L Bargetzi1, C Brack2, J Herrmann2, A Bargetzi1, L Hersberger1, M Bargetzi3, N Kaegi-Braun4, P Tribolet5, F Gomes6, C Hoess7, V Pavlicek7, S Bilz8, S Sigrist8, M Brändle8, C Henzen9, R Thomann10, J Rutishauser11, D Aujesky12, N Rodondi13, J Donzé14, A Laviano15, Z Stanga16, B Mueller1, P Schuetz17. 1. Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland;; Medical Faculty of the University of Basel, Switzerland. 2. Medical Faculty of the University of Basel, Switzerland. 3. Division of Oncology, Hematology and Transfusion Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Switzerland. 4. Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland. 5. Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland;; Departement of Health Professions, Bern University of Applied Sciences, Bern, Switzerland. 6. Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland;; The New York Academy of Sciences, New York City, NY, USA. 7. Internal Medicine, Kantonsspital Muensterlingen, Switzerland. 8. Internal Medicine & Endocrinology/Diabetes, Kantonsspital St.Gallen, Switzerland. 9. Internal Medicine, Kantonsspital Luzern, Switzerland. 10. Internal Medicine, Buergerspital Solothurn, Switzerland. 11. Internal Medicine, Kantonsspital Baselland, Switzerland. 12. Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland. 13. Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland;; Institute of Primary Health Care (BIHAM), University of Bern, Switzerland. 14. Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland;; Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA. 15. Department of Translational and Precision Medicine, Sapienza University, I-00185 Rome, Italy. 16. Division of Diabetes, Endocrinology, Nutritional Medicine & Metabolism, Inselspital, Bern University Hospital, University of Bern, Switzerland. 17. Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland;; Medical Faculty of the University of Basel, Switzerland. Electronic address: schuetzph@gmail.com.
Abstract
INTRODUCTION: Nutritional support in patients with cancer aims at improving quality of life. Whether use of nutritional support is also effective in improving clinical outcomes remains understudied. METHODS: In this preplanned secondary analysis of patients with cancer included in a prospective, randomized-controlled, Swiss, multicenter trial (EFFORT), we compared protocol-guided individualized nutritional support (intervention group) to standard hospital food (control group) regarding mortality at 30-day (primary endpoint) and other clinical outcomes. RESULTS: We analyzed 506 patients with a main admission diagnosis of cancer, including lung cancer (n=113), gastrointestinal tumors (n=84), hematological malignancies (n=108) and other types of cancer (n=201). Nutritional risk based on Nutritional Risk Screening [NRS 2002] was an independent predictor for mortality over 180 days with a (age-, sex-, center-, type of cancer-, tumor activity- and treatment-) adjusted hazard ratio of 1.29 (95% CI 1.09 to 1.54; p=0.004) per point increase in NRS. In the 30-day follow-up period, 50 patients (19.9%) died in the control group compared to 36 (14.1%) in the intervention group resulting in an adjusted odds ratio of 0.57 (95% CI 0.35 to 0.94; p=0.027). Interaction tests did not show significant differences in mortality across the cancer type subgroups. Nutritional support also significantly improved functional outcomes and quality of life measures. CONCLUSION: Compared to usual hospital nutrition without nutrition support, individualized nutritional support reduced the risk for mortality and improved functional and quality of life outcomes in cancer patients with increased nutritional risk. These data further support the inclusion of nutritional care in cancer management guidelines.
RCT Entities:
INTRODUCTION: Nutritional support in patients with cancer aims at improving quality of life. Whether use of nutritional support is also effective in improving clinical outcomes remains understudied. METHODS: In this preplanned secondary analysis of patients with cancer included in a prospective, randomized-controlled, Swiss, multicenter trial (EFFORT), we compared protocol-guided individualized nutritional support (intervention group) to standard hospital food (control group) regarding mortality at 30-day (primary endpoint) and other clinical outcomes. RESULTS: We analyzed 506 patients with a main admission diagnosis of cancer, including lung cancer (n=113), gastrointestinal tumors (n=84), hematological malignancies (n=108) and other types of cancer (n=201). Nutritional risk based on Nutritional Risk Screening [NRS 2002] was an independent predictor for mortality over 180 days with a (age-, sex-, center-, type of cancer-, tumor activity- and treatment-) adjusted hazard ratio of 1.29 (95% CI 1.09 to 1.54; p=0.004) per point increase in NRS. In the 30-day follow-up period, 50 patients (19.9%) died in the control group compared to 36 (14.1%) in the intervention group resulting in an adjusted odds ratio of 0.57 (95% CI 0.35 to 0.94; p=0.027). Interaction tests did not show significant differences in mortality across the cancer type subgroups. Nutritional support also significantly improved functional outcomes and quality of life measures. CONCLUSION: Compared to usual hospital nutrition without nutrition support, individualized nutritional support reduced the risk for mortality and improved functional and quality of life outcomes in cancerpatients with increased nutritional risk. These data further support the inclusion of nutritional care in cancer management guidelines.
Authors: Riccardo Caccialanza; Alessandro Laviano; Cristina Bosetti; Mariateresa Nardi; Valentina Casalone; Lucilla Titta; Roberto Mele; Giovanni De Pergola; Francesco De Lorenzo; Paolo Pedrazzoli Journal: Support Care Cancer Date: 2022-07-06 Impact factor: 3.603
Authors: Céline Bretschera; Fabienne Boesiger; Nina Kaegi-Braun; Lara Hersberger; Dileep N Lobo; David C Evans; Pascal Tribolet; Filomena Gomes; Claus Hoess; Vojtech Pavlicek; Stefan Bilz; Sarah Sigrist; Michael Brändle; Christoph Henzen; Robert Thomann; Jonas Rutishauser; Drahomir Aujesky; Nicolas Rodondi; Jacques Donzé; Zeno Stanga; Beat Mueller; Philipp Schuetz Journal: EClinicalMedicine Date: 2022-02-11
Authors: Isabel Cornejo-Pareja; Maria Ramirez; Maria Camprubi-Robles; Ricardo Rueda; Isabel Maria Vegas-Aguilar; Jose Manuel Garcia-Almeida Journal: Nutrients Date: 2021-12-03 Impact factor: 5.717