Cachexia and Dietetic Interventions in Patients With Esophagogastric Cancer: A Multicenter Cohort Study

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  • 1 Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam;
  • 2 Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Amsterdam;
  • 3 Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam;
  • 4 Division of Human Nutrition and Health, Wageningen University, Wageningen;
  • 5 Department of Medical Oncology, Leiden University Medical Center, Leiden;
  • 6 Department of Dietetics, University Medical Center Utrecht, Utrecht;
  • 7 Department of Surgery, Elisabeth-TweeSteden Hospital, Tilburg;
  • 8 Stichting voor Patiënten met Kanker aan het Spijsverteringskanaal, Utrecht;
  • 9 Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen; and
  • 10 Department of Nutrition and Health, HAN University of Applied Sciences, Nijmegen, the Netherlands.
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Background: Cachexia is common in patients with esophagogastric cancer and is associated with increased mortality. Nutritional screening and dietetic interventions can be helpful in preventing evolvement of cachexia. Our aim was to study the real-world prevalence and prognostic value of pretreatment cachexia on overall survival (OS) using patient-reported weight loss, and to explore dietetic interventions in esophagogastric cancer. Materials and Methods: Patients with esophagogastric cancer (2015–2018), regardless of disease stage, who participated in the Prospective Observational Cohort Study of Esophageal-Gastric Cancer Patients (POCOP) and completed patient-reported outcome measures were included. Data on weight loss and dietetic interventions were retrieved from questionnaires before start of treatment (baseline) and 3 months thereafter. Additional patient data were obtained from the Netherlands Cancer Registry. Cachexia was defined as self-reported >5% half-year body weight loss at baseline or >2% in patients with a body mass index (BMI) <20 kg/m2 according to the Fearon criteria. The association between cachexia and OS was analyzed using multivariable Cox proportional hazard analyses adjusted for sex, age, performance status, comorbidities, primary tumor location, disease stage, histology, and treatment strategy. Results: Of 406 included patients, 48% had pretreatment cachexia, of whom 65% were referred for dietetic consultation at baseline. The proportion of patients with cachexia was the highest among those who received palliative chemotherapy (59%) or best supportive care (67%). Cachexia was associated with decreased OS (hazard ratio, 1.52; 95% CI, 1.11–2.09). Median weight loss after 3-month follow-up was lower in patients with cachexia who were referred to a dietician at baseline compared with those who were not (0% vs 2%; P=.047). Conclusions: Nearly half of patients with esophagogastric cancer have pretreatment cachexia. Dietetic consultation at baseline was not reported in more than one-third of the patients with cachexia. Because cachexia was independently associated with decreased survival, improving nutritional screening and referral for dietetic consultation are warranted to prevent further deterioration of malnutrition and mortality.

Submitted April 19, 2020; accepted for publication July 1, 2020. Published online January 8, 2021.

Author contributions: Study concept and design: Dijksterhuis, Latenstein, van Oijen, Beijer, van Laarhoven. Data acquisition: Dijksterhuis, van Kleef. Data analysis: Dijksterhuis. Manuscript preparation: Dijksterhuis, Latenstein, van Oijen, Beijer, van Laarhoven. Final approval of manuscript: All authors.

Disclosures: Dr. Verhoeven has disclosed that he has received grant/research support from Bristol-Myers Squibb and Roche. Dr. van Oijen has disclosed that he has received grant/research support from Bristol-Myers Squibb, Merck Serono, Nordic, Roche, and Servier. Dr. van Laarhoven has disclosed that he has received consulting fees from Bristol-Myers Squibb, Celgene, Lilly, Nordic Pharma, and Servier, and grant/research support from Bayer, Bristol-Myers Squibb, Celgene, Lilly, Merck Serono, Merck Sharpe & Dohme, Nordic, Philips, Roche, and Servier. The remaining authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Funding: This work was supported by funding from the Dutch Cancer Society.

Disclaimer: According to the Central Committee on Research Involving Human Subjects, this type of study does not require approval from an ethics committee in the Netherlands. The study was approved by the Privacy Review Board of the Netherlands Cancer Registry and the scientific committee of the Dutch Upper GI Cancer Group. Patients who participated in the Prospective Observational Cohort Study of Oesophageal-Gastric Cancer Patients (POCOP) provided written informed consent.

Correspondence: Hanneke W.M. van Laarhoven, MD, Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Meibergdreef 9, D3-221.1, 1105 AZ Amsterdam, the Netherlands. Email: h.vanlaarhoven@amsterdamumc.nl

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