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MON-P097: Anthropometric Measurements as a Predictor of Survival in Patients with Incurable Cancers Receiving Home Parenteral Nutrition (HPN)
Nutrition and cancer 2 MON-P096 BIOCHEMICAL MEASUREMENTS AS A PREDICTOR OF SURVIVAL IN PATIENTS WITH INCURABLE CANCERS RECEIVING HOME PARENTERAL NUTRITION (HPN) N. Keane1 *, K. Fragkos2, P. S. Patel1, K. Murray2, S. Obbard2, S. Ajibodu3, S. O’callaghan3, H. Kwok2, E. Paulon2, J. Barragry2, S. Mehta2, S. Di Caro2, F. Rahman2. 1Dietetics, 2 GI Services, 3Pharmacy, University College London Hospital, London, United Kingdom Rationale: To identify factors like biochemical measurements that may affect prognosis in HPN patients with incurable cancer. Methods: Data was collected retrospectively for all patients receiving HPN between 01/01/2006 and 15/10/2016. Demographic, biochemical and medical factors, Karnofsky Performance Status (KPS) and Glasgow Prognostic Score (GPS) were recorded. Univariate and multivariate analyses were performed including Kaplan-Meier curves, Cox Regression and correlation analyses. Results: 66 HPN patients (43 female, mean age 57 years) with incurable cancers were identified. On discharge, mean CRP was high at 46 mg/L (SD = 48.3) and albumin borderline low at 32.2 g/L (SD = 6). Mean haemoglobin was slightly below normal (101.6 g/L, SD = 15) and mean values of electrolytes were within normal values. The only significant predictors of survival were CRP [(HR = 1.01 (95% CI 1.004–1.015, p = 0.001)] and WCC [HR = 1.06 (95% CI 1.01–1.10, p = 0.011)], with higher levels of markers of inflammation being correlated with higher incidence of deaths. Sodium predicted survival (overall and 6month) with borderline significance [those with sodium ≥ 135 mmol/L showing 38% less incidence of deaths compared to sodium <135 mmol/L]. Higher levels of albumin were associated with an improved survival [HR = 0.96 (95% CI 0.91– 1.00, p = 0.052)] with a borderline statistical significance. These results are aligned with the findings of the correlation between survival and GPS which encompass both CRP and albumin. Conclusion: Our study supports that a systemic inflammatory status, as assessed with higher GPS, CRP, and WCC is associated with a worse performance status (i.e. lower KPS and prognosis). Possible timely referral for nutrition support may be required as patients with earlier stage disease will likely have better GPS and KPS scores which is associated with improved overall survival. Disclosure of Interest: None declared.
MON-P097 ANTHROPOMETRIC MEASUREMENTS AS A PREDICTOR OF SURVIVAL IN PATIENTS WITH INCURABLE CANCERS RECEIVING HOME PARENTERAL NUTRITION (HPN) N. Keane1 *, K. Fragkos2, P. S. Patel1, K. Murray2, S. Obbard2, S. Ajibodu3, S. O’callaghan3, H. Kwok2, E. Paulon2, J. Barragry2, S. Mehta2, S. Di Caro2, F. Rahman2. 1Dietetics, 2GI Services, 3Pharmacy, University College London Hospital, London, United Kingdom Rationale: To identify factors like anthropometry that may affect prognosis in HPN patients with incurable cancer. Methods: Data was collected retrospectively for all patients receiving HPN between 01/01/2006 and 15/10/2016.
S215 Univariate and multivariate analyses were performed including Kaplan-Meier curves, Cox Regression and correlation analyses. Results: 71 HPN patients with incurable cancers (49 females, 22 males) with mean age 56.8 years (SD = 11.9). The malignancy types were gynaecological (33.8%), upper gastrointestinal (25.4%), lower gastrointestinal (18.3%), hepatopancreatic-biliary (7%), haematological (5.6%) and others (9.9%). Most patients had metastatic disease (81.7%) and had undergone prior surgery for their malignancy (74.3%), or chemotherapy before and/or during PN administration (88.6%). The majority of patients also had radiotherapy (31.4%). The mean BMI upon starting HPN was 19.9 kg/m2 (SD = 4.13), with 58.1% of patients presenting with a weight loss of more than 10%, and, 11.3% with more than 30%. Therefore, 87% patients were in a state of cancer cachexia. The mean weight upon starting HPN was 55.3 kg (SD = 11.5), while in the outpatient setting between 0–3 months and 3–6 months, mean weight was 54.5 kg (SD = 9) and 58.6 kg (SD = 11.3) respectively, indicating a relative increase. None of the weight, height, BMI and presence of cancer cachexia variables significantly predicted survival. Conclusion: Several studies1 have examined anthropometrics as predictors of survival in patients with advanced cancer on HPN, although this study failed to observe any associations amongst BMI, height and weight with survival. Reference 1. Bozzetti F, Santarpia L, Pironi L, et al. The prognosis of incurable cachectic cancer patients on home parenteral nutrition: A multicentre observational study with prospective follow-up of 414 patients. Annals of Oncology 25:487–493, 2014. Disclosure of Interest: None declared.
MON-P098 RISK OF MALNUTRITION ASSOCIATED WITH GASTROINTESTINAL SIGNS AND SYMPTOMS AND THE LOCATION OF THE DISEASE: RESULTS OF BRAZILIAN RESEARCH ON NUTRITION ONCOLOGY N. B. de Pinho1 *, C. Saunders2, R. B. Martucci1,3, V. D. Rodrigues1, C. A. D’almeida1, L. C. S. Thuler4, W. A. F. Peres2. 1Nutrition and Dietetic Service, National Cancer Institute, 2Nutrition and Dietetic, Universidade Federal do Rio de Janeiro, 3Applied Nutrition, Universidade do Estado do Rio de Janeiro, 4Research Center, National Cancer Institute, Rio de Janeiro, Brazil Rationale: Nutritional Patient-Generated Subjective Global Assessment (PG-SGA) plays an important role in the diagnosis of malnutrition in cancer patients. The objective was to evaluate the prevalence of malnutrition and its association with tumor location and nutritional impact signs and symptoms at the time of hospital admission in all regions of Brazil. Methods: Multicenter, cross-sectional study, included 45 hospitals. 4,783 nutritional status of adult and elderly patients, of both genders, was assessed at the time of hospital admission using PG-SGA. The association between the independent variables (signs and symptoms of nutritional impact and tumor location) and the nutritional status classification was evaluated in three levels: A (well nourished), B (moderately malnourished or nutritional risk) and C (severe malnourished), using the ordinal polytomic regression with proportional odds model.
MON-P097 ANTHROPOMETRIC MEASUREMENTS AS A PREDICTOR OF SURVIVAL IN PATIENTS WITH INCURABLE CANCERS RECEIVING HOME PARENTERAL NUTRITION (HPN) N. Keane1 *, K. Fragkos2, P. S. Patel1, K. Murray2, S. Obbard2, S. Ajibodu3, S. O’callaghan3, H. Kwok2, E. Paulon2, J. Barragry2, S. Mehta2, S. Di Caro2, F. Rahman2. 1Dietetics, 2GI Services, 3Pharmacy, University College London Hospital, London, United Kingdom Rationale: To identify factors like anthropometry that may affect prognosis in HPN patients with incurable cancer. Methods: Data was collected retrospectively for all patients receiving HPN between 01/01/2006 and 15/10/2016.
S215 Univariate and multivariate analyses were performed including Kaplan-Meier curves, Cox Regression and correlation analyses. Results: 71 HPN patients with incurable cancers (49 females, 22 males) with mean age 56.8 years (SD = 11.9). The malignancy types were gynaecological (33.8%), upper gastrointestinal (25.4%), lower gastrointestinal (18.3%), hepatopancreatic-biliary (7%), haematological (5.6%) and others (9.9%). Most patients had metastatic disease (81.7%) and had undergone prior surgery for their malignancy (74.3%), or chemotherapy before and/or during PN administration (88.6%). The majority of patients also had radiotherapy (31.4%). The mean BMI upon starting HPN was 19.9 kg/m2 (SD = 4.13), with 58.1% of patients presenting with a weight loss of more than 10%, and, 11.3% with more than 30%. Therefore, 87% patients were in a state of cancer cachexia. The mean weight upon starting HPN was 55.3 kg (SD = 11.5), while in the outpatient setting between 0–3 months and 3–6 months, mean weight was 54.5 kg (SD = 9) and 58.6 kg (SD = 11.3) respectively, indicating a relative increase. None of the weight, height, BMI and presence of cancer cachexia variables significantly predicted survival. Conclusion: Several studies1 have examined anthropometrics as predictors of survival in patients with advanced cancer on HPN, although this study failed to observe any associations amongst BMI, height and weight with survival. Reference 1. Bozzetti F, Santarpia L, Pironi L, et al. The prognosis of incurable cachectic cancer patients on home parenteral nutrition: A multicentre observational study with prospective follow-up of 414 patients. Annals of Oncology 25:487–493, 2014. Disclosure of Interest: None declared.
MON-P098 RISK OF MALNUTRITION ASSOCIATED WITH GASTROINTESTINAL SIGNS AND SYMPTOMS AND THE LOCATION OF THE DISEASE: RESULTS OF BRAZILIAN RESEARCH ON NUTRITION ONCOLOGY N. B. de Pinho1 *, C. Saunders2, R. B. Martucci1,3, V. D. Rodrigues1, C. A. D’almeida1, L. C. S. Thuler4, W. A. F. Peres2. 1Nutrition and Dietetic Service, National Cancer Institute, 2Nutrition and Dietetic, Universidade Federal do Rio de Janeiro, 3Applied Nutrition, Universidade do Estado do Rio de Janeiro, 4Research Center, National Cancer Institute, Rio de Janeiro, Brazil Rationale: Nutritional Patient-Generated Subjective Global Assessment (PG-SGA) plays an important role in the diagnosis of malnutrition in cancer patients. The objective was to evaluate the prevalence of malnutrition and its association with tumor location and nutritional impact signs and symptoms at the time of hospital admission in all regions of Brazil. Methods: Multicenter, cross-sectional study, included 45 hospitals. 4,783 nutritional status of adult and elderly patients, of both genders, was assessed at the time of hospital admission using PG-SGA. The association between the independent variables (signs and symptoms of nutritional impact and tumor location) and the nutritional status classification was evaluated in three levels: A (well nourished), B (moderately malnourished or nutritional risk) and C (severe malnourished), using the ordinal polytomic regression with proportional odds model.