Providing nutritional support to patients with thoracic cancer: findings of a dedicated rehabilitation service

Respir Med. 2013 May;107(5):753-61. doi: 10.1016/j.rmed.2013.01.012. Epub 2013 Feb 27.

Abstract

Background: National guidelines recommend screening patients with thoracic cancer to identify those requiring nutritional support. To help quantify this area of need, the associated workload and explore its impact, we report findings from a dedicated rehabilitation service.

Methods: Patients were screened soon after diagnosis to determine the prevalence of malnutrition, and various aspects compared between malnourished and not malnourished groups. A nutritional care plan was instigated and all contacts recorded, together with follow-up body weight.

Results: Of 243 patients seen, 35% were malnourished which was associated with a palliative treatment intent (P < 0.05) and a reduced survival (median 155 days less, 1-year survival 19% vs. 41%; P < 0.01 for both); nonetheless, for about one-fifth, treatment intent was curative. Overall, about two-thirds of patients were failing to meet their daily recommended energy intake. The dietitian provided over 870 episodes of care, a median of three per patient. More of the malnourished group received oral nutritional supplements, but also experienced problems tolerating them. Over one month, neither the pattern nor magnitude of the change in weight differed between malnourished and not malnourished groups. Overall, weight was stable, increased or decreased in 52 (27%), 80 (42%) and 59 (31%) respectively, with no difference in overall survival (P = 0.16).

Conclusion: Our data provides a pragmatic insight into the implications of following national guidance on nutritional screening and support in this patient group. Nutritional support failed to prevent weight loss in some patients, and did not appear to impact on survival; new assessments and treatments for cachexia are required.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Body Weight / physiology
  • Cachexia / diagnosis
  • Cachexia / etiology
  • Cachexia / physiopathology
  • Cachexia / therapy
  • Dietetics / organization & administration
  • Female
  • Humans
  • Lung Neoplasms / complications
  • Lung Neoplasms / physiopathology
  • Lung Neoplasms / therapy*
  • Male
  • Malnutrition / diagnosis
  • Malnutrition / etiology
  • Malnutrition / physiopathology
  • Malnutrition / therapy*
  • Needs Assessment
  • Nutrition Assessment
  • Nutritional Support / methods*
  • Practice Guidelines as Topic
  • Survival Analysis
  • Treatment Outcome
  • Workload / statistics & numerical data