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01.11.2018 | Original Article

Early 7-day supplemental parenteral nutrition improves body composition and muscle strength in hypophagic cancer patients at nutritional risk

verfasst von: Riccardo Caccialanza, Emanuele Cereda, Marilisa Caraccia, Catherine Klersy, Mariateresa Nardi, Silvia Cappello, Valeria Borioli, Annalisa Turri, Ilaria Imarisio, Angioletta Lasagna, Jessica Saddi, Luca Arcaini, Marco Benazzo, Silvia Stragliotto, Vittorina Zagonel, Paolo Pedrazzoli

Erschienen in: Supportive Care in Cancer | Ausgabe 7/2019

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Abstract

Purpose

The international guidelines recommend the use of supplemental parenteral nutrition (SPN) in cancer patients when they are malnourished and hypophagic and where enteral nutrition is not feasible. However, there are limited data on the short-term effects of SPN in this patient population.

Methods

The aim of this bicentric single-arm clinical trial (NCT02828150) was to evaluate the effects of early 7-day SPN on bioimpedance vectorial analysis (BIVA)–derived body composition, handgrip strength (HG), and serum prealbumin (PAB) in 131 hypophagic, hospitalized cancer patients at nutritional risk, with contraindications for enteral nutrition.

Results

One hundred eighteen patients (90.1%) completed the 7-day SPN support regimen and 102 of them (86.4%) were in advanced disease stage.

SPN induced a significant improvement of phase angle (PhA, + 0.25 [95% CI 0.11, 0.39]; p = 0.001), standardized phase angle (SPA, + 0.33 [95% CI 0.13, 0.53]; p = 0.002), HG (+ 2.1 kg -95% CI 1.30, 2.81]; p < 0.001), and PAB (+ 3.8 mg/dL [95% CI 2.1, 5.6]; p < 0.001).

In multivariable analysis, the effects on BIVA parameters were more pronounced in patients (N = 90, 76.3%) in whom estimated protein and calorie requirements were both satisfied (adjusted difference: PhA, + 0.39 [95% CI 0.04, 0.73]; p = 0.030; SPA, + 0.62 [95% CI 0.16, 1.09]; p = 0.009).

No significant changes in hydration status were detected and no severe metabolic or other complications occurred.

Conclusions

Early 7-day SPN resulted in improved body composition, HG and PAB levels in hypophagic, and hospitalized cancer patients at nutritional risk in the absence of any relevant clinical complications. Further trials, aimed at verifying the efficacy of this early nutritional intervention on mid- and long-term primary clinical endpoints in specific cancer types, are warranted.

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Hébuterne X, Lemarié E, Michallet et al (2014) Prevalence of malnutrition and current use of nutrition support in patients with cancer. JPEN 38:196–204CrossRef

Van Cutsem E, Arends J (2005) The causes and consequences of cancer-associated malnutrition. Eur J Oncol Nurs 9:S51–S63CrossRefPubMed

Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F, Fearon K, Hütterer E, Isenring E, Kaasa S, Krznaric Z, Laird B, Larsson M, Laviano A, Mühlebach S, Muscaritoli M, Oldervoll L, Ravasco P, Solheim T, Strasser F, de van der Schueren M, Preiser JC (2017) ESPEN guidelines on nutrition in cancer patients. Clin Nutr 36:11–48CrossRefPubMed

Caccialanza R, Pedrazzoli P, Cereda E, Gavazzi C, Pinto C, Paccagnella A, Beretta GD, Nardi M, Laviano A, Zagonel V (2016) Nutritional support in cancer patients: a position paper from the Italian Society of Medical Oncology (AIOM) and the Italian Society of Artificial Nutrition and Metabolism (SINPE). J Cancer 7:131–135CrossRefPubMedPubMedCentral

Caccialanza R, Klersy C, Cereda E, Cameletti B, Bonoldi A, Bonardi C, Marinelli M, Dionigi P (2010) Nutritional parameters associated with prolonged hospital stay among ambulatory adult patients. CMAJ 182:1843–1849CrossRefPubMedPubMedCentral

Kyle UG, Schneider SM, Pirlich M, Lochs H, Hebuterne X, Pichard C (2005) Does nutritional risk, as assessed by Nutritional Risk Index, increase during hospital stay? A multinational population-based study. Clin Nutr 24:516–524CrossRefPubMed

Norman K, Pichard C, Lochs H, Pirlich M (2008) Prognostic impact of disease-related malnutrition. Clin Nutr 27:5–15CrossRefPubMed

Prado CM, Antoun S, Sawyer MB, Baracos VE (2011) Two faces of drug therapy in cancer: drug-related lean tissue loss and its adverse consequences to survival and toxicity. Curr Opin Clin Nutr Metab Care 14:250–254CrossRefPubMed

Aoyama T, Kawabe T, Fujikawa H, Hayashi T, Yamada T, Tsuchida K, Yukawa N, Oshima T, Rino Y, Masuda M, Ogata T, Cho H, Yoshikawa T (2015) Loss of lean body mass as an independent risk factor for continuation of S-1 adjuvant chemotherapy for gastric cancer. Ann Surg Oncol 22:2560–2566CrossRefPubMed

10.

Jung HW, Kim JW, Kim JY, Kim SW, Yang HK, Lee JW, Lee KW, Kim DW, Kang SB, Kim KI, Kim CH, Kim JH (2015) Effect of muscle mass on toxicity and survival in patients with colon cancer undergoing adjuvant chemotherapy. Support Care Cancer 23:687–694CrossRefPubMed

11.

Strulov Shachar S, Deal AM, Weinberg M, Nyrop KA, Williams GR, Nishijima TF, Benbow JM, Muss HB (2017) Skeletal muscle measures as predictors of toxicity, hospitalization, and survival in patients with metastatic breast cancer receiving taxane based chemotherapy. Clin Cancer Res 23:658–665CrossRef

12.

Nipp RD, Fuchs G, El-Jawahri A, Mario J, Troschel FM, Greer JA, Gallagher ER, Jackson VA, Kambadakone A, Hong TS, Temel JS, Fintelmann FJ (2018) Sarcopenia is associated with quality of life and depression in patients with advanced cancer. Oncologist 23:97–104CrossRefPubMed

13.

Batsis JA, Mackenzie TA, Lopez-Jimenez F, Bartels SJ (2015) Sarcopenia, sarcopenic obesity, and functional impairments in older adults: National Health and Nutrition Examination Surveys 1999-2004. Nutr Res 35:1031–1039CrossRefPubMedPubMedCentral

14.

Guinan EM, Doyle SL, Bennett AE, O’Neill L, Gannon J, Elliott JA, O’Sullivan J, Reynolds JV, Hussey J Sarcopenia during neoadjuvant therapy for oesophageal cancer: characterising the impact on muscle strength and physical performance. Support Care Cancer 2017. https://doi.org/10.1007/s00520-017-3993-0

15.

Russell MK, Wischmeyer P (2018) Supplemental parenteral nutrition: review of the literature and current nutrition guidelines. Nutr Clin Pract 33:359–369CrossRefPubMed

16.

Worthington P, Balint J, Bechtold M, Bingham A, Chan LN, Durfee S, Jevenn AK, Malone A, Mascarenhas M, Robinson DT, Holcombe B (2017) When is parenteral nutrition appropriate? JPEN J Parenter Enteral Nutr 41:324–377CrossRefPubMed

17.

Cotogni P, De Carli L, Passera R, Amerio ML, Agnello E, Fadda M, Ossola M, Monge T, De Francesco A, Bozzetti F (2017) Longitudinal study of quality of life in advanced cancer patients on home parenteral nutrition. Cancer Med 6:1799–1806CrossRefPubMedPubMedCentral

18.

Pelzer U, Arnold D, Gövercin M, Stieler J, Doerken B, Riess H, Oettle H (2010) Parenteral nutrition support for patients with pancreatic cancer. Results of a phase II study. BMC Cancer 10:86CrossRefPubMedPubMedCentral

19.

Richter E, Denecke A, Klapdor S, Klapdor R (2012) Parenteral nutrition support for patients with pancreatic cancer--improvement of the nutritional status and the therapeutic outcome. Anticancer Res 32:2111–2118PubMed

20.

Wu W, Zhong M, Zhu DM, Song JQ, Huang JF, Wang Q, Tan LJ (2017) Effect of early full-calorie nutrition support following esophagectomy: a randomized controlled trial. JPEN 41:1146–1154CrossRef

21.

Obling SR, Wilson BV, Pfeiffer P, Kjeldsen J (2017) Home parenteral nutrition increases fat free mass in patients with incurable gastrointestinal cancer. Results of a randomized controlled trial. Clin Nutr. https://doi.org/10.1016/j.clnu.2017.12.011

22.

Caccialanza R, Cereda E, Klersy C, Bonardi C, Cappello S, Quarleri L, Turri A, Montagna E, Iacona I, Valentino F, Pedrazzoli P (2015) Phase angle and handgrip strength are sensitive early markers of energy intake in hypophagic, non-surgical patients at nutritional risk, with contraindications to enteral nutrition. Nutrients 7:1828–1840CrossRefPubMedPubMedCentral

23.

Pereira MME, Queiroz MDSC, de Albuquerque NMC, Rodrigues J, Wiegert EVM, Calixto-Lima L, de Oliveira LC (2018; in press) The prognostic role of phase angle in advanced cancer patients: a systematic review. Nutr Clin Pract. https://doi.org/10.1002/ncp.10100.

24.

Pérez Camargo DA, Allende Pérez SR, Verastegui Avilés E, Rivera Franco MM, Meneses García A, Herrera Gómez Á, Urbalejo Ceniceros VI (2017) Assessment and impact of phase angle and sarcopenia in palliative cancer patients. Nutr Cancer 69:1227–1233CrossRefPubMed

25.

Souza BU, Souza NCS, Martucci RB, Rodrigues VD, Pinho NB, Gonzalez MC, Avesani CM (2018) Factors associated with sarcopenia in patients with colorectal cancer. Nutr Cancer 70:176–183CrossRefPubMed

26.

Kilgour RD, Vigano A, Trutschnigg B, Lucar E, Borod M, Morais JA (2013) Handgrip strength predicts survival and is associated with markers of clinical and functional outcomes in advanced cancer patients. Support Care Cancer 21:3261–3270CrossRefPubMed

27.

Caccialanza R, Palladini G, Klersy C, Cereda E, Bonardi C, Quarleri L, Vadacca G, Albertini R, Merlini G (2013) Serum prealbumin: an independent marker of short-term energy intake in the presence of multiple-organ disease involvement. Nutrition 29:580–582CrossRefPubMed

28.

Dellière S, Cynober L (2017) Is transthyretin a good marker of nutritional status? Clin Nutr 36:364–370CrossRefPubMed

29.

Kondrup J, Rasmussen HH, Hamberg O, Stanga Z, Ad Hoc ESPEN Working Group (2003) Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr 22:321–336CrossRefPubMed

30.

Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, Carbone PP (1982) Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 5:649–655CrossRefPubMed

31.

Lukaski HC, Bolonchuk WW, Hall CB, Siders WA (1986) Validation of tetrapolar bioelectrical impedance method to assess human body composition. J Appl Physiol 60:1327–1332CrossRefPubMed

32.

Nwosu AC, Mayland CR, Mason S, Cox TF, Varro A, Ellershaw J (2016) The association of hydration status with physical signs, symptoms and survival in advanced cancer-the use of bioelectrical impedance vector analysis (BIVA) technology to evaluate fluid volume in palliative care: an observational study. PLoS One 11(9):e0163114CrossRefPubMedPubMedCentral

33.

Kyle UG, Bosaeus I, De Lorenzo AD, Deurenberg P, Elia M, Gómez JM, Heitmann BL, Kent-Smith L, Melchior JC, Pirlich M, Scharfetter H, Schols AM, Pichard C (2004) Composition of the ESPEN Working Group. Bioelectrical impedance analysis- part I: review of principles and methods. Clin Nutr 23:1226–1243CrossRefPubMed

34.

Kyle UG, Bosaeus I, De Lorenzo AD, Deurenberg P, Elia M, Manuel Gómez J, Lilienthal Heitmann B, Kent-Smith L, Melchior JC, Pirlich M, Scharfetter H, Schols A MWJ, Pichard C, ESPEN (2004) Bioelectrical impedance analysis-part II: utilization in clinical practice. Clin Nutr 23:1430–1453CrossRefPubMed

35.

Piccoli A, Rossi B, Pillon L, Bucciante G (1994) A new method for monitoring body fluid variation by bioimpedance analysis: the RXc graph. Kidney Int 46:534–539CrossRefPubMed

36.

Piccoli A, Nigrelli S, Caberlotto A, Bottazzo S, Rossi B, Pillon L, Maggiore Q (1995) Bivariate normal values of the bioelectrical impedance vector in adult and elderly populations. Am J Clin Nutr 61:269–270CrossRefPubMed

37.

Krüger J, Meffert PJ, Vogt LJ, Gärtner S, Steveling A, Kraft M, Mayerle J, Lerch MM, Aghdassi AA (2016) Early parenteral nutrition in patients with biliopancreatic mass lesions, a prospective, randomized intervention trial. PLoS One 11(11):e0166513CrossRefPubMedPubMedCentral

38.

Drissi M, Cwieluch O, Lechner P, Radziwill R, Vehling-Kaiser U, Hengst K, Masin M (2015) Nutrition care in patients with cancer: a retrospective multicenter analysis of current practice - indications for further studies? Clin Nutr 34:207–211CrossRefPubMed

39.

Della Valle S, Colatruglio S, La Vela V, Tagliabue E, Mariani L, Gavazzi C (2018) Nutritional intervention in head and neck cancer patients during chemo-radiotherapy. Nutrition 51–52:95–97CrossRefPubMed

40.

Giles KH, Kubrak C, Baracos VE, Olson K, Mazurak VC (2016) Recommended European Society of Parenteral and Enteral Nutrition protein and energy intakes and weight loss in patients with head and neck cancer. Head Neck 38:1248–1257CrossRefPubMed

41.

De Waele E, Mattens S, Honoré PM, Spapen H, De Grève J, Pen JJ (2015) Nutrition therapy in cachectic cancer patients. The Tight Caloric Control (TiCaCo) pilot trial. Appetite 91:298–301CrossRefPubMed

42.

Oshima T, Berger MM, De Waele E, Guttormsen AB, Heidegger CP, Hiesmayr M, Singer P, Wernerman J, Pichard C (2017) Indirect calorimetry in nutritional therapy. A position paper by the ICALIC study group. Clin Nutr 36:651–662CrossRefPubMed

43.

Bally MR, Blaser Yildirim PZ, Bounoure L, Gloy VL, Mueller B, Briel M, Schuetz P (2016) Nutritional support and outcomes in malnourished medical inpatients: a systematic review and meta-analysis. JAMA Intern Med 176:43–53CrossRefPubMed

44.

Leong DP, Teo KK, Rangarajan S, Lopez-Jaramillo P, Avezum A Jr, Orlandini A, Seron P, Ahmed SH, Rosengren A, Kelishadi R, Rahman O, Swaminathan S, Iqbal R, Gupta R, Lear SA, Oguz A, Yusoff K, Zatonska K, Chifamba J, Igumbor E, Mohan V, Anjana RM, Gu H, Li W, Yusuf S (2015) Prospective Urban Rural Epidemiology (PURE) Study investigators. Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study. Lancet 386:266–273CrossRefPubMed

45.

Teodozio CGC, Chaves GV, Arcuri IP, Frajacomo FT (2018) Does grip strength decrease in the very early stages of hematological treatment? Support Care Cancer 26:333–335CrossRefPubMed

Titel: Early 7-day supplemental parenteral nutrition improves body composition and muscle strength in hypophagic cancer patients at nutritional risk
verfasst von: Riccardo Caccialanza
Emanuele Cereda
Marilisa Caraccia
Catherine Klersy
Mariateresa Nardi
Silvia Cappello
Valeria Borioli
Annalisa Turri
Ilaria Imarisio
Angioletta Lasagna
Jessica Saddi
Luca Arcaini
Marco Benazzo
Silvia Stragliotto
Vittorina Zagonel
Paolo Pedrazzoli
Publikationsdatum: 01.11.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: Supportive Care in Cancer / Ausgabe 7/2019
Print ISSN: 0941-4355
Elektronische ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-018-4527-0

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Early 7-day supplemental parenteral nutrition improves body composition and muscle strength in hypophagic cancer patients at nutritional risk