Oesophageal cancer: the effect of early nutrition support on clinical outcomes
Oesophageal cancer: the effect of early nutrition support on clinical outcomes
Background and aims: Malnutrition is prevalent in oesophageal cancer. Evidence for the use of nutrition support and prehabilitation in this cohort is variable. The aim of this study was to examine the effect of early nutrition support and functional measures of nutritional status on post-operative outcomes in adult patients with oesophageal cancer. Methods: Retrospective review of adults with oesophageal cancer undergoing oesophagectomy (n = 151). Early nutrition support was defined as: oral or enteral nutrition supplementation during neoadjuvant treatment. Late nutrition support defined as: oral or enteral nutrition supplementation prescribed post-operatively. Nutrition outcome measures were; percentage weight loss from 3 to 6 months prior to diagnosis, peri- and post-operatively, and pre-operative assessment of handgrip-strength (HGS). Results: Pre-operative weight loss ≥10% was a significant predictor of mortality at 1 year (OR 2.84, 95%CI 1.03–7.83, p = 0.04) independent of tumour stage, adjuvant treatment, age and gender. Adults prescribed early nutrition support during neoadjuvant treatment experienced less weight loss at 12-months post-oesophagectomy compared to adults prescribed late oral nutrition support (p=<0.05). Pre-operative HGS measurements were not a useful predictor of postoperative complications (p = 0.2), length of stay (p = 0.9) or 90-day mortality (p = 0.6). Conclusions: Pre-operative weight loss ≥10% was associated with mortality. Early nutrition support was associated with less weight loss at 12-months post-operatively. Pre-operative HGS measures did not have prognostic value as a stand-alone measure. Future work should investigate the efficacy of early nutrition support in reducing both pre- and post-operative weight loss to improve nutritional status and surgical outcomes as part of a multimodal prehabilitation programme in adults with oesophageal cancer.
Esophageal cancer, Esophagectomy, Handgrip strength, Nutrition support, Prehabilitation
117-123
Davies, S.J.
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West, Malcolm
98b67e58-9875-4133-b236-8a10a0a12c04
Rahman, Saqib A
e2b565d4-df7f-4496-8cc3-80fc63a9e4cd
Underwood, Timothy
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Marino, L.V.
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25 April 2021
Davies, S.J.
6321bcb6-1e91-4d59-9101-46a59da2d9c0
West, Malcolm
98b67e58-9875-4133-b236-8a10a0a12c04
Rahman, Saqib A
e2b565d4-df7f-4496-8cc3-80fc63a9e4cd
Underwood, Timothy
8e81bf60-edd2-4b0e-8324-3068c95ea1c6
Marino, L.V.
c479400f-9424-4879-9ca6-d81e6351de26
Davies, S.J., West, Malcolm, Rahman, Saqib A, Underwood, Timothy and Marino, L.V.
(2021)
Oesophageal cancer: the effect of early nutrition support on clinical outcomes.
Clinical Nutrition ESPEN, 42, .
(doi:10.1016/j.clnesp.2021.02.006).
Abstract
Background and aims: Malnutrition is prevalent in oesophageal cancer. Evidence for the use of nutrition support and prehabilitation in this cohort is variable. The aim of this study was to examine the effect of early nutrition support and functional measures of nutritional status on post-operative outcomes in adult patients with oesophageal cancer. Methods: Retrospective review of adults with oesophageal cancer undergoing oesophagectomy (n = 151). Early nutrition support was defined as: oral or enteral nutrition supplementation during neoadjuvant treatment. Late nutrition support defined as: oral or enteral nutrition supplementation prescribed post-operatively. Nutrition outcome measures were; percentage weight loss from 3 to 6 months prior to diagnosis, peri- and post-operatively, and pre-operative assessment of handgrip-strength (HGS). Results: Pre-operative weight loss ≥10% was a significant predictor of mortality at 1 year (OR 2.84, 95%CI 1.03–7.83, p = 0.04) independent of tumour stage, adjuvant treatment, age and gender. Adults prescribed early nutrition support during neoadjuvant treatment experienced less weight loss at 12-months post-oesophagectomy compared to adults prescribed late oral nutrition support (p=<0.05). Pre-operative HGS measurements were not a useful predictor of postoperative complications (p = 0.2), length of stay (p = 0.9) or 90-day mortality (p = 0.6). Conclusions: Pre-operative weight loss ≥10% was associated with mortality. Early nutrition support was associated with less weight loss at 12-months post-operatively. Pre-operative HGS measures did not have prognostic value as a stand-alone measure. Future work should investigate the efficacy of early nutrition support in reducing both pre- and post-operative weight loss to improve nutritional status and surgical outcomes as part of a multimodal prehabilitation programme in adults with oesophageal cancer.
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Clinical nutrition ESPEN v3 3.2.21 Revisions made
- Accepted Manuscript
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Oesophageal cancer
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More information
Accepted/In Press date: 14 February 2021
e-pub ahead of print date: 25 February 2021
Published date: 25 April 2021
Additional Information:
Funding Information:
This work is part of independent research completed by SD as part of a Health Education Wessex Clinical Academic Training Internship and LVM arising from a Health Education England/NIHR Clinical Lectureship (ICA-CL-2016-02-001) supported by the National Institute for Health and Social Care Research. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research, Health Education England or the Department of Health.
Publisher Copyright:
© 2021 The Authors
Keywords:
Esophageal cancer, Esophagectomy, Handgrip strength, Nutrition support, Prehabilitation
Identifiers
Local EPrints ID: 447188
URI: http://eprints.soton.ac.uk/id/eprint/447188
ISSN: 2405-4577
PURE UUID: a7caaac4-1e4a-4c37-90ab-ee92c7fea536
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Date deposited: 04 Mar 2021 17:42
Last modified: 17 Mar 2024 06:21
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Author:
S.J. Davies
Author:
Saqib A Rahman
Author:
L.V. Marino
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