Screening for malnutrition in patients with gastro-entero-pancreatic neuroendocrine tumours: a cross-sectional study

Abstract

Objectives: To investigate whether screening for malnutrition using the validated malnutrition universal screening tool (MUST) identifies specific characteristics of patients at risk, in patients with gastro-entero-pancreatic neuroendocrine tumours (GEP-NET).

Design: Cross-sectional study.

Setting: University Hospitals Coventry & Warwickshire NHS Trust; European Neuroendocrine Tumour Society Centre of Excellence.

Participants: Patients with confirmed GEP-NET (n=161) of varying primary tumour sites, functioning status, grading, staging and treatment modalities.

Main outcome measure: To identify disease and treatment-related characteristics of patients with GEP-NET who score using MUST, and should be directed to detailed nutritional assessment.

Results: MUST score was positive (≥1) in 14% of outpatients with GEP-NET. MUST-positive patients had lower faecal elastase concentrations compared to MUST-negative patients (244±37 vs 383±20 µg/g stool; p=0.018), and were more likely to be on treatment with long-acting somatostatin analogues (65 vs 38%, p=0.021). MUST-positive patients were also more likely to have rectal or unknown primary NET, whereas, frequencies of other GEP-NET including pancreatic NET were comparable between MUST-positive and MUST-negative patients.

Conclusions: Given the frequency of patients identified at malnutrition risk using MUST in our relatively large and diverse GEP-NET cohort and the clinical implications of detecting malnutrition early, we recommend routine use of malnutrition screening in all patients with GEP-NET, and particularly in patients who are treated with long-acting somatostatin analogues.

Keywords: MUST malnutrition universal screening tool; exocrine pancreatic insufficiency; malnutrition; neuroendocrine tumours; somatostatin analogues.

Figure 1

Simplified scheme of use of the MUST score (adapted from BAPEN15). MUST was positive in 14.2% of the screened patients (23/161 patients with GEP-NET). The majority of the patients with positive MUST scored 1 (n=14) or 2 (n=7), mostly related to BMI <20 kg/m² (n=16) and/or, less frequently, recent weight loss (n=9). Only n=2 of the patients in the entire cohort had a MUST score of ≥3. MUST, malnutrition universal screening tool; GEP-NET, gastro-entero-pancreatic neuroendocrine tumours; BMI, body mass index.

Figure 2

Characteristics of the GEP-NET cohort. (A) location of the primary tumour, (B) distribution of tumour staging, with the remaining 11.2% of the patients being classified as Tx (no signs of primary tumour), (C) histological grading (well differentiated, grade 1 and 2; poorly differentiated, grade 3). GEP-NET, gastro-entero-pancreatic neuroendocrine tumours.

Figure 3

MUST-positive compared with MUST-negative patients with GEP-NET. Patients who scored using MUST were significantly more likely to have rectum NET (p<0.017) or a NET with an unknown primary (p<0.017). Other types of NET were not significantly different between MUST-positive and MUST-negative patients, which included pancreatic NET (p=0.195). Black bars: MUST-positive patients; grey bars: MUST-negative patients. pNET, pancreatic neuroendocrine tumour. MUST, malnutrition universal screening tool; GEP-NET, gastro-entero-pancreatic neuroendocrine tumours; NET, neuroendocrine tumours.