- Email: [email protected]
OR59: Nutritional Counseling with or without Systematic Use of Oral Nutritional Supplements in Head and Neck Cancer Patients Undergoing Radiotherapy
S24 old. Thirty-nine of forty-six miRNAs were significantly changed during the weekly treatment over a cycle (33 were down regulated and 3 were up regulated). Two miRNA were significantly down regulated in all patients over treatment: miRNA-143 (P = 0.03, 95% CI = −0.154 to −0.041) & miRNA-27b (P = 0.04, 95% CI = −0.184 to −0.047). MirRNA-451 showed a decreasing trend and this correlated with improved progression free survival (P = 0.002). Conclusion: Intravenous omega-3 in combination with conventional chemotherapy significantly reduces miRNA-143 and miRNA-27b. MiRNA-143 is implicated in tumour invasion and lymph node metastasis. MirRNA-27b has been shown to play a role in chemo resistance. A reduction in miRNA-451 levels correlated with progression free survival, this miRNA has been implicated in invasion and metastasis. A randomised trial is indicated to investigate this further. Disclosure of Interest: None declared.
OR59 NUTRITIONAL COUNSELING WITH OR WITHOUT SYSTEMATIC USE OF ORAL NUTRITIONAL SUPPLEMENTS IN HEAD AND NECK CANCER PATIENTS UNDERGOING RADIOTHERAPY E. Cereda1 *, S. Cappello1, S. Colombo2, C. Klersy3, I. Imarisio4, A. Turri1, M. Caraccia1, T. Monaco4, M. Benazzo5, P. Pedrazzoli4, F. Corbella2, R. Caccialanza1. 1Nutrition and Dietetics Service, 2 Division of Radiation Oncology, Department of HematoOncology, 3Biometry and Statistics Service, 4Division of Medical Oncology, Department of Hemato-Oncology, Fondazione IRCCS Policlinico San Matteo, 5Department of Otolaryngology Head Neck Surgery, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy Rationale: To evaluate the benefit of oral nutritional supplements (ONS) in addition to nutritional counseling in head and neck cancer (HNC) patients undergoing radiotherapy (RT). Methods: In a single-center, randomized, pragmatic, parallelgroup controlled trial (NCT02055833), 159 newly diagnosed HNC patients suitable for to RT regardless of previous surgery and induction chemotherapy were randomly assigned to nutritional counseling in combination with omega-3 enriched ONS (N = 78) or without ONS (N = 81) from the start of RT and continuing for up to 3 months after its end. The primary endpoint was the change in body weight at the end of RT. Secondary endpoints included changes in protein-calorie intake, muscle strength, phase angle and quality of life (QoL) over the study time points and anti-cancer treatment tolerance. Results: In patients in whom all the variables could be assessed, counseling plus ONS (N = 67) resulted in smaller loss of body weight than nutritional counseling alone (N = 69; mean difference, 1.6 kg [95%CI, 0.5–2.7]; P = 0.006). Imputation of missing outcomes provided consistent findings. In the ONSsupplemented group, higher protein-calorie intake and improvement in QoL over time were also observed (P < 0.001 for all). The use of ONS reduced the need for changes in scheduled anti-cancer treatments (i.e. for RT and/or systemic treatment dose reduction or complete suspension, HR = 0.40 [95%CI, 0.18–0.91], P = 0.029). Nine patients reported gastrointestinal intolerance to ONS.
Oral communications Conclusion: In HNC patients undergoing RT or RT plus systemic treatment, and receiving nutritional counseling, weight loss could not be completely prevented, but the use of ONS resulted in better weight maintenance, increased protein-calorie intake, improved quality of life and was associated with better anti-cancer treatment tolerance. References: Supported by a grant from ESPEN (Research Fellowship 2013) Disclosure of Interest: None declared.
Oral Communication VII: Critical Care OR60 GASTROINTESTINAL ORGAN FAILURE SYMPTOMS INCLUDED IN SOFA SCORES IMPROVE MORTALITY PREDICTION IN THE ICU: A MATHEMATICAL APPROACH P. Singer1 *, L. Cohen Fox2, Y. Aperstein2, J. Cohen1, M. Theilla1, I. Kagan1. 1Intensive Care Department and Institute for Nutrition Research, RABIN MEDICAL CENTER, Petah Tikva, 2 Afeka Tel Aviv Academic College of Engineering, Tel Aviv, Israel Rationale: SOFA (Sequential Organ Failure Assessment) score predicts mortality in critically ill patients but does not include gastrointestinal tract (GIT) organ dysfunction. Previous inclusion of this organ to the 6 organs assessment of SOFA did not improve the predictive value of the score (1), reaching only 70%. Consecutive evaluation of daily SOFA added to GIT symptoms (SOFA i) has never been tested. We evaluated 3 days (SOFA i to improve the predictive value of SOFA. Methods: A cohort of 2,709 ICU patients was included from our ICU database to assess SOFA scores, after IRB approval. 1.304 patients with 3 SOFA scores and 3 GIT available symptoms (vomiting, bowel movements and reaching REE through enteral feeding) were analyzed (20 × 106 items) for mortality prediction. Area under the curve (AUC) was evaluated for the following analysis: ANN (artificial neural network), SVM (support vector machine), Linear Regression, Logistic Regression. Results: From the 1,304 patients included, 909 survived and 394 died. The best predictive AUC values (0.91 and 0.93) were obtained using the association of linear regression and logistic regression, and ANN and linear regression respectively, when SOFA i was used. These results are reaching a much stronger predictive value than those previously published in a comparable population. Sensitivity was 84.7%, Specificity 86.3%, Accuracy 85.6%, Positive predictive value and Negative predictive value were respectively 84.7% and 13.7%. Conclusion: Our results suggest that SOFA score predictive value for mortality can be improved when GIT symptoms are included. A new SOFAi score should be considered. The importance of GIT failure is stressed. Reference 1. Blaser Reintam A, et al. Gastrointestinal symptoms during the first week of intensive care are associated with poor outcome: a prospective multicentre study. Intensive Care Medicine 2013; 39: 899–909. Disclosure of Interest: None declared.
OR59 NUTRITIONAL COUNSELING WITH OR WITHOUT SYSTEMATIC USE OF ORAL NUTRITIONAL SUPPLEMENTS IN HEAD AND NECK CANCER PATIENTS UNDERGOING RADIOTHERAPY E. Cereda1 *, S. Cappello1, S. Colombo2, C. Klersy3, I. Imarisio4, A. Turri1, M. Caraccia1, T. Monaco4, M. Benazzo5, P. Pedrazzoli4, F. Corbella2, R. Caccialanza1. 1Nutrition and Dietetics Service, 2 Division of Radiation Oncology, Department of HematoOncology, 3Biometry and Statistics Service, 4Division of Medical Oncology, Department of Hemato-Oncology, Fondazione IRCCS Policlinico San Matteo, 5Department of Otolaryngology Head Neck Surgery, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy Rationale: To evaluate the benefit of oral nutritional supplements (ONS) in addition to nutritional counseling in head and neck cancer (HNC) patients undergoing radiotherapy (RT). Methods: In a single-center, randomized, pragmatic, parallelgroup controlled trial (NCT02055833), 159 newly diagnosed HNC patients suitable for to RT regardless of previous surgery and induction chemotherapy were randomly assigned to nutritional counseling in combination with omega-3 enriched ONS (N = 78) or without ONS (N = 81) from the start of RT and continuing for up to 3 months after its end. The primary endpoint was the change in body weight at the end of RT. Secondary endpoints included changes in protein-calorie intake, muscle strength, phase angle and quality of life (QoL) over the study time points and anti-cancer treatment tolerance. Results: In patients in whom all the variables could be assessed, counseling plus ONS (N = 67) resulted in smaller loss of body weight than nutritional counseling alone (N = 69; mean difference, 1.6 kg [95%CI, 0.5–2.7]; P = 0.006). Imputation of missing outcomes provided consistent findings. In the ONSsupplemented group, higher protein-calorie intake and improvement in QoL over time were also observed (P < 0.001 for all). The use of ONS reduced the need for changes in scheduled anti-cancer treatments (i.e. for RT and/or systemic treatment dose reduction or complete suspension, HR = 0.40 [95%CI, 0.18–0.91], P = 0.029). Nine patients reported gastrointestinal intolerance to ONS.
Oral communications Conclusion: In HNC patients undergoing RT or RT plus systemic treatment, and receiving nutritional counseling, weight loss could not be completely prevented, but the use of ONS resulted in better weight maintenance, increased protein-calorie intake, improved quality of life and was associated with better anti-cancer treatment tolerance. References: Supported by a grant from ESPEN (Research Fellowship 2013) Disclosure of Interest: None declared.
Oral Communication VII: Critical Care OR60 GASTROINTESTINAL ORGAN FAILURE SYMPTOMS INCLUDED IN SOFA SCORES IMPROVE MORTALITY PREDICTION IN THE ICU: A MATHEMATICAL APPROACH P. Singer1 *, L. Cohen Fox2, Y. Aperstein2, J. Cohen1, M. Theilla1, I. Kagan1. 1Intensive Care Department and Institute for Nutrition Research, RABIN MEDICAL CENTER, Petah Tikva, 2 Afeka Tel Aviv Academic College of Engineering, Tel Aviv, Israel Rationale: SOFA (Sequential Organ Failure Assessment) score predicts mortality in critically ill patients but does not include gastrointestinal tract (GIT) organ dysfunction. Previous inclusion of this organ to the 6 organs assessment of SOFA did not improve the predictive value of the score (1), reaching only 70%. Consecutive evaluation of daily SOFA added to GIT symptoms (SOFA i) has never been tested. We evaluated 3 days (SOFA i to improve the predictive value of SOFA. Methods: A cohort of 2,709 ICU patients was included from our ICU database to assess SOFA scores, after IRB approval. 1.304 patients with 3 SOFA scores and 3 GIT available symptoms (vomiting, bowel movements and reaching REE through enteral feeding) were analyzed (20 × 106 items) for mortality prediction. Area under the curve (AUC) was evaluated for the following analysis: ANN (artificial neural network), SVM (support vector machine), Linear Regression, Logistic Regression. Results: From the 1,304 patients included, 909 survived and 394 died. The best predictive AUC values (0.91 and 0.93) were obtained using the association of linear regression and logistic regression, and ANN and linear regression respectively, when SOFA i was used. These results are reaching a much stronger predictive value than those previously published in a comparable population. Sensitivity was 84.7%, Specificity 86.3%, Accuracy 85.6%, Positive predictive value and Negative predictive value were respectively 84.7% and 13.7%. Conclusion: Our results suggest that SOFA score predictive value for mortality can be improved when GIT symptoms are included. A new SOFAi score should be considered. The importance of GIT failure is stressed. Reference 1. Blaser Reintam A, et al. Gastrointestinal symptoms during the first week of intensive care are associated with poor outcome: a prospective multicentre study. Intensive Care Medicine 2013; 39: 899–909. Disclosure of Interest: None declared.