- Email: [email protected]
PP079-SUN LOW ENERGY INTAKE IN ONCOLOGY PATIENTS DESPITE NUTRITIONAL SCREENING AND CARE PLANS
Nutrition and cancer II PP077-SUN A PHASE II CLUSTER RANDOMISED EXPLORATORY TRIAL OF A PSYCHOSOCIAL INTERVENTION FOR WEIGHT AND EATING RELATED PROBLEMS IN PEOPLE WITH ADVANCED CANCER: EFFECT OF THE MACMILLAN APPROACH TO WEIGHT AND EATING (MAWE) ON QUALITY OF LIFE J.B. Hopkinson1 . 1 Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom Rationale: Weight loss and anorexia are symptoms of cancer cachexia experienced by 80% of patients with advanced cancer. The Macmillan Weight and Eating Studies (2000 2011) have used the UK Medical Research Council complex interventions framework to develop the first psych-educational intervention for cachexia-related problems in people with advanced cancer: The Macmillan Approach to Weight and Eating (MAWE). This paper is about a Phase II exploratory trial of MAWE, which investigated its effect on quality of life in patients with involuntary weight loss and/or poor appetite. Methods: The trial was of cluster randomised design, with two community palliative care teams randomised to different arms. It used mixed methods to compare a MAWE Group (n = 25), who were supported by MAWE trained nurses; with a treatment as usual group (TAU) (n = 25). An outcome measure was the EORTC-QLQ-C15PAL, designed and validated to measure quality of life in palliative care patients. Non-parametric methods were used to examine variability in the measure. Other data collection methods included patient interviews. Results: There was no statistically significant change in quality of life in either the MAWE group or the TAU group. However, there was a significant change at the 5% level in the MAWE, but not the TAU group, in two quality of life sub-scales; appetite (p = 0.02) and emotional function (p = 0.01). Qualitative data analysis found MAWE patients to perceive benefit in the eating changes that they had made. Conclusion: Further investigation is warranted. Psychoeducation could have a role to play in the nutritional care of patients with advanced cancer. This small exploratory investigation suggests that it may help patients selfmanage tumour induced weight loss and anorexia. Disclosure of Interest: J. Hopkinson Grant/Research Support from: Macmillan Cancer Support
PP078-SUN POTENTIAL PREDICTORS FOR SURVIVAL IN ADVANCED CANCER PATIENTS J. Arends1 , M. Avlar1 , C. Unger1 . 1 Medical Oncology, Tumor Biology Center, Freiburg, Germany Rationale: Predicting survival in patients with advanced tumors is inherently difficult but is usually included in the complex decisions concerning artificial nutrition. The objective, therefore, was to screen for clinical and laboratory predictors of survival in cancer patients. Methods: For cancer patients, who had undergone nutrition assessment at our institution, the date of death was available. We correlated survival from time of assessment (OS) and some of the documented parameters.
53 Results: In 90 patients (40m, 50w) mean age was 64±10 years [x±SD], OS 71±80 (2; 381; 43) days [min; max; median], BMI 21.9±3.5 (14.5; 35.3; 21.2) kg/m2 , weight change since cancer diagnosis 15±12%, CRP 76±73 (1; 293; 54) mg/l, albumin 31±5 g/l, WHO index 2.6±0.7 (1; 4; 3), bioimpedance phase angle 3.6±0.9º (1.7; 6.9; 3.4). A special activity score (1 = lowest, bedridden; 10 = highest, strenuous exercise possible) was 3.7±1.7 (1; 8; 4). Correlation with OS yielded the following coefficients of correlation r: albumin 0.48, CRP 0.44, WHO index 0.41, mobility score 0.35, weight loss in 3m 0.28, BIA phase angle 0.29 (all p < 0.001); anorexia 0.25, pain 0.21 (both p < 0.05); weight change since diagnosis NS, fibrinogen NS. The chances of surviving 100 days was very low for albumin <30 or CRP > 50 or phase angle <4 or mobility <5. Conclusion: Several laboratory and clinical parameters may contribute to predicting potential survival in patients with advanced cancer when institution of artificial nutrition is considered. Disclosure of Interest: None Declared
PP079-SUN LOW ENERGY INTAKE IN ONCOLOGY PATIENTS DESPITE NUTRITIONAL SCREENING AND CARE PLANS J. Sk¨ old1 , K. Holmberg2 , P. Nordstedt3 , M. Annborn4 , ¨ dlund Olin8 . M. B¨ acklund5 , O. Irtun6 , M. Holst7 , A. O 1 Sk˚ ane Oncology Department, Sk˚ ane University Hospital, Malm¨ o, 2 Center for Allogen Stem Cell Transplantation, 3 Department of Tranplantation Surgery, Karolinska University Hospital, Stockholm, 4 Department of Anaesthesia and Intensive Care, Sk˚ ane University Hospital, Lund, Sweden; 5 Department of Intensive Care, Helsinki University Hospital, Helsinki, Finland; 6 Department of GI-Surgery, University Hospital North-Norway, Tromso, Norway; 7 Centre for Nutrition and Bowel Disease, Gastroenterology Department, Aalborg University Hospital, Aalborg, Denmark; 8 Department of Quality and Patient Safety, Karolinska University Hospital, Stockholm, Sweden Rationale: Many studies show difficulties in following existing guidelines. ESPEN recommends that nutritional screening should be performed at admittance to hospital and for cancer patients at every visit to the hospital. For patients at risk for malnutrition ESPEN recommends that a nutrition care plan and early interventions should be done. ESPEN recommends an energy intake for bedridden patients between 20 25 kcal/kg/day and for ambulant patients between 25 30 kcal/kg/day. The aim of the study was to investigate how ESPEN guidelines for nutritional screening and energy intake were followed in an oncology department. Methods: All patients admitted to an oncology ward during a two week period were asked to participant in the study. Energy intake was registered every day until discharge or end of study. An audit of the nutritional documentation in the patients’ record was performed. Results: A total number of 26 (13 men) patients with a mean age of 67.6 (SD 9.3) years were included in the study. Sixty one percent of the patients were screened for malnutrition when admitted to the ward. Of the patients
54 screened for malnutrition 73% were high risk patients. A nutrition care plan was made in 78% of those cases. The energy intake was followed on 21 of the 26 patients. When calculated with an energy need for bedridden patients of 25 kcal/kg/day and for ambulant patients 30 kcal/kg/day a mean energy need of 2041 (SD 402) kcal and a mean energy intake of 1396 (SD 481) kcal. This gives a deficit of 645 kcal (32% of daily need) per day and patient. The patients received 55% of calculated energy requirements from ordinary food. Ninty five percent of the patients received oral nutritional supplement and this increased the energy intake to 63% of needed. Conclusion: Despite screening and nutrition care plans, energy requirements were not met. Other actions seem to be necessary to increase energy intake in this patient group. Disclosure of Interest: None Declared
PP080-SUN ENTERAL IMMUNONUTRITION IN H&N AND OESOPHAGUS CANCER PATIENTS DURING RADIOCHEMOTHERAPY TREATMENT C. Bouteloup1 , A. Dillies2 , P. Bachman3 , A. Achim4 , D. Pezet4 , L. Pommier5 , S. Racadot5 , R. Randani6 , J. Talvas7 , M. Vasson7 . 1 Oncologie Digestive, CHRU Estaing, 2 Oncologie M´ edicale, Centre Jean Perrin, Clermont-Ferrand, 3 Unit´ e de Nutrition Clinique, Centre epato-Gastro-Ent´ erologie, L´ eon B´ erard, Lyon, 4 Service H´ CHRU Estaing, Clermont-Ferrand, 5 Service de Radioth´ erapie, Centre L´ eon B´ erard, Lyon, 6 Service H´ epato-Gastro-Ent´ erologie, CHU, B´ eziers, 7 EA5433, Universit´ e d’Auvergne, Clermont-Ferrand, France Rationale: Malnutrition, frequently observed in head & neck (HN) and oesophageal (O) cancers, is exacerbated by radiochemotherapy (RCT) and associated with less resistance to treatment toxicity and increase in morbidity and mortality. Our goal was to investigate if enteral immunonutrition (IMPACT® , Nestl´ e), administered during RCT, could improve nutritional status of cancer patients and limit toxicity of treatment. Methods: A randomized double-blind clinical trial was driven with 33 patients (62.3±8 years old, 17 HN, 16 O). They received either an Immune (IG) or a Standardized nutrition (SG) during all RCT period (intakes mean: 2300 kcal/d, 105 g protein/d). Based on NRI < 97.5, there were 18 malnourished patients at inclusion (IG = 10, SG = 8). Clinical and biological parameters were investigated at the beginning (Db) and at the end (De) of RCT. Results: Body weight (kg) tended to increase in both groups comparing Db and De (IG: +2.9±2.8; SG: +2.3±2.4; ns). Lean mass tissues at De tended to be higher in IG compared to SG (51.3±10 vs 44.5±8; p = 0.09). A tendency to a better improvement of NRI from Db to De is observed in IG (IG: +4.1±5.7; SG: +0.3±4; p = 0.07). Therefore, the albuminemia and CRP levels were stable during this period. Impairment of performance test (OMS score) between Db and De could be limited by immunonutrition (IG: +0.16±0.7; SG: +0.50±0.7; ns). Interestingly, OMS score was significantly lower in IG vs SG at De (1.14±0.3 vs 1.63±0.5; p = 0.03). Mucositis occurrence measured between Db and De tends to be
Poster presentations counteracted by immunonutrition (IG: 0.5±1.3; SG: +1.0±1.4; p = 0.15). Conclusion: In conclusion, immunonutrition tends to improve nutritional status and limit mucositis occurrence during RCT. Moreover, it permits to reduce performances degradation in RCT treated patients. Disclosure of Interest: None Declared
PP081-SUN STUDY ON FOOD ACCEPTANCE AND FOOD INGREDIENTS OF CHOICE IN CANCER PATIENTS RECEIVING CHEMOTHERAPY J. Angkatavanich1 , N. Voravud2 , T. Siangprasert1 , S. Phromwong1 . 1 Department of Nutrition and Dietetics, Faculty of Allied Health Sciences, Chulalongkorn University, 2 Department of Medicine (Oncology and Radiotherapy), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand Rationale: Chemotherapy adversely affected cancer patients causing sensory aversions, eating difficulties and significant weight loss. This research is intended to explore food acceptance and the best choice of food ingredients especially dietary herbs and cooking processes for menu development. Methods: A cross-sectional survey was undertaken by in-depth interview with questionnaires in Thai cancer patients receiving chemotherapy at King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Results: A total of 129 cancer patients receiving chemotherapy, 75.97% female and 24.03% male, aged 52.73±11.40 years, with body weight 57.99±10.55 kg were interviewed. Half of the patients reported significant reduced intake. This ranged from ‘need of considerable effort to eat despite no appetite’, to ‘no willingness to eat except drinking’, to ‘taking nothing’. Intolerance to hot and spicy food is the most frequent problem found in 50.00% of the patients. Most unacceptable foods are high-fat especially coconut milk, chicken, and beef. Protein sources best accepted are fish, soybean and its products, eggs, and cow milk. Meat from aquatic animals is better accepted than land animals. Liquid and softtextured foods, and cooled desserts are reported to be comfortable and facilitate eating. Lemon, lemon grass, holy basil leaves, sweet basil leaves, and many other herbs are acceptable and helpful. The cooking process most avoided is grilling while steaming, simmering, and other cooking method without fat are most chosen. There are 22.48% of patients that need to add seasoning mostly for saltiness to improve and enjoy eating. Conclusion: Despite greatly reduced appetite and sensory aversions, cancer patients under chemotherapy could comfortably consume low-fat, least hot and spicy, soft textured foods and enhanced flavoring with various dietary herbs. Disclosure of Interest: J. Angkatavanich Grant/Research Support from: Faculty of Allied Health Sciences, Chulalongkorn University and the Chulalongkorn University 100th Anniversary Academic Fund, N. Voravud: None Declared, T. Siangprasert: None Declared, S. Phromwong: None Declared
PP078-SUN POTENTIAL PREDICTORS FOR SURVIVAL IN ADVANCED CANCER PATIENTS J. Arends1 , M. Avlar1 , C. Unger1 . 1 Medical Oncology, Tumor Biology Center, Freiburg, Germany Rationale: Predicting survival in patients with advanced tumors is inherently difficult but is usually included in the complex decisions concerning artificial nutrition. The objective, therefore, was to screen for clinical and laboratory predictors of survival in cancer patients. Methods: For cancer patients, who had undergone nutrition assessment at our institution, the date of death was available. We correlated survival from time of assessment (OS) and some of the documented parameters.
53 Results: In 90 patients (40m, 50w) mean age was 64±10 years [x±SD], OS 71±80 (2; 381; 43) days [min; max; median], BMI 21.9±3.5 (14.5; 35.3; 21.2) kg/m2 , weight change since cancer diagnosis 15±12%, CRP 76±73 (1; 293; 54) mg/l, albumin 31±5 g/l, WHO index 2.6±0.7 (1; 4; 3), bioimpedance phase angle 3.6±0.9º (1.7; 6.9; 3.4). A special activity score (1 = lowest, bedridden; 10 = highest, strenuous exercise possible) was 3.7±1.7 (1; 8; 4). Correlation with OS yielded the following coefficients of correlation r: albumin 0.48, CRP 0.44, WHO index 0.41, mobility score 0.35, weight loss in 3m 0.28, BIA phase angle 0.29 (all p < 0.001); anorexia 0.25, pain 0.21 (both p < 0.05); weight change since diagnosis NS, fibrinogen NS. The chances of surviving 100 days was very low for albumin <30 or CRP > 50 or phase angle <4 or mobility <5. Conclusion: Several laboratory and clinical parameters may contribute to predicting potential survival in patients with advanced cancer when institution of artificial nutrition is considered. Disclosure of Interest: None Declared
PP079-SUN LOW ENERGY INTAKE IN ONCOLOGY PATIENTS DESPITE NUTRITIONAL SCREENING AND CARE PLANS J. Sk¨ old1 , K. Holmberg2 , P. Nordstedt3 , M. Annborn4 , ¨ dlund Olin8 . M. B¨ acklund5 , O. Irtun6 , M. Holst7 , A. O 1 Sk˚ ane Oncology Department, Sk˚ ane University Hospital, Malm¨ o, 2 Center for Allogen Stem Cell Transplantation, 3 Department of Tranplantation Surgery, Karolinska University Hospital, Stockholm, 4 Department of Anaesthesia and Intensive Care, Sk˚ ane University Hospital, Lund, Sweden; 5 Department of Intensive Care, Helsinki University Hospital, Helsinki, Finland; 6 Department of GI-Surgery, University Hospital North-Norway, Tromso, Norway; 7 Centre for Nutrition and Bowel Disease, Gastroenterology Department, Aalborg University Hospital, Aalborg, Denmark; 8 Department of Quality and Patient Safety, Karolinska University Hospital, Stockholm, Sweden Rationale: Many studies show difficulties in following existing guidelines. ESPEN recommends that nutritional screening should be performed at admittance to hospital and for cancer patients at every visit to the hospital. For patients at risk for malnutrition ESPEN recommends that a nutrition care plan and early interventions should be done. ESPEN recommends an energy intake for bedridden patients between 20 25 kcal/kg/day and for ambulant patients between 25 30 kcal/kg/day. The aim of the study was to investigate how ESPEN guidelines for nutritional screening and energy intake were followed in an oncology department. Methods: All patients admitted to an oncology ward during a two week period were asked to participant in the study. Energy intake was registered every day until discharge or end of study. An audit of the nutritional documentation in the patients’ record was performed. Results: A total number of 26 (13 men) patients with a mean age of 67.6 (SD 9.3) years were included in the study. Sixty one percent of the patients were screened for malnutrition when admitted to the ward. Of the patients
54 screened for malnutrition 73% were high risk patients. A nutrition care plan was made in 78% of those cases. The energy intake was followed on 21 of the 26 patients. When calculated with an energy need for bedridden patients of 25 kcal/kg/day and for ambulant patients 30 kcal/kg/day a mean energy need of 2041 (SD 402) kcal and a mean energy intake of 1396 (SD 481) kcal. This gives a deficit of 645 kcal (32% of daily need) per day and patient. The patients received 55% of calculated energy requirements from ordinary food. Ninty five percent of the patients received oral nutritional supplement and this increased the energy intake to 63% of needed. Conclusion: Despite screening and nutrition care plans, energy requirements were not met. Other actions seem to be necessary to increase energy intake in this patient group. Disclosure of Interest: None Declared
PP080-SUN ENTERAL IMMUNONUTRITION IN H&N AND OESOPHAGUS CANCER PATIENTS DURING RADIOCHEMOTHERAPY TREATMENT C. Bouteloup1 , A. Dillies2 , P. Bachman3 , A. Achim4 , D. Pezet4 , L. Pommier5 , S. Racadot5 , R. Randani6 , J. Talvas7 , M. Vasson7 . 1 Oncologie Digestive, CHRU Estaing, 2 Oncologie M´ edicale, Centre Jean Perrin, Clermont-Ferrand, 3 Unit´ e de Nutrition Clinique, Centre epato-Gastro-Ent´ erologie, L´ eon B´ erard, Lyon, 4 Service H´ CHRU Estaing, Clermont-Ferrand, 5 Service de Radioth´ erapie, Centre L´ eon B´ erard, Lyon, 6 Service H´ epato-Gastro-Ent´ erologie, CHU, B´ eziers, 7 EA5433, Universit´ e d’Auvergne, Clermont-Ferrand, France Rationale: Malnutrition, frequently observed in head & neck (HN) and oesophageal (O) cancers, is exacerbated by radiochemotherapy (RCT) and associated with less resistance to treatment toxicity and increase in morbidity and mortality. Our goal was to investigate if enteral immunonutrition (IMPACT® , Nestl´ e), administered during RCT, could improve nutritional status of cancer patients and limit toxicity of treatment. Methods: A randomized double-blind clinical trial was driven with 33 patients (62.3±8 years old, 17 HN, 16 O). They received either an Immune (IG) or a Standardized nutrition (SG) during all RCT period (intakes mean: 2300 kcal/d, 105 g protein/d). Based on NRI < 97.5, there were 18 malnourished patients at inclusion (IG = 10, SG = 8). Clinical and biological parameters were investigated at the beginning (Db) and at the end (De) of RCT. Results: Body weight (kg) tended to increase in both groups comparing Db and De (IG: +2.9±2.8; SG: +2.3±2.4; ns). Lean mass tissues at De tended to be higher in IG compared to SG (51.3±10 vs 44.5±8; p = 0.09). A tendency to a better improvement of NRI from Db to De is observed in IG (IG: +4.1±5.7; SG: +0.3±4; p = 0.07). Therefore, the albuminemia and CRP levels were stable during this period. Impairment of performance test (OMS score) between Db and De could be limited by immunonutrition (IG: +0.16±0.7; SG: +0.50±0.7; ns). Interestingly, OMS score was significantly lower in IG vs SG at De (1.14±0.3 vs 1.63±0.5; p = 0.03). Mucositis occurrence measured between Db and De tends to be
Poster presentations counteracted by immunonutrition (IG: 0.5±1.3; SG: +1.0±1.4; p = 0.15). Conclusion: In conclusion, immunonutrition tends to improve nutritional status and limit mucositis occurrence during RCT. Moreover, it permits to reduce performances degradation in RCT treated patients. Disclosure of Interest: None Declared
PP081-SUN STUDY ON FOOD ACCEPTANCE AND FOOD INGREDIENTS OF CHOICE IN CANCER PATIENTS RECEIVING CHEMOTHERAPY J. Angkatavanich1 , N. Voravud2 , T. Siangprasert1 , S. Phromwong1 . 1 Department of Nutrition and Dietetics, Faculty of Allied Health Sciences, Chulalongkorn University, 2 Department of Medicine (Oncology and Radiotherapy), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand Rationale: Chemotherapy adversely affected cancer patients causing sensory aversions, eating difficulties and significant weight loss. This research is intended to explore food acceptance and the best choice of food ingredients especially dietary herbs and cooking processes for menu development. Methods: A cross-sectional survey was undertaken by in-depth interview with questionnaires in Thai cancer patients receiving chemotherapy at King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Results: A total of 129 cancer patients receiving chemotherapy, 75.97% female and 24.03% male, aged 52.73±11.40 years, with body weight 57.99±10.55 kg were interviewed. Half of the patients reported significant reduced intake. This ranged from ‘need of considerable effort to eat despite no appetite’, to ‘no willingness to eat except drinking’, to ‘taking nothing’. Intolerance to hot and spicy food is the most frequent problem found in 50.00% of the patients. Most unacceptable foods are high-fat especially coconut milk, chicken, and beef. Protein sources best accepted are fish, soybean and its products, eggs, and cow milk. Meat from aquatic animals is better accepted than land animals. Liquid and softtextured foods, and cooled desserts are reported to be comfortable and facilitate eating. Lemon, lemon grass, holy basil leaves, sweet basil leaves, and many other herbs are acceptable and helpful. The cooking process most avoided is grilling while steaming, simmering, and other cooking method without fat are most chosen. There are 22.48% of patients that need to add seasoning mostly for saltiness to improve and enjoy eating. Conclusion: Despite greatly reduced appetite and sensory aversions, cancer patients under chemotherapy could comfortably consume low-fat, least hot and spicy, soft textured foods and enhanced flavoring with various dietary herbs. Disclosure of Interest: J. Angkatavanich Grant/Research Support from: Faculty of Allied Health Sciences, Chulalongkorn University and the Chulalongkorn University 100th Anniversary Academic Fund, N. Voravud: None Declared, T. Siangprasert: None Declared, S. Phromwong: None Declared