nach oben

Strahlentherapie und Onkologie

Erschienen in:

04.09.2018 | Original Article

Treatment of malnutrition decreases complication rates and shortens the length of hospital stays in a radiation oncology department

verfasst von: Johannes Kufeldt, Marén Viehrig, Daniela Schweikert, Andreas Fritsche, Michael Bamberg, Michael Adolph

Erschienen in: Strahlentherapie und Onkologie | Ausgabe 11/2018

Einloggen, um Zugang zu erhalten

Abstract

Purpose

The nutritional status of inpatients influences the therapeutic outcome. Malnutrition is a common comorbidity in oncological patients. Both radio- and radiochemotherapy may contribute to the additional deterioration of the nutritional status. The aim of this study was to evaluate the impact of specialized treatment of malnutrition as a clinical routine.

Methods

The nutritional status of inpatients was assessed by the Nutritional risk screening (NRS-2002) on the day of admission to the University Department of Radiation Oncology. In case of significantly elevated NRS-2002 (NRS ≥ 3), a guideline-compliant, individual nutritional treatment was initiated by a specialized nutrition support team. The influence of the nutritional status and nutritional treatment on length of stay and complication rate was assessed.

Results

Of 840 included patients, 344 patients (40.95%) were at risk for malnutrition. Malnutrition was a significant, independent risk factor for both prolonged hospital stay, represented by the deviation between the actual length of stay and the DRG-associated mean length of stay (dLOS at risk: 0.88 days, dLOS not at risk: −0.88 days, p = 0.0047), as well as for the occurrence of complications (OR: 1.758 CI: [1.286–2.402], p = 0.0006). In the group of 337 (40.12%) rehospitalized patients the nutritional management was able to assimilate the values of length of stay as well as the complication rates to standard values.

Conclusions

The high risk for malnutrition and the negative consequences for patients and hospitals underline the urgent need for malnutrition screening on admission and treatment of malnutrition. A specialized, interdisciplinary nutrition support team positively influences patient outcome and should be established routinely in all oncological disciplines.

Nur mit Berechtigung zugänglich

Working Group on Prevention and Integrative Oncology (PRIO) (2016) Improving nutritional care for cancer patients in Germany. Joint position paper from the German Cancer Society‘s (GCS) Working Group on Prevention and Integrative Oncology (PRIO), in collaboration with other associations. Ernahr Umsch 63(02):43–47. https://doi.org/10.4455/eu.2016.011 CrossRef

Cepton Strategies (2007) Mangelernährung in Deutschland

Pirlich M, Schutz T, Norman K, Gastell S, Lubke HJ, Bischoff SC, Bolder U, Frieling T, Guldenzoph H, Hahn K, Jauch KW, Schindler K, Stein J, Volkert D, Weimann A, Werner H, Wolf C, Zurcher G, Bauer P, Lochs H (2006) The German hospital malnutrition study. Clin Nutr 25(4):563–572. https://doi.org/10.1016/j.clnu.2006.03.005 CrossRefPubMed

Thomas MN, Kufeldt J, Kisser U, Hornung HM, Hoffmann J, Andraschko M, Werner J, Rittler P (2016) Effects of malnutrition on complication rates, length of hospital stay, and revenue in elective surgical patients in the G‑DRG-system. Nutrition 32(2):249–254. https://doi.org/10.1016/j.nut.2015.08.021 CrossRefPubMed

Kisser U, Kufeldt J, Adderson-Kisser C, Becker S, Baumeister P, Reiter M, Harreus U, Thomas MN, Rittler P (2016) Clinical impact of malnutrition on complication rate and length of stay in elective ENT patients: a prospective cohort study. Eur Arch Otorhinolaryngol. https://doi.org/10.1007/s00405-016-3974-9 CrossRefPubMed

Rosenbaum A, Piper S, Riemann JF, Schilling D (2007) Mangelernährung bei internistischen Patienten – eine Screeninguntersuchung von 1308 Patienten mit Verlaufsbeobachtung. Aktuel Ernahrungsmed 32(04):181–184. https://doi.org/10.1055/s-2007-970921 (Malnutrition in Medical Patients – Screening of 1308 Patients and Follow-Up)CrossRef

Bonetti L, Terzoni S, Lusignani M, Negri M, Froldi M, Destrebecq A (2017) Prevalence of malnutrition among older people in medical and surgical wards in hospital and quality of nutritional care: a multicenter, cross-sectional study. J Clin Nurs. https://doi.org/10.1111/jocn.14051 CrossRefPubMed

Planas M, Alvarez-Hernandez J, Leon-Sanz M, Celaya-Perez S, Araujo K, Garcia de Lorenzo A, PREDyCES® researchers (2016) Prevalence of hospital malnutrition in cancer patients: a sub-analysis of the PREDyCES(R) study. Support Care Cancer 24(1):429–435. https://doi.org/10.1007/s00520-015-2813-7 CrossRefPubMed

Unsal D, Mentes B, Akmansu M, Uner A, Oguz M, Pak Y (2006) Evaluation of nutritional status in cancer patients receiving radiotherapy: a prospective study. Am J Clin Oncol 29(2):183–188. https://doi.org/10.1097/01.coc.0000198745.94757.ee CrossRefPubMed

10.

Pressoir M, Desne S, Berchery D, Rossignol G, Poiree B, Meslier M, Traversier S, Vittot M, Simon M, Gekiere JP, Meuric J, Serot F, Falewee MN, Rodrigues I, Senesse P, Vasson MP, Chelle F, Maget B, Antoun S, Bachmann P (2010) Prevalence, risk factors and clinical implications of malnutrition in French Comprehensive Cancer Centres. Br J Cancer 102(6):966–971. https://doi.org/10.1038/sj.bjc.6605578 CrossRefPubMedPubMedCentral

11.

Sorensen J, Kondrup J, Prokopowicz J, Schiesser M, Krahenbuhl L, Meier R, Liberda M, EuroOOPS study group (2008) EuroOOPS: an international, multicentre study to implement nutritional risk screening and evaluate clinical outcome. Clin Nutr 27(3):340–349. https://doi.org/10.1016/j.clnu.2008.03.012 CrossRefPubMed

12.

Harter J, Orlandi SP, Gonzalez MC (2017) Nutritional and functional factors as prognostic of surgical cancer patients. Support Care Cancer 25(8):2525–2530. https://doi.org/10.1007/s00520-017-3661-4 CrossRefPubMed

13.

Burgos R, Sarto B, Elio I, Planas M, Forga M, Canton A, Trallero R, Munoz MJ, Perez D, Bonada A, Salo E, Lecha M, Enrich G, Salas-Salvado J, Group for the Study of Malnutrition in Hospitals in Catalonia (2012) Prevalence of malnutrition and its etiological factors in hospitals. Nutr Hosp 27(2):469–476. https://doi.org/10.1590/S0212-16112012000200018 CrossRefPubMed

14.

Correia MI, Waitzberg DL (2003) The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr 22(3):235–239CrossRef

15.

Silver HJ, Dietrich MS, Murphy BA (2007) Changes in body mass, energy balance, physical function, and inflammatory state in patients with locally advanced head and neck cancer treated with concurrent chemoradiation after low-dose induction chemotherapy. Head Neck 29(10):893–900. https://doi.org/10.1002/hed.20607 CrossRefPubMed

16.

Bozzetti F (2013) Nutritional support of the oncology patient. Crit Rev Oncol Hematol 87(2):172–200. https://doi.org/10.1016/j.critrevonc.2013.03.006 CrossRefPubMed

17.

van den Berg MG, Rutten H, Rasmussen-Conrad EL, Knuijt S, Takes RP, van Herpen CM, Wanten GJ, Kaanders JH, Merkx MA (2014) Nutritional status, food intake, and dysphagia in long-term survivors with head and neck cancer treated with chemoradiotherapy: a cross-sectional study. Head Neck 36(1):60–65. https://doi.org/10.1002/hed.23265 CrossRefPubMed

18.

Korner P, Ehrmann K, Hartmannsgruber J, Metz M, Steigerwald S, Flentje M, van Oorschot B (2017) Patient-reported symptoms during radiotherapy: clinically relevant symptom burden in patients treated with palliative and curative intent. Strahlenther Onkol 193(7):570–577. https://doi.org/10.1007/s00066-017-1146-5 CrossRefPubMed

19.

Alterio D, Gerardi MA, Cella L, Spoto R, Zurlo V, Sabbatini A, Fodor C, D’Avino V, Conson M, Valoriani F, Ciardo D, Pacelli R, Ferrari A, Maisonneuve P, Preda L, Bruschini R, Cossu Rocca M, Rondi E, Colangione S, Palma G, Dicuonzo S, Orecchia R, Sanguineti G, Jereczek-Fossa BA (2017) Radiation-induced acute dysphagia: prospective observational study on 42 head and neck cancer patients. Strahlenther Onkol 193(11):971–981. https://doi.org/10.1007/s00066-017-1206-x CrossRefPubMed

20.

Martin L, Senesse P, Gioulbasanis I, Antoun S, Bozzetti F, Deans C, Strasser F, Thoresen L, Jagoe RT, Chasen M, Lundholm K, Bosaeus I, Fearon KH, Baracos VE (2015) Diagnostic criteria for the classification of cancer-associated weight loss. J Clin Oncol 33(1):90–99. https://doi.org/10.1200/JCO.2014.56.1894 CrossRef

21.

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(3):321–336CrossRef

22.

Arends J, Bertz H, Bischoff SC, Fietkau R, Herrmann HJ, Holm E, Horneber M, Hütterer E, Körber J, Schmid I, und das DSC (2015) S3-Leitline der Deutschen Gesellschaft für Ernährungsmedizin e. V. (DGEM) in Kooperation mit der Deutschen Gesellschaft für Hämatologie und Onkologie e. V. (DGHO), der Arbeitsgemeinschaft „Supportive Maßnahmen in der Onkologie, Rehabilitation und Sozialmedizin“ der Deutschen Krebsgesellschaft (ASORS) und der Österreichischen Arbeitsgemeinschaft für klinische Ernährung (AKE) (S3-Guideline of the German Society for Nutritional Medicine (DGEM) in Cooperation with the DGHO, the ASORS and the AKE). Aktuel Ernahrungsmed 40 (05):e1–e74. https://doi.org/10.1055/s-0035-1552741 CrossRef

23.

Kufeldt J, Kovarova M, Adolph M, Staiger H, Bamberg M, Haring HU, Fritsche A, Peter A (2017) Prevalence and distribution of diabetes mellitus in a maximum care hospital: urgent need for HbA1c-screening. Exp Clin Endocrinol Diabetes. https://doi.org/10.1055/s-0043-112653 CrossRefPubMed

24.

Deutsches Institut für Medizinische Dokumentation und Information (DIMDI) im Auftrag des Bundesministeriums für Gesundheit (BMG) unter Beteiligung der Arbeitsgruppe ICD des Kuratoriums für Fragen der Klassifikation im Gesundheitswesen (2018) ICD-10-GM Version 2018. Systematisches Verzeichnis Internationale statistische Klassifikation der Krankheiten und verwandter Gesundheitsprobleme (10. Revision, German modification). https://www.dimdi.de/static/de/klassifikationen/icd/icd-10-gm/kode-suche/htmlgm2018/

25.

Kuppinger D, Hartl WH, Bertok M, Hoffmann JM, Cederbaum J, Bender A, Küchenhoff H, Rittler P (2013) Nutritional screening for risk prediction in patients scheduled for extra-abdominal surgery. Nutrition 29(2):399–404. https://doi.org/10.1016/j.nut.2012.06.013 CrossRefPubMed

26.

Fietkau R (2016) Einfluss der Ernährung bei Strahlen- und Radiochemotherapie. Onkologe 22(4):268–274. https://doi.org/10.1007/s00761-016-0012-x CrossRef

Titel: Treatment of malnutrition decreases complication rates and shortens the length of hospital stays in a radiation oncology department
verfasst von: Johannes Kufeldt
Marén Viehrig
Daniela Schweikert
Andreas Fritsche
Michael Bamberg
Michael Adolph
Publikationsdatum: 04.09.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: Strahlentherapie und Onkologie / Ausgabe 11/2018
Print ISSN: 0179-7158
Elektronische ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-018-1360-9

Neu im Fachgebiet Onkologie

Umsetzung der POMGAT-Leitlinie läuft

03.05.2024 DCK 2024 Kongressbericht

Seit November 2023 gibt es evidenzbasierte Empfehlungen zum perioperativen Management bei gastrointestinalen Tumoren (POMGAT) auf S3-Niveau. Vieles wird schon entsprechend der Empfehlungen durchgeführt. Wo es im Alltag noch hapert, zeigt eine Umfrage in einem Klinikverbund.

Springer Medizin

Treatment of malnutrition decreases complication rates and shortens the length of hospital stays in a radiation oncology department