LB109 - PREVALENCE AND PREDICTORS OF MALNUTRITION IN PATIENTS WITH PANCREATIC CANCER – A SINGLE CENTRE PROSPECTIVE STUDY

LB109

PREVALENCE AND PREDICTORS OF MALNUTRITION IN PATIENTS WITH PANCREATIC CANCER – A SINGLE CENTRE PROSPECTIVE STUDY

P. Patil^1,*, S. Khan¹, S. Hegde¹, S. F. Hasan¹, D. Mistry¹, V. Almeida¹, S. Sundaram¹, A. Kale¹, M. Bhandare², V. Chaudhari², R. Arul³, S. Mehta¹, S. Shrikhande²

¹Department of Digestive Diseases and Clinical Nutrition, ²Department of Surgical Oncology, ³Clinical Research Secretariat and DAE-CTC, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India

Rationale: Patients with Pancreatic cancers (PC) are considered to be at high risk of malnutrition. Symptoms like jaundice, abdominal pain, anorexia along with maldigestion and malabsorption contribute to the malnutrition. Malnutrition is frequently unrecognized and can impact treatment tolerance and outcomes. Many malnutrition screening and assessment tools such as Subjective Global Assessment (SGA), Malnutrition Universal Screening Tool (MUST), Mini Nutritional Assessment (MNA), and the Nutrition Risk Screening (NRS) 2002 are used in practice in addition to the standard anthropometric measurements. 

Methods: We conducted a prospective IRB-approved study to evaluate the prevalence and predictors of malnutrition in patients with Pancreatic Cancer and to study the concordance between SGA and other malnutrition screening or assessment tools. Consecutive untreated patients with histologically confirmed adenocarcinoma of the pancreas or with a radiological diagnosis of operable Pancreatic Cancer were recruited over 2.5 years at a high volume referral cancer center. Demography and baseline disease related parameters were noted. Nutritional assessments were done by a trained dietician at baseline and at predefined intervals. We present the baseline data of the first 400 patients.

Results: The mean age was 61.5 years (median 62, range 18-92 years) and 69% were males. 25% were less than 52 years old and 25% were above 69 years old. 85% patients had an ECOG-Performance Status of 0/1 at baseline. 50% had diabetes mellitus. Oral tobacco consumption, smoking and alcohol consumption were reported by 35%, 25%, and 24% patients respectively. 3% had a history of Chronic Pancreatitis.

The commonest symptoms at presentation were abdominal pain in 64%, anorexia in 46%, weight loss in 31% and jaundice in 26%. 55 (14%) patients had undergone biliary drainage before presenting at our centre. The CA-19.9 levels were >1000 U/ml in 56%.  20% of patients had operable disease at the first MDT assessment. The median serum albumin was 3.8 g/dL (range 1.5-5.1) with 25% patients having levels < 3.5 g/dL.

The prevalence of malnutrition using the SGA was 82%. 46% were SGA B (moderately malnourished) and 36% patients were SGA C (severely malnourished). Using MUST, MNA, and NRS 2002, 86%, 94%, and 54% of the patients respectively were malnourished or at risk.

The kappa coefficient analysis to study concordance between the MUST, MNA, NRS 2002, and the gold standard SGA showed moderate agreement between the SGA and MUST (0.42). There was fair agreement between the SGA and MNA (0.24) and SGA with NRS 2002 (0.37). Sensitivity with MUST, MNA, and NRS 2002 was 96%, 98%, and 64% respectively in detecting malnourishment, but the specificity was lower except for NRS-2002 (39%, 20%, and 96%, respectively).

Body mass index (BMI) <18.5 Kg/m2, low calf circumference, and low mid- upper arm circumference suggestive of malnutrition were seen in 22%, 86%, and 24% patients respectively.

On multivariate logistic regression analysis, there was no significant association of malnutrition with anorexia, weight loss, jaundice, pain, older age and unresectable disease at presentation. CA-19.9 levels >1000 U/ml and serum albumin levels < 3.5 g/dL were significantly associated with the presence of malnutrition with an adjusted odds ratio of 2.05 (95%CI 1.13-3.70, p=0.018) and 3.86 (95%CI 1.47-10.12, p=0.006).

Conclusion: Malnutrition was seen in 82% of Pancreatic Cancer patients at diagnosis. MUST had a slightly better concordance with SGA as compared to MNA or NRS 2002. S albumin, BMI and anthropometry underestimated the prevalence of malnutrition highlighting the need to use standard validated screening tools like SGA. CA-19.9 levels >1000 U/ml and serum albumin levels < 3.5 g/dL predicted malnutrition in patients with PC. Nutritional assessment should be integrated in management of patients with PC.

Disclosure of Interest: None declared