Exploring potential benefit of earlier nutritional interventions in adults with upper gastrointestinal cancer: a randomised trial (#45)
Despite evidence of nutritional deficiency, specific nutritional interventions are often not sought until severe malnutrition is evident in the upper gastrointestinal cancer population. This may limit patient response to therapy, and diminish their Quality of Life (QOL) and overall survival. This study evaluated the efficacy of early and intensive nutrition intervention (INI), compared to standard nutrition care (SNC) for improving health outcomes amongst patients with primary oesophageal or stomach cancer. Patients were randomised and stratified by diagnosis to receive early and intensive nutrition intervention or standard nutrition care. SNC involved no dietetic intervention until the patient was admitted for treatment. INI were consulted weekly for 18 weeks, which covered time of diagnosis and the patient’s treatment journey, and then at week 26. Behaviour change techniques were categorised (Abraham & Michie’s Taxonomy of Behaviour Change Techniques).Outcome measures were collected at several time points.The primary outcome measure was Health-Related Quality of Life (HR-QOL) using the global EQ-5D, and the cancer specific EORTC QLQ-C30. Scores were linearly transformed to obtain quantified scores. Nutritional status was the secondary outcome measure and evaluated using the PG-SGA. Dietetic interaction time and participants’ perceptions of nutrition counselling were measured. The effect of the intervention on outcomes was examined using linear mixed model analysis. At baseline (diagnosis) the prevalence of malnutrition was similar between the groups (90%). Six deaths occurred, five in the SNC group and one in the INI group (p=0.06). At week 26, HR-QOL scores were significantly higher in the INI group (n=10) compared with SNC group (n=11) (EQ-5D p<0.001; EORTC QLQ-C30 p<0.001). Weight on average was 6 kilograms greater (p<0.001) and nutritional risk lower (PG-SGA score 10 points lower, p<0.001) in the INI group compared to the SNC group. This study demonstrates the potential of a novel nutrition care model in benefiting health outcomes in newly diagnosed upper gastrointestinal cancer patients.