Chemotherapy dose intensity predicted by baseline nutrition assessment in gastrointestinal malignancies: A multicentre analysis

Kelsey A. Klute, Julianna Brouwer, Minaxi Jhawer, Hayley Sachs, Anatasia Gangadin, Allyson Ocean, Elizabeta Popa, Tong Dai, Guojiao Wu, Paul Christos, Manish A. Shah

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background Malnutrition is prevalent in cancer patients and is associated with inferior outcomes. We examined the association between malnutrition, as measured by the Subjective Global Assessment (SGA), and chemotherapy dose reduction in patients with gastrointestinal malignancies. We hypothesised that malnutrition, defined by a patient's baseline SGA, would be associated with a greater degree of chemotherapy dose-reduction, with the implication of greater chemotherapy related toxicity. Design We reviewed chemotherapy dosing and treatment related toxicity for patients enrolled in a prospective Gastrointestinal Cancer Registry over their first 8 weeks of treatment. We compared results between well-nourished and malnourished patients. Results Malnourished patients were more likely than well-nourished patients to have their starting chemotherapy dose reduced from standard published dosing (67% versus 35%, p = 0.0001). Despite attenuated initial dosing, malnourished patients received a smaller fraction of planned chemotherapy (mean 80 ± 23% versus 90 ± 15% of cycle 1, p = 0.005), primarily due to toxicity-related dose reductions. After controlling for age, gender, Eastern Cooperative Oncology Group performance status (ECOG), albumin, smoking status, body habitus, and weight loss, malnutrition remained the strongest independent predictor of the magnitude of chemotherapy dose reduction (estimate -10.3%, 95% confidence interval -19.0 to -0.1.6%, p = 0.020). Conclusions Malnutrition is an independent predictor of chemotherapy dose-reduction for toxicity. This study highlights the practical significance of malnutrition in gastrointestinal malignancies and provides a baseline for future nutrition intervention studies to improve chemotherapy tolerability in malnourished patients.

Original languageEnglish (US)
Pages (from-to)189-200
Number of pages12
JournalEuropean Journal of Cancer
Volume63
DOIs
StatePublished - Aug 1 2016

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Nutrition Assessment
Drug Therapy
Malnutrition
Neoplasms
Gastrointestinal Neoplasms
Registries
Weight Loss
Albumins
Smoking
Body Weight
Confidence Intervals

Keywords

  • Chemotherapy toxicity
  • Gastrointestinal malignancy
  • Malnutrition

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Chemotherapy dose intensity predicted by baseline nutrition assessment in gastrointestinal malignancies : A multicentre analysis. / Klute, Kelsey A.; Brouwer, Julianna; Jhawer, Minaxi; Sachs, Hayley; Gangadin, Anatasia; Ocean, Allyson; Popa, Elizabeta; Dai, Tong; Wu, Guojiao; Christos, Paul; Shah, Manish A.

In: European Journal of Cancer, Vol. 63, 01.08.2016, p. 189-200.

Research output: Contribution to journalArticle

Klute, KA, Brouwer, J, Jhawer, M, Sachs, H, Gangadin, A, Ocean, A, Popa, E, Dai, T, Wu, G, Christos, P & Shah, MA 2016, 'Chemotherapy dose intensity predicted by baseline nutrition assessment in gastrointestinal malignancies: A multicentre analysis', European Journal of Cancer, vol. 63, pp. 189-200. https://doi.org/10.1016/j.ejca.2016.05.011
Klute, Kelsey A. ; Brouwer, Julianna ; Jhawer, Minaxi ; Sachs, Hayley ; Gangadin, Anatasia ; Ocean, Allyson ; Popa, Elizabeta ; Dai, Tong ; Wu, Guojiao ; Christos, Paul ; Shah, Manish A. / Chemotherapy dose intensity predicted by baseline nutrition assessment in gastrointestinal malignancies : A multicentre analysis. In: European Journal of Cancer. 2016 ; Vol. 63. pp. 189-200.
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abstract = "Background Malnutrition is prevalent in cancer patients and is associated with inferior outcomes. We examined the association between malnutrition, as measured by the Subjective Global Assessment (SGA), and chemotherapy dose reduction in patients with gastrointestinal malignancies. We hypothesised that malnutrition, defined by a patient's baseline SGA, would be associated with a greater degree of chemotherapy dose-reduction, with the implication of greater chemotherapy related toxicity. Design We reviewed chemotherapy dosing and treatment related toxicity for patients enrolled in a prospective Gastrointestinal Cancer Registry over their first 8 weeks of treatment. We compared results between well-nourished and malnourished patients. Results Malnourished patients were more likely than well-nourished patients to have their starting chemotherapy dose reduced from standard published dosing (67{\%} versus 35{\%}, p = 0.0001). Despite attenuated initial dosing, malnourished patients received a smaller fraction of planned chemotherapy (mean 80 ± 23{\%} versus 90 ± 15{\%} of cycle 1, p = 0.005), primarily due to toxicity-related dose reductions. After controlling for age, gender, Eastern Cooperative Oncology Group performance status (ECOG), albumin, smoking status, body habitus, and weight loss, malnutrition remained the strongest independent predictor of the magnitude of chemotherapy dose reduction (estimate -10.3{\%}, 95{\%} confidence interval -19.0 to -0.1.6{\%}, p = 0.020). Conclusions Malnutrition is an independent predictor of chemotherapy dose-reduction for toxicity. This study highlights the practical significance of malnutrition in gastrointestinal malignancies and provides a baseline for future nutrition intervention studies to improve chemotherapy tolerability in malnourished patients.",
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T2 - A multicentre analysis

AU - Klute, Kelsey A.

AU - Brouwer, Julianna

AU - Jhawer, Minaxi

AU - Sachs, Hayley

AU - Gangadin, Anatasia

AU - Ocean, Allyson

AU - Popa, Elizabeta

AU - Dai, Tong

AU - Wu, Guojiao

AU - Christos, Paul

AU - Shah, Manish A.

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N2 - Background Malnutrition is prevalent in cancer patients and is associated with inferior outcomes. We examined the association between malnutrition, as measured by the Subjective Global Assessment (SGA), and chemotherapy dose reduction in patients with gastrointestinal malignancies. We hypothesised that malnutrition, defined by a patient's baseline SGA, would be associated with a greater degree of chemotherapy dose-reduction, with the implication of greater chemotherapy related toxicity. Design We reviewed chemotherapy dosing and treatment related toxicity for patients enrolled in a prospective Gastrointestinal Cancer Registry over their first 8 weeks of treatment. We compared results between well-nourished and malnourished patients. Results Malnourished patients were more likely than well-nourished patients to have their starting chemotherapy dose reduced from standard published dosing (67% versus 35%, p = 0.0001). Despite attenuated initial dosing, malnourished patients received a smaller fraction of planned chemotherapy (mean 80 ± 23% versus 90 ± 15% of cycle 1, p = 0.005), primarily due to toxicity-related dose reductions. After controlling for age, gender, Eastern Cooperative Oncology Group performance status (ECOG), albumin, smoking status, body habitus, and weight loss, malnutrition remained the strongest independent predictor of the magnitude of chemotherapy dose reduction (estimate -10.3%, 95% confidence interval -19.0 to -0.1.6%, p = 0.020). Conclusions Malnutrition is an independent predictor of chemotherapy dose-reduction for toxicity. This study highlights the practical significance of malnutrition in gastrointestinal malignancies and provides a baseline for future nutrition intervention studies to improve chemotherapy tolerability in malnourished patients.

AB - Background Malnutrition is prevalent in cancer patients and is associated with inferior outcomes. We examined the association between malnutrition, as measured by the Subjective Global Assessment (SGA), and chemotherapy dose reduction in patients with gastrointestinal malignancies. We hypothesised that malnutrition, defined by a patient's baseline SGA, would be associated with a greater degree of chemotherapy dose-reduction, with the implication of greater chemotherapy related toxicity. Design We reviewed chemotherapy dosing and treatment related toxicity for patients enrolled in a prospective Gastrointestinal Cancer Registry over their first 8 weeks of treatment. We compared results between well-nourished and malnourished patients. Results Malnourished patients were more likely than well-nourished patients to have their starting chemotherapy dose reduced from standard published dosing (67% versus 35%, p = 0.0001). Despite attenuated initial dosing, malnourished patients received a smaller fraction of planned chemotherapy (mean 80 ± 23% versus 90 ± 15% of cycle 1, p = 0.005), primarily due to toxicity-related dose reductions. After controlling for age, gender, Eastern Cooperative Oncology Group performance status (ECOG), albumin, smoking status, body habitus, and weight loss, malnutrition remained the strongest independent predictor of the magnitude of chemotherapy dose reduction (estimate -10.3%, 95% confidence interval -19.0 to -0.1.6%, p = 0.020). Conclusions Malnutrition is an independent predictor of chemotherapy dose-reduction for toxicity. This study highlights the practical significance of malnutrition in gastrointestinal malignancies and provides a baseline for future nutrition intervention studies to improve chemotherapy tolerability in malnourished patients.

KW - Chemotherapy toxicity

KW - Gastrointestinal malignancy

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