Nutritional status in patients receiving curative treatment for oesophageal and gastric cancer: A quality improvement study

Abstract

Background: Curative treatment for patients with oesophageal and gastric cancer is multimodal and includes chemotherapy and surgery. Side effects from treatment and symptoms from the tumour put this group at high risk of developing nutritional challenges, including-, weight loss, and malnutrition. These risk factors can affect the patient's prognosis and treatment outcomes. The present study aimed to investigate the prevalence of malnutrition and weight loss in oesophageal and gastric cancer patients throughout the course of cancer treatment and whether patients met their estimated energy- and protein requirements on their fifth postoperative day.

Methods: This study included adult patients with oesophageal or gastric cancer who underwent surgery and had scheduled follow-ups by a dietitian at Haukeland University Hospital before and/or after surgery from March 2020 to October 2022. The data was extracted retrospectively from medical records and curve systems. The prevalence of malnutrition was defined based on ICD-10 diagnosis codes (E46.00, E44.00, E43.00). Daily energy- and protein intake were determined adequate on the fifth postoperative day if the intake exceeded 75% of the estimated requirements.

Results: The current study included a total of 113 patients (76% men) with oesophageal (n=59) or gastric cancer (n=54) (mean age 68±12 years and BMI 26.1±4.1 kg/m2). At baseline, 17% met the criteria for severe malnutrition and 25% for moderate malnutrition. The median weight loss from baseline to surgery was 0% (-2.6-1.6). At the time of surgery, 13% of the patients met the criteria for severe malnutrition and 12% for moderate malnutrition. The highest prevalence of malnutrition and most extensive weight loss was two weeks after discharge: 50% of the patients met the criteria for severe malnutrition, 14% moderate malnutrition, and a median weight loss of 5.3% (2.4-8.1). On the fifth postoperative day, 56% had adequate energy intake, 41.5% had adequate protein intake, and 39% had adequate energy- and protein intake.

Conclusion: This study observed a lower prevalence of preoperative malnutrition and weight loss than previous studies. Our findings may emphasise the importance of early and close follow-up by dietitians. However, postoperative weight loss and malnutrition remain significant concerns, with low adherence to nutritional recommendations on the fifth postoperative day potentially contributing to these outcomes. These insights highlight the need for further research and guidelines to optimise this patient group's nutritional treatment and outcomes.