Screening of Malnutrition Risk Versus Indicators of Nutritional Status and Systemic Inflammatory Response in Newly Diagnosed Lung Cancer Patients

Česká verzia

Authors: P. Illa; M. Tomíšková; J. Skřičková
Authors place of work: Klinika nemocí plicních a TBC LF MU a FN Brno
Published in the journal: Klin Onkol 2014; 27(4): 261-268
Category: Original Articles

Summary

Background:
Most lung cancers are already advanced at the time of diagnosis. In these patients, a frequent symptom is protein‑energy malnutrition, often diagnosed prior to oncological treatment. Malnutrition results in poor tolerance of treatment and increased morbidity and mortality.

Methods:
Nutritional Risk Screening (NRS) 2002 adapted for oncological patients was used to assess the risk of undernutrition in a group of 188 lung cancer patients. The risk was evaluated on a 6- point scale according to common signs of nutritional status and tumor and its treatment risk factors. A score of 3 and more (called „nutritional risk“) means a significant risk of malnutrition. Furthermore, pretreatment nutritional characteristics were evaluated in patients (including the value of BMI) and laboratory values indicating malnutrition/ acute phase response (albumin/ C‑ reactive protein – CRP).

Results:
Acceptable NRS score was found in 50.6%, while in 45.3% was suggested into risk of malnutrition („nutritional risk“). Only 6.6% of our patients had a BMI less than 20 kg/ m². Significant differences in albumin and CRP values in various categories of NRS were confirmed.

Conclusion:
Initial signs of cancer malnutrition may be overlooked in patients who fall within or above the range of BMI for adequate weight, although these patients may be at significant risk of malnutrition. The indicators of nutritional status and systemic inflammatory responses were significantly associated with resulting values NRS score.

Key words:
nutritional status – nutritional risk – lung cancer – acute phase response

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Submitted:
12. 1. 2014

Accepted:
16. 2. 2014

Zdroje

1. Dewys WD, Begg C, Lavin PT et al. Prognostic effect of weight loss prior to chemotherapy in cancer patients. Am J Med 1980; 69(4): 491– 497.

2. Chute CG, Greenberg ER, Baron J et al. Presenting conditions of 1539 population‑based lung cancer patients by cell type and stage in New Hampshire and Vermont. Cancer 1985; 56(8): 2107– 2111.

3. Ross PJ, Ashley S, Norton A et al. Do patients with weight loss have a worse outcome when undergoing chemotherapy for lung cancers? Br J Cancer 2004; 90(10): 1905– 1911.

4. Buccheri G, Ferrigno D. Importance of weight loss definition in the prognostic evaluation of non‑small‑cell lung cancer. Lung Cancer 2001; 34(3): 433– 440.

5. Jeremic B, Milicic B, Dagovic A et al. Pretreatment clinical prognostic factors in patients with stage IV non‑small cell lung cancer (NSCLC) treated with chemotherapy. J Cancer Res Clin Oncol 2003; 129(2): 114– 122.

6. van Eys J. Effect of nutritional status on response to therapy. Cancer Res 1982; 42 (Suppl): 747– 753.

7. Simons JP, Schols AM, Buurman WA et al. Weight loss and low body cell mass in males with lung cancer: relationship with systemic inflammation, acute phase response, resting energy expenditure and catabolic and anabolic hormones. Clin Sci 1999; 97(2): 215– 223.

8. Martín F, Santolaria F, Batista N et al. Cytokine levels (IL‑6 and IFN‑ gamma), acute phase response and nutritional status as prognostic factors in lung cancer. Cytokine 1999; 11(1): 80– 86.

9. O‘Gorman P, McMillan DC, McArdle CS. Prognostic factors in advanced gastrointestinal cancer patients with weight loss. Nutr Cancer 2000; 37(1): 36– 40.

10. Tisdale MJ. Cachexia in cancer patients. Nat Rev Cancer 2002; 2(11): 862– 871.

11. Forrest LM, McMillan DC, McArdle CS et al. Comparison of an inflammation‑based prognostic score (GPS) with performance status (ECOG) in patients receiving platinum‑based chemotherapy for inoperable non‑small‑cell lung cancer. Br J Cancer 2004; 90(9): 1704– 1705.

12. McMillan DC. An inflammation‑based prognostic score and its role in the nutrition‑based management of patients with cancer. Proc Nutr Soc 2008; 67(3): 257– 262. doi: 10.1017/ S0029665108007131.

13. Murry D, Riva L, Poplack DG. Impact of nutrition on pharmacokinetics of antineoplastic agents. Int J Cancer 1998; 11: 48– 51.

14. Watanabe H, Yamamoto N, Tamura T et al. Study of paclitaxel and dose escalation of cisplatin in patients with advanced non‑small cell lung cancer. Jpn J Clin Oncol 2003; 33(12): 626– 630.

15. Kondrup J, Rasmussen HH, Hamberg O et al. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr 2003; 22(3): 321– 336.

16. Kondrup J, Allison SP, Elia M et al. ESPEN guidelines for nutrition screening 2002. Clin Nutr 2003; 22(4): 415– 421.

17. Tomíška M. Nutriční rizikový screening v onkologické ambulanci. Medical Tribune 2008; 1: 15.

18. Arrieta O, Michel Ortega RM, Villanueva‑ Rodríguez Get al. Association of nutritional status and serum albumin levels with development of toxicity in patients with advanced non‑small cell lung cancer treated with paclitaxel‑cisplatin chemotherapy: a prospective study. BMC Cancer 2010; 50(10). doi: 10.1186/ 1471‑ 2407‑ 10‑ 50.

19. Gioulbasanis I., Baracos VE, Giannousi Z et al. Baseline nutritional evaluation in metastatic lung cancerpatients: Mini Nutritional Assessment versus weightloss history. Ann Oncol 2011; 22(4): 835– 841. doi: 10.1093/ annonc/ mdq440.

20. Bozzetti F, Mariani L, Lo Vullo S et al. The nutritional risk in oncology: a study of 1453 cancer outpatients. Support Care Cancer 2012; 20(8): 1919– 1928. doi: 10.1007/ s00520‑ 012‑ 1387‑ x.

21. Orreval Y, Tishelman C, Permert J et al. Nutritional support and risk status among cancer patients in palliative home care service. Support Care Cancer 2009; 17(2): 153– 161. doi: 10.1007/ s00520‑ 008‑ 0467‑ 4.

22. Deng H, Seidel K, Bruemmer B et al. Impact of patient weight on non‑relapse mortality after marrow transplantation. Bone Marrow Trasnplant 1995; 15(3): 461– 468.

23. Tomíšková M, Tomíška M, Illa P et al. Nutritional risk screening predicts tumor response in lung cancer patients. J Thor Oncol 2009; 4(9): 435– 436.

24. Lochs H, Allison SP, Meier R et al. Introductory to the ESPEN Guidelines on Enteral Nutrition:terminology, definitions and general topics. Clin Nutr 2006; 25(2): 180–186.

25. Segura A, Pardo J, Jara C et al. An epidemiological evaluation of the prevalence of malnutrition in Spanish patients with locally advance or metastatic cancer. Clin Nutr 2005; 24(5): 801– 814.

26. Forrest LM, McMillan DC, McArdle CS et al. Evaluation of cumulative prognostic scores based on the systemic inflammatory response in patients with inoperable non‑small‑cell lung cancer. Br J Cancer 2003; 89(6): 1028– 1030.

27. Forrest LM, McMillan DC, McArdle CS et al. Comparison of an inflammation‑based prognostic score (GPS) with performance status (ECOG) in patients receiving platinum‑based chemotherapy for inoperable non‑small‑cell lung cancer. Br J Cancer 2004; 90(9): 1704– 1706.

28. Doweiko JP, Nompleggi DJ. The role of albumin in human physiology and pathophysiology, Part III: albumin and disease states. J Parent Enteral Nutr 1991; 15(4): 476– 482.

29. Tomíška M. Syndrom nádorové anorexie a kachexie. Onkologie 2008; 2(3): 174–178.

30. Scott HR, McMillan DC, Forrest LM et al. The systemic inflammatory response, weight loss, performance status and survival in patients with inoperable non‑small cell lung cancer. Br J Cancer 2002; 87(3): 264– 267.