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

Authors:
Willemieke P.M. Dijksterhuis Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam;
Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Amsterdam;

Search for other papers by Willemieke P.M. Dijksterhuis in
Current site
Google Scholar
PubMed
Close
 MD
,
Anouk E.J. Latenstein Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam;

Search for other papers by Anouk E.J. Latenstein in
Current site
Google Scholar
PubMed
Close
 MD
,
Jessy Joy van Kleef Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam;

Search for other papers by Jessy Joy van Kleef in
Current site
Google Scholar
PubMed
Close
 MSc
,
Rob H.A. Verhoeven Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Amsterdam;

Search for other papers by Rob H.A. Verhoeven in
Current site
Google Scholar
PubMed
Close
 PhD
,
Jeanne H.M. de Vries Division of Human Nutrition and Health, Wageningen University, Wageningen;

Search for other papers by Jeanne H.M. de Vries in
Current site
Google Scholar
PubMed
Close
 PhD
,
Marije Slingerland Department of Medical Oncology, Leiden University Medical Center, Leiden;

Search for other papers by Marije Slingerland in
Current site
Google Scholar
PubMed
Close
 MD, PhD
,
Elles Steenhagen Department of Dietetics, University Medical Center Utrecht, Utrecht;

Search for other papers by Elles Steenhagen in
Current site
Google Scholar
PubMed
Close
 BSc
,
Joos Heisterkamp Department of Surgery, Elisabeth-TweeSteden Hospital, Tilburg;

Search for other papers by Joos Heisterkamp in
Current site
Google Scholar
PubMed
Close
 MD, PhD
,
Liesbeth M. Timmermans Stichting voor Patiënten met Kanker aan het Spijsverteringskanaal, Utrecht;
Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen; and

Search for other papers by Liesbeth M. Timmermans in
Current site
Google Scholar
PubMed
Close
 PhD
,
Marian A.E. de van der Schueren Department of Nutrition and Health, HAN University of Applied Sciences, Nijmegen, the Netherlands.

Search for other papers by Marian A.E. de van der Schueren in
Current site
Google Scholar
PubMed
Close
 PhD
,
Martijn G.H. van Oijen Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam;
Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Amsterdam;

Search for other papers by Martijn G.H. van Oijen in
Current site
Google Scholar
PubMed
Close
 PhD
,
Sandra Beijer Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Amsterdam;

Search for other papers by Sandra Beijer in
Current site
Google Scholar
PubMed
Close
 PhD
, and
Hanneke W.M. van Laarhoven Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam;

Search for other papers by Hanneke W.M. van Laarhoven in
Current site
Google Scholar
PubMed
Close
 MD, PhD
Restricted access

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

Supplementary Materials

    • Supplemental Materials (PDF 531.67 KB)
  • Collapse
  • Expand
  • 1.

    Cederholm T, Jensen GL, Correia MITD, et al.. GLIM criteria for the diagnosis of malnutrition—a consensus report from the global clinical nutrition community. J Cachexia Sarcopenia Muscle 2019;10:207217.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Arends J, Bachmann P, Baracos V, et al.. ESPEN guidelines on nutrition in cancer patients. Clin Nutr 2017;36:1148.

  • 3.

    Mak M, Bell K, Ng W, et al.. Nutritional status, management and clinical outcomes in patients with esophageal and gastro-oesophageal cancers: a descriptive study. Nutr Diet 2017;74:229235.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Miller KR, Bozeman MC. Nutrition therapy issues in esophageal cancer. Curr Gastroenterol Rep 2012;14:356366.

  • 5.

    Rosania R, Chiapponi C, Malfertheiner P, et al.. Nutrition in patients with gastric cancer: an update. Gastrointest Tumors 2016;2:178187.

  • 6.

    Marshall KM, Loeliger J, Nolte L, et al.. Prevalence of malnutrition and impact on clinical outcomes in cancer services: a comparison of two time points. Clin Nutr 2019;38:644651.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    de Vries YC, Helmich E, Karsten MDA, et al.. The impact of chemosensory and food-related changes in patients with advanced oesophagogastric cancer treated with capecitabine and oxaliplatin: a qualitative study. Support Care Cancer 2016;24:31193126.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Van Cutsem E, Arends J. The causes and consequences of cancer-associated malnutrition. Eur J Oncol Nurs 2005;9(Suppl 2):S5163.

  • 9.

    Ravasco P, Monteiro-Grillo I, Marques Vidal P, et al.. Impact of nutrition on outcome: a prospective randomized controlled trial in patients with head and neck cancer undergoing radiotherapy. Head Neck 2005;27:659668.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Baracos VE. Cancer-associated malnutrition. Eur J Clin Nutr 2018;72:12551259.

  • 11.

    de van der Schueren MAE. Use and effects of oral nutritional supplements in patients with cancer. Nutrition 2019;67–68:110550.

  • 12.

    Anandavadivelan P, Lagergren P. Cachexia in patients with oesophageal cancer. Nat Rev Clin Oncol 2016;13:185198.

  • 13.

    Fearon K, Strasser F, Anker SD, et al.. Definition and classification of cancer cachexia: an international consensus. Lancet Oncol 2011;12:489495.

  • 14.

    Baracos VE, Martin L, Korc M, et al.. Cancer-associated cachexia. Nat Rev Dis Primers 2018;4:17105.

  • 15.

    Järvinen T, Ilonen I, Kauppi J, et al.. Loss of skeletal muscle mass during neoadjuvant treatments correlates with worse prognosis in esophageal cancer: a retrospective cohort study. World J Surg Oncol 2018;16:27.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Elliott JA, Doyle SL, Murphy CF, et al.. Sarcopenia: prevalence, and impact on operative and oncologic outcomes in the multimodal management of locally advanced esophageal cancer. Ann Surg 2017;266:822830.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Andreyev HJ, Norman AR, Oates J, et al.. Why do patients with weight loss have a worse outcome when undergoing chemotherapy for gastrointestinal malignancies? Eur J Cancer 1998;34:503509.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Capuano G, Grosso A, Gentile P, et al.. Adult height and head and neck cancer: a pooled analysis within the INHANCE Consortium. Head Neck 2008;30:503508.

  • 19.

    Martin L, Kubrak C. How much does reduced food intake contribute to cancer-associated weight loss? Curr Opin Support Palliat Care 2018;12:410419.

  • 20.

    Dijksterhuis WPM, Pruijt MJ, van der Woude SO, et al.. Association between body composition, survival, and toxicity in advanced esophagogastric cancer patients receiving palliative chemotherapy. J Cachexia Sarcopenia Muscle 2019;10:199206.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Lakenman P, Ottens-Oussoren K, Witvliet-van Nierop J, et al.. Handgrip strength is associated with treatment modifications during neoadjuvant chemoradiation in patients with esophageal cancer. Nutr Clin Pract 2017;32:652657.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Ligthart-Melis GC, Weijs PJM, te Boveldt ND, et al.. Dietician-delivered intensive nutritional support is associated with a decrease in severe postoperative complications after surgery in patients with esophageal cancer. Dis Esophagus 2013;26:587593.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Kruizenga HM, Seidell JC, de Vet HCW, et al.. Development and validation of a hospital screening tool for malnutrition: the Short Nutritional Assessment Questionnaire (SNAQ). Clin Nutr 2005;24:7582.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Boléo-Tomé C, Monteiro-Grillo I, Camilo M, et al.. Validation of the Malnutrition Universal Screening Tool (MUST) in cancer. Br J Nutr 2012;108:343348.

  • 25.

    de van der Schueren MAE, Laviano A, Blanchard H, et al.. Systematic review and meta-analysis of the evidence for oral nutritional intervention on nutritional and clinical outcomes during chemo(radio)therapy: current evidence and guidance for design of future trials. Ann Oncol 2018;29:11411153.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Bozzetti F. Nutritional support in patients with oesophageal cancer. Support Care Cancer 2010;18(Suppl 2):S4150.

  • 27.

    Coebergh van den Braak RRJ, van Rijssen LB, van Kleef JJ, et al.. Nationwide comprehensive gastro-intestinal cancer cohorts: the 3P initiative. Acta Oncol 2018;57:195202.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    van Lee L, Feskens EJM, Meijboom S, et al.. Evaluation of a screener to assess diet quality in the Netherlands. Br J Nutr 2016;115:517526.

  • 29.

    Health Council of the Netherlands. Guidelines for a Healthy Diet 2006. The Hague, Netherlands: Health Council of the Netherlands; 2006. Publication no. 2006/21E.

    • PubMed
    • Export Citation
  • 30.

    van Doorn-van Atten MN, Haveman-Nies A, van Bakel MM, et al.. Effects of a multi-component nutritional telemonitoring intervention on nutritional status, diet quality, physical functioning and quality of life of community-dwelling older adults. Br J Nutr 2018;119:11851194.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Gezondheidsraad [Health Council of the Netherlands]. Richtlijnen goede voiding 2015 [Guidelines for a healthy diet 2015]. Accessed October 30, 2020. Available at: https://www.gezondheidsraad.nl/documenten/adviezen/2015/11/04/richtlijnen-goede-voeding-2015

    • PubMed
    • Export Citation
  • 32.

    DUCG. Dutch Upper GI Cancer Group. DUCG 2015. Available at: www.ducg.nl

  • 33.

    Martin L, Senesse P, Gioulbasanis I, et al.. Diagnostic criteria for the classification of cancer-associated weight loss. J Clin Oncol 2015;33:9099.

  • 34.

    Ravasco P, Monteiro-Grillo I, Vidal PM, et al.. Dietary counseling improves patient outcomes: a prospective, randomized, controlled trial in colorectal cancer patients undergoing radiotherapy. J Clin Oncol 2005;23:14311438.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35.

    Rietveld SCM, Witvliet-van Nierop JE, Ottens-Oussoren K, et al.. The prediction of deterioration of nutritional status during chemoradiation therapy in patients with esophageal cancer. Nutr Cancer 2018;70:229235.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36.

    Helfenstein SF, Uster A, Rühlin M, et al.. Are four simple questions able to predict weight loss in outpatients with metastatic cancer? A prospective cohort study assessing the Simplified Nutritional Appetite Questionnaire. Nutr Cancer 2016;68:743749.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37.

    Leistra E, Langius JAE, Evers AM, et al.. Validity of nutritional screening with MUST and SNAQ in hospital outpatients. Eur J Clin Nutr 2013;67:738742.

  • 38.

    Abbott J, Teleni L, McKavanagh D, et al.. Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF) is a valid screening tool in chemotherapy outpatients. Support Care Cancer 2016;24:38833887.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 7204 2209 1035
PDF Downloads 2635 547 28
EPUB Downloads 0 0 0