This study aimed to test whether a very early nutrition intervention delivered over the telephone was feasible and could improve outcomes amongst patients with upper gastrointestinal cancer.
Participants with a histologically proven new diagnosis of primary oesophageal or stomach cancer and who were to undergo surgery and/or chemotherapy were randomised to receive either standard nutrition care (SC) or early and intensive nutrition intervention (NI) over the telephone/face-to-face. Participants were followed for 6 months. The primary outcome was quality of life (QoL), assessed using the European Organization for Research and Treatment of Cancer Global Quality of Life questionnaire C30 (EORTC QLQ-C30) and the European Quality of Life Instrument (EQ-5D) tool; secondary outcomes were nutritional status and survival.
Twenty-one participants were recruited (11 SC and 10 NI). At baseline, the prevalence of malnutrition was 90 %. Compared with SC, the NI group had a significantly higher EORTC global QoL score at the first mid-study follow-up (coefficient (95 % CI) 21.0 (12.1, 29.9) adjusted for baseline, p < 0.001) and at 26 weeks (28.4 (21.3, 35.4) adjusted for baseline, p < 0.001). Nutritional risk score was lower (p < 0.001), and loss of body weight attenuated (p < 0.001) in the NI group compared with SC. Six deaths occurred during the study, five in the SC group and one in the NI group (p = 0.06). The mean time spent with a dietitian per contact was significantly less for the NI group compared with SC (16(3) vs 40(6) min per dietetic contact, p < 0.001).
This pilot study has shown the potential of a novel telephone-based early and intensive dietetic model of care for newly diagnosed upper gastrointestinal cancer patients.
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Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JC et al (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85:365–376
Abraham C, Michie S (2008) A taxonomy of behavior change techniques used in interventions. Health Psychol 27:379–387
ADA (1997) Medical nutrition therapy across the continuum of care. The American Dietetic Association and Morrison Healthcare
Andreyev HJ, Norman AR, Oates J, Cunningham D (1998) Why do patients with weight loss have a worse outcome when undergoing chemotherapy for gastrointestinal malignancies? Eur J Cancer 34:503–509
Baldwin C, McGough C, Norman AR, Frost GS, Cunningham DC, Andreyev HJ (2006) Failure of dietetic referral in patients with gastrointestinal cancer and weight loss. Eur J Cancer 42:2504–2509
Baldwin C, McGough C, Spiro A, Thomas K, Cunningham DC, Andreyev HJN (2009) Nutritional and clinical characteristics of patients with gastrointestinal tract (GI) cancers at presentation proceedings of the Nutrition Society 68: null-null
Baldwin C, Spiro A, Ahern R, Emery PW (2012) Oral nutritional interventions in malnourished patients with cancer: a systematic review and meta-analysis. J Natl Cancer Inst 104:371–385
Bauer J, Capra S, Ferguson M (2002) Use of the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in patients with cancer. Eur J Clin Nutr 56:779–785
Bauer JD, Ash S, Davidson WL, Hill JM, Brown T, Isenring EA, Reeves M (2006) Evidence based practice guidelines for the nutritional management of cancer cachexia. Nutr Diet 63:S3–S32
Bozzetti F, Group SW (2009) Screening the nutritional status in oncology: a preliminary report on 1,000 outpatients. Support Care Cancer 17:279–284
Car J, Sheikh A (2003) Telephone consultations. BMJ 326:966–969
Chasen MR, Bhargava R (2009) A descriptive review of the factors contributing to nutritional compromise in patients with head and neck cancer. Support Care Cancer 17:1345–1351
Daly JM, Fry WA, Little AG, Winchester DP, McKee RF, Stewart AK, Fremgen AM (2000) Esophageal cancer: results of an American College of Surgeons Patient Care Evaluation Study. J Am Coll Surg 190:562–572, discussion 572-563
Di Fiore F, Lecleire S, Pop D, Rigal O, Hamidou H, Paillot B, Ducrotte P, Lerebours E, Michel P (2007) Baseline nutritional status is predictive of response to treatment and survival in patients treated by definitive chemoradiotherapy for a locally advanced esophageal cancer. Am J Gastroenterol 102:2557–2563
Ferlay J SI, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F (2013) GLOBOCAN 2012 v1.0, Cancer incidence and mortality worldwide: IARC cancer base no. 11 In: Editor (ed)^(eds) Book GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 City.
Garth AK, Newsome CM, Simmance N, Crowe TC (2010) Nutritional status, nutrition practices and post-operative complications in patients with gastrointestinal cancer. J Hum Nutr Diet 23:393–401
Hauchecorne CM, Barr SI, Sork TJ (1994) Evaluation of nutrition counseling in clinical settings: do we make a difference? J Am Diet Assoc 94:437–440
Isenring EA, Bauer JD, Capra S (2007) Nutrition support using the American Dietetic Association medical nutrition therapy protocol for radiation oncology patients improves dietary intake compared with standard practice. J Am Diet Assoc 107:404–412
Isenring EA, Capra S, Bauer JD (2004) Nutrition intervention is beneficial in oncology outpatients receiving radiotherapy to the gastrointestinal or head and neck area. Br J Cancer 91:447–452
Laviano A, Renvyle T, Yang ZJ (1996) From laboratory to bedside: new strategies in the treatment of malnutrition in cancer patients. Nutrition 12:112–122
Martin IG, Young S, Sue-Ling H, Johnston D (1997) Delays in the diagnosis of oesophagogastric cancer: a consecutive case series. BMJ 314:467
Nourissat A, Vasson MP, Merrouche Y, Bouteloup C, Goutte M, Mille D, Jacquin JP, Collard O, Michaud P, Chauvin F (2008) Relationship between nutritional status and quality of life in patients with cancer. Eur J Cancer 44:1238–1242
Odelli C, Burgess D, Bateman L, Hughes A, Ackland S, Gillies J, Collins CE (2005) Nutrition support improves patient outcomes, treatment tolerance and admission characteristics in oesophageal cancer. Clin Oncol 17:639–645, Royal College of Radiologists
Ottery FD (1994) Cancer cachexia: prevention, early diagnosis, and management. Cancer Pract 2:123–131
Ovesen L, Allingstrup L, Hannibal J, Mortensen EL, Hansen OP (1993) Effect of dietary counseling on food intake, body weight, response rate, survival, and quality of life in cancer patients undergoing chemotherapy: a prospective, randomized study. J Clin Oncol 11:2043–2049
Persson CR, Johansson BBK, Sjoden PO, Glimelius BLG (2002) A randomized study of nutritional support in patients with colorectal and gastric cancer. Nutr Cancer 42:48–58
Rabin R, de Charro F (2001) EQ-5D: a measure of health status from the EuroQol Group. Ann Med 33:337–343
Senesse P, Assenat E, Schneider S, Chargari C, Magné N, Azria D, Hébuterne X (2008) Nutritional support during oncologic treatment of patients with gastrointestinal cancer: who could benefit? Cancer Treat Rev 34:568–575
SIGN SIGNS (2006) Management of oesophageal and gastric cancer. A national clinical guideline. In: Editor (ed) Book management of oesophageal and gastric cancer. A national clinical guideline, City
Spiro A, Baldwin C, Patterson A, Thomas J, Andreyev HJN (2006) The views and practice of oncologists towards nutritional support in patients receiving chemotherapy. Br J Cancer 95:431–434
Turton P, Cooke H (2000) Meeting the needs of people with cancer for support and self-management Complementary. Ther Nurs Midwifery 6:130–137
The authors would like to thank (1) Liang Low, Paul Cashin, John Gribbin and the Upper Gastrointestinal consultants of Monash Health for their contribution to recruiting patients to this study; (2) Carmen Puskas for data entry; (3) Southern Melbourne Integrated Cancer Service for funding.
Conflict of interest
None of the authors have a conflict of interest to declare. This work was funded by Southern Melbourne Integrated Cancer Service (SMICS).
Statement of authorship
All authors have made substantial contributions and final approval of the conceptions, drafting and final version.
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Silvers, M.A., Savva, J., Huggins, C.E. et al. Potential benefits of early nutritional intervention in adults with upper gastrointestinal cancer: a pilot randomised trial. Support Care Cancer 22, 3035–3044 (2014). https://doi.org/10.1007/s00520-014-2311-3
- Oesophageal cancer
- Stomach cancer
- Quality of life