Nutritional support during the hospital stay reduces mortality in patients with different types of cancers: secondary analysis of a prospective randomized trial

L Bargetzi¹, C Brack², J Herrmann², A Bargetzi¹, L Hersberger¹, M Bargetzi³, N Kaegi-Braun⁴, P Tribolet⁵, F Gomes⁶, C Hoess⁷, V Pavlicek⁷, S Bilz⁸, S Sigrist⁸, M Brändle⁸, C Henzen⁹, R Thomann¹⁰, J Rutishauser¹¹, D Aujesky¹², N Rodondi¹³, J Donzé¹⁴, A Laviano¹⁵, Z Stanga¹⁶, B Mueller¹, P Schuetz¹⁷

Affiliations

¹ Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Basel, Switzerland.
² Medical Faculty of the University of Basel, Basel, Switzerland.
³ Medical Faculty of the University of Basel, Basel, Switzerland; Division of Oncology, Hematology and Transfusion Medicine, Kantonsspital Aarau, Aarau, Switzerland.
⁴ Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland.
⁵ Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland.
⁶ Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; The New York Academy of Sciences, New York, USA.
⁷ Internal Medicine, Kantonsspital Muensterlingen, Muensterlingen, Switzerland.
⁸ Internal Medicine & Endocrinology/Diabetes, Kantonsspital St.Gallen, St.Gallen, Switzerland.
⁹ Internal Medicine, Kantonsspital Luzern, Luzern, Switzerland.
¹⁰ Internal Medicine, Buergerspital Solothurn, Solothurn, Switzerland.
¹¹ Internal Medicine, Kantonsspital Baselland, Liestal, Switzerland.
¹² Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
¹³ Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
¹⁴ Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Division of General Internal Medicine, Brigham and Women's Hospital, Boston, USA.
¹⁵ Department of Translational and Precision Medicine, Sapienza University, Rome, Italy.
¹⁶ Division of Diabetes, Endocrinology, Nutritional Medicine & Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
¹⁷ Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Basel, Switzerland. Electronic address: schuetzph@gmail.com.

PMID: 34022376
DOI: 10.1016/j.annonc.2021.05.793

Free article

Randomized Controlled Trial

Nutritional support during the hospital stay reduces mortality in patients with different types of cancers: secondary analysis of a prospective randomized trial

L Bargetzi et al. Ann Oncol. 2021 Aug.

Free article

. 2021 Aug;32(8):1025-1033.

doi: 10.1016/j.annonc.2021.05.793. Epub 2021 May 19.

Authors

Affiliations

¹ Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Basel, Switzerland.
² Medical Faculty of the University of Basel, Basel, Switzerland.
³ Medical Faculty of the University of Basel, Basel, Switzerland; Division of Oncology, Hematology and Transfusion Medicine, Kantonsspital Aarau, Aarau, Switzerland.
⁴ Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland.
⁵ Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland.
⁶ Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; The New York Academy of Sciences, New York, USA.
⁷ Internal Medicine, Kantonsspital Muensterlingen, Muensterlingen, Switzerland.
⁸ Internal Medicine & Endocrinology/Diabetes, Kantonsspital St.Gallen, St.Gallen, Switzerland.
⁹ Internal Medicine, Kantonsspital Luzern, Luzern, Switzerland.
¹⁰ Internal Medicine, Buergerspital Solothurn, Solothurn, Switzerland.
¹¹ Internal Medicine, Kantonsspital Baselland, Liestal, Switzerland.
¹² Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
¹³ Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
¹⁴ Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Division of General Internal Medicine, Brigham and Women's Hospital, Boston, USA.
¹⁵ Department of Translational and Precision Medicine, Sapienza University, Rome, Italy.
¹⁶ Division of Diabetes, Endocrinology, Nutritional Medicine & Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
¹⁷ Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Basel, Switzerland. Electronic address: schuetzph@gmail.com.

PMID: 34022376
DOI: 10.1016/j.annonc.2021.05.793

Abstract

Background: Nutritional support in patients with cancer aims at improving quality of life. Whether use of nutritional support is also effective in improving clinical outcomes requires further study.

Patients and methods: In this preplanned secondary analysis of patients with cancer included in a prospective, randomized-controlled, Swiss, multicenter trial (EFFORT), we compared protocol-guided individualized nutritional support (intervention group) to standard hospital food (control group) regarding mortality at 30-day (primary endpoint) and other clinical outcomes.

Results: We analyzed 506 patients with a main admission diagnosis of cancer, including lung cancer (n = 113), gastrointestinal tumors (n = 84), hematological malignancies (n = 108) and other types of cancer (n = 201). Nutritional risk based on Nutritional Risk Screening (NRS 2002) was an independent predictor for mortality over 180 days with an (age-, sex-, center-, type of cancer-, tumor activity- and treatment-) adjusted hazard ratio of 1.29 (95% CI 1.09-1.54; P = 0.004) per point increase in NRS. In the 30-day follow-up period, 50 patients (19.9%) died in the control group compared to 36 (14.1%) in the intervention group resulting in an adjusted odds ratio of 0.57 (95% CI 0.35-0.94; P = 0.027). Interaction tests did not show significant differences in mortality across the cancer type subgroups. Nutritional support also significantly improved functional outcomes and quality of life measures.

Conclusions: Compared to usual hospital nutrition without nutrition support, individualized nutritional support reduced the risk of mortality and improved functional and quality of life outcomes in cancer patients with increased nutritional risk. These data further support the inclusion of nutritional care in cancer management guidelines.

Keywords: cancer; malnutrition; nutrition; outcomes; randomized trial.

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Conflict of interest statement

Disclosure The Institution of PS has previously received unrestricted grant money unrelated to this project from Nestlé Health Science and Abbott Nutrition. The institution of ZS received speaking honoraria and research support from Nestlé Health Science, Abbott Nutrition and Fresenius Kabi. All other authors have declared no conflicts of interest.

Comment in

Suboptimal nutritional support in cancer patients gets excellent results. Reply to the Letter to the Editor: 'Nutritional support during the hospital stay reduces mortality in patients with different types of cancers: secondary analysis of a prospective randomized trial' by L. Bargetzi et al.
Bozzetti F. Bozzetti F. Ann Oncol. 2021 Oct;32(10):1304-1305. doi: 10.1016/j.annonc.2021.06.021. Epub 2021 Jun 26. Ann Oncol. 2021. PMID: 34186198 No abstract available.
What is optimal nutritional support in acutely ill cancer patients? More may not be better.
Bargetzi L, Laviano A, Stanga Z, Schuetz P. Bargetzi L, et al. Ann Oncol. 2021 Oct;32(10):1305-1306. doi: 10.1016/j.annonc.2021.06.025. Epub 2021 Jul 2. Ann Oncol. 2021. PMID: 34217804 No abstract available.
Important news on nutritional support in cancer patients - but some EFFORT is still ahead: Referring to Bargetzi et al., 'Nutritional support during hospital stay reduces mortality in patients with different types of cancer: a secondary analysis of a prospective randomized trial'.
Arends J, Roeland EJ, Baracos VE. Arends J, et al. Ann Oncol. 2021 Aug;32(8):954-956. doi: 10.1016/j.annonc.2021.06.020. Ann Oncol. 2021. PMID: 34272040 No abstract available.
Inflammation reduces the effect of nutritional therapy on clinical outcomes in cancer patients.
Bargetzi L, Bargetzi M, Laviano A, Stanga Z, Schuetz P. Bargetzi L, et al. Ann Oncol. 2021 Nov;32(11):1451-1452. doi: 10.1016/j.annonc.2021.08.1989. Epub 2021 Aug 21. Ann Oncol. 2021. PMID: 34428510 No abstract available.

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Nutritional support during the hospital stay reduces mortality in patients with different types of cancers: secondary analysis of a prospective randomized trial

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Nutritional support during the hospital stay reduces mortality in patients with different types of cancers: secondary analysis of a prospective randomized trial

Authors

Affiliations

Abstract

Conflict of interest statement

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