS Istituto Nazionale dei Tumori, Clinical Nutrition Unit, Milano, Italy 2 Fondazione IRCCS Istituto Nazionale dei Tumori, Department of Radiology, Milano, Italy 3 Fondazione IRCCS Isituto Nazionale dei Tumori, Clinical Epidemiology and trial Organization Unit, Milano, Italy 4 Fondazione IRCCS Isituto Nazionale dei Tumori, Medical Oncology and Hematology Department, Milano, Italy Sarcopenia is a predictor of poorer prognosis in cancer patients. Emerging data suggest the association between computed tomography (CT)-defined body composition and clinical outcomes. The aim of the study was to compare imaging method with conventional diagnostic criteria to identify malnutrition and altered body composition (BC) in oncological patients. In a prospective study, patients with a new diagnosis of advanced solid tumors were enrolled before starting chemotherapy. Anthropometric, BC and systemic inflammation measurements were collected: weight loss (WL), in the previous 6 months, body mass index (BMI), skeletal muscle index (SMI) by CT, fat-free mass index (FFMI) by bioelectrical impedance vector analysis (BIVA) and neutrophil-to-lymphocyte ratio (NLR). As cutoff point for sarcopenia, SMI<38.5-52.4cm2/m2 and FFMI<15-17kg/m2 were used for female and male patients respectively. Statistical analysis was performed with McNemar’s test. Data are given as means§SD. 60 patients were assessed: 37M/23F; average age 59§13years; 37(62%) upper gastrointestinal, 10 lung, 9 colorectal, 1 breast, 3 other cancers. According to CT criteria, 41 patients (68%) were sarcopenic, of those 31(76%) reported a WL10%. Using BIVA, only 13 patients (22%) had pathologic FFMI, of those 12 (92%) reported a WL10%. CT identified a higher prevalence of sarcopenia than BIVA (p<0.0001). Among sarcopenic patients, 22(54%) had NLR4. Our preliminary results suggest that CT seems to be a more sensitive method for identifing sarcopenic patients, while BIVA is more specific. Further studies are required to confirm these data and to identify the best methods for monitoring BC during nutritional intervention.
CACHEXIA AND MALNUTRITION IN CANCER PATIENTS: INFLAMMATION INDEXES EVALUATION AND NUTRITIONAL INTERVENTION M. Borghi *,1, M. Bartoletti 2, D. Basile 2, C.A. Bertuzzi 1, S. Bodecchi 3, L. Bortot 2, F. Brescia 1, C. Corvaja 2, V. Fanotto 2, M. Favarato 1, S.K. Garattini 2, L. Gerratana 2, C. Lisanti 2, G. Pelizzari 2, F. Puglisi 2, V. Solfrini 4, F. Valoriani 5, F. Fabiani 1 1 Anesthesia and Intensive Care Unit, IRCCS CRO National Cancer Institute, Aviano, Italy 2 Unit of Medical Oncology and Cancer Prevention, IRCCS CRO National Cancer Institute, Aviano, Italy 3 Multidisciplinary Internist Unit, Azienda USL-IRCCS, Reggio Emilia, Italy 4 Sanitary Direction, IRCCS CRO National Cancer Institute, Aviano, Italy 5 Department of Metabolism Disease and Clinical Nutrition, Polyclinic Hospital, Modena, Italy Cancer patients (CP) typically experiment cachexia and malnutrition due to cancer type and systemic inflammation, that may cause greater treatment toxicities, impacting on prognosis, response to treatment, hospitalization and quality of life. We retrospectively analyzed consecutive data of 190 CP treated from February 2017 to July 2018 at the Anesthesia and Intensive Care Unit of National Cancer Institute, Aviano. At nutritional assessment we
SINPE conference abstracts / Nutrition 65 (2019) 110580
evaluated the rate of weight loss (WL) compared to self-reported usual weight (UW) and at 6 and 1 months before the visit, performed by an expert physician and a certified dietitian. We explored the association of WL10% with inflammation biomarkers, total protein, albumin, diagnosis and nutritional intervention through chi-squared or Kruskal-Wallis test, as statistically appropriate (Tab.2). Patients’ characteristics were summarized through descriptive analysis (Tab.1). Noteworthy 48% of CP was 65 years old, 20% had BMI<18.49; 21% had BMI25, 51% of them had a WL10%. About 63%, 44% and 13% of patients had a WL10% from UW, at 6 months and at 1 month, respectively. Moreover, 57% received oral supplementation after nutritional counseling. Conversely, 31% received artificial nutrition. Interestingly, WL10% from UW was associated with neutrophils-to-lymphocytes ratio (P=0.049) (Fig.1), cholesterol level (P=0.016) (Fig.2) and cancer type both from UW (P=0.003) (Fig.3) and at 6 months (P=0.007) before evaluation. A trend was observed with artificial nutrition (P=0.067). Prevention and treatment of cachexia still remain a critical need in CP. Therefore, integrating nutritional supportive care to oncologic treatments is crucial.
3
Fig. 2. Association of Total Cholesterol and %WL from UW.
Table 1 Patients' characteristics.
Fig. 3. Association of Diagnosis and %WL from UW.
Table 2 Association with %WL UW.
TAILORED NUTRITIONAL SUPPORT AS A PREDICTIVE FACTOR FOR SURVIVAL IN HEAD AND NECK CANCER PATIENTS UNDERGOING TREATMENTS I. Trestini *,1, L. Carbognin 2,3, I. Sperduti 4, C. Bonaiuto 1, L. Tondulli 1, S. Pilotto 1, G. Tortora 5, M. Milella 1, E. Bria 5 1 Department of Oncology, University of Verona Hospital, Verona, Italy 2 University of Verona, Verona, Italy 3 Division of Gynecologic Oncology, Department of Woman and Child Cattolica del Sacro Cuore, Fondazione Policlinico Health, Universita Universitario A. Gemelli IRCCS, Roma, Italy 4 Biostatistics, Regina Elena National Cancer Institute, Roma, Italy 5 Medical Oncology, Fondazione Policlinico Universitario A. Gemelli Cattolica del Sacro Cuore, Roma, Italy IRCCS, Universita
Fig. 1. Association of NLR with %WL from UW.
The purpose of the present study was to explore the prognostic relevance of tailored nutritional intervention in patients affected by head and neck (HNC) undergoing chemotherapy and/or radiotherapy. We retrospectively analysed data from patients affected by HNC (stage II-IV), diagnosed between April 2010 and August 2016 at the AOUI of Verona and undergoing chemotherapy and/or radiotherapy. Descriptive statistics was adopted. Clinical, pathological and nutritional data were correlated with Overall Survival (OS) using a Cox model. Overall data from 87 patients were gathered. Forty-one patients (47.1%) received an individualized nutritional intervention, including tailored nutritional counselling by a skilled dietitian, in addition to oral nutritional supplements, addressing the patients’ needs, and 46 patients (52.9%) did not receive that, without significant differences for baseline clinical and pathological characteristics. At the multivariate analysis, the independent significant predictors of OS were the response or stable disease after the first line treatment (HR 4.62,p<0.0001), the Performance Status (ECOG)<1 (HR 2.06, p=0.037), the nutritional intervention (HR 3.72, p<0.0001), and the BMI 25 at baseline (HR 2.85, p=0.006). Particularly, the 3-year OS