NutriCancer: A French observational multicentre cross-sectional study of malnutrition in elderly patients with cancer

doi:10.1016/j.jgo.2017.08.003

Journal of Geriatric Oncology

Volume 9, Issue 1, January 2018, Pages 74-80

https://doi.org/10.1016/j.jgo.2017.08.003 Get rights and content

Abstract

Objectives

To compare the prevalence of malnutrition and nutritional management between elderly (≥ 70 years old) and younger patients (< 70 years) with cancer.

Patients and Methods

This is a post-hoc analysis of NutriCancer 2012 study; a one-day cross-sectional nationwide survey conducted to assess malnutrition in adult patients with cancer in France. Patients diagnosed with cancer at the study date in both inpatient and outpatient settings were included. Data collection was performed by means of questionnaires completed by the physician, the patient and the caregiver.

Results

This post-hoc analysis compared 578 elderly patients (27.6%) vs. 1517 younger patients (72.4%). There were significant differences in cancer localization between the groups particularly in gastrointestinal cancer (27% in younger patients vs. 42% in elderly), breast cancer (17% vs 8% in elderly) and oropharyngeal (15% vs. 9% in elderly). Weight loss was significantly more reported in the elderly than in younger patients (73.6% vs. 67.6%, p = 0.009). Elderly patients were more frequently malnourished than younger patients (44.9% vs. 36.7%, p = 0.0006). Food intake was comparable between the groups; however, physicians overestimated the food intake, particularly in the elderly. The malnutrition management was more frequently proposed in elderly, as dietary advice and oral nutritional supplements, than in younger patients; however, enteral nutrition was significantly less undertaken in the elderly.

Conclusion

Malnutrition is prevalent in elderly patients with cancer, and more frequent than in younger patients. There is a need for an early integration of the nutritional counselling in patients with cancer, and particularly in the elderly.

Introduction

Ageing is one of the ultimate social and economic challenges of the 21st century for European countries. By 2025, more than 20% of Europeans will be 65 years or older. Although malignant diseases occur at all ages, the elderly represents more than 40% of patients with cancer [1]; 71% of cancer deaths occur in this age group [2].

Because of the rapidly growing elderly population and the steady increase in cancer incidence with advancing age, the management of elderly patients with cancer, aged 70 years and older, has become a major public health issue. This population is subject to frequent comorbidities and associated polypharmacy, as well as nutritional concerns. Nutritional status is now established as a strong independent predictor of mortality and morbidity, as well as reduced chemotherapy exposure and increased therapy-related toxicities in patients with cancer [3], [4], [5], [6]. Up to 10% of patients with terminal cancer die ultimately from progressive cachexia [7]. Malnutrition in elderly patients with cancer may result from dysphagia and metabolism changes. Beside cachexia, side effects and acute toxicities of anticancer therapies may further exacerbate the nutritional deterioration [8], [9].

In France, diagnosis and management of malnutrition in elderly is one of the main concerns of the health authorities. Clinical practice guidelines for diagnosis and management of elderly patients who are malnourished or at risk of malnutrition were developed [10], [11].

The NutriCancer 2012 study was a one-day cross-sectional epidemiological nationwide survey conducted to assess malnutrition in adult patients with cancer in France [12]. The aim of the current post-hoc analysis is to present a comparison between two groups of patients with cancer: ≥ 70 years (elderly) and < 70 years old, particularly in terms of prevalence of malnutrition and nutritional management.

Section snippets

Study Design

This is a post-hoc analysis of NutriCaner 2012 study, focusing on the malnutrition in the elderly. The NutriCancer 2012 study was carried out simultaneously in 30 participating centres, and included 2197 patients over one day on October 9, 2012. Participating centres included private practice, medical oncology departments, radiotherapy services and other specialized services (i.e.: otorhinolaryngology, haematology, pulmonary, gastroenterology). The primary objective of the present analysis was

Results

On October 9, 2012, among the 2197 eligible patients consecutively included in the study, the age was missing for 102 patients. In consequence, this post-hoc analysis compared 578 patients (27.6%) aged 70 years or older vs. 1517 patients (72.4%) aged less than 70 years.

Discussion

The present survey is one of the largest one-day studies addressing the differences between the elderly and younger patients with cancer, in terms of prevalence of malnutrition, nutritional management in real-life settings, and patient and physician perceptions of nutritional interventions. The focus of this analysis is the elderly patients with cancer.

This one-day study showed that elderly patients with cancer represented 27.6% of the population diagnosed with cancer. These results are

Disclosures and Conflict of Interest Statements

Jean Lacau St Guily, Bruno Raynard, Emmanuel Gyan, François Goldwasser, And Xavier Hebuterne received honoraria from Fresenius Kabi France as members of the NutriCancer2012 advisory board and as speakers in workshops; Éric Bouvard received honoraria from Fresenius Kabi France as members of the NutriCancer2012 advisory board; Jean Lacau St Guily was also paid for his participation as an investigator in this work. The other authors were paid for their participation as investigators in this work

Author Contributions

Study Concepts: JL St Guily, B Raynard, F Goldwasser, E Gyan, X Hebuterne

Study Design: JL St Guily, B Raynard, F Goldwasser, E Gyan, X Hebuterne

Data Acquisition: JL St Guily, B Maget, A Prevost, D Seguy, O Romano, B Narciso, C Couet, JM Balon, D Vansteene, S Salas, P Grandval

Quality Control of Data and Algorithms: JL St Guily, É Bouvard, B Raynard

Data Analysis and Interpretation: JL St Guily, É Bouvard, B Raynard

Statistical Analysis: JL St Guily, É Bouvard, B Raynard

Manuscript Preparation: JL

Funding

This work was supported by Fresenius-Kabi France.

Acknowledgements

The authors would like to thank all of the study investigators at the sites participating in this trial, and NutriCancer investigator group.

The authors wish to thank Doctor Claude Yvon, Medical Affairs Director Fresenius-Kabi, for her assistance in preparing this manuscript.

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NutriCancer: A French observational multicentre cross-sectional study of malnutrition in elderly patients with cancer

Abstract

Objectives

Patients and Methods

Results

Conclusion

Introduction

Section snippets

Study Design

Results

Discussion

Disclosures and Conflict of Interest Statements

Author Contributions

Funding

Acknowledgements

J Nutr

Ann Oncol

Eur J Cancer

Surg Clin North Am

Clin Nutr

Clin Nutr

Crit Rev Oncol Hematol

J Geriatr Oncol

Am J Clin Nutr

Nutrition

Clin Nutr

Nutrition

Recent trends in incidence of five common cancers in 26 European countries since 1988: analysis of the European Cancer Observatory

Eur J Cancer

Population aging and cancer: a cross-national concern

Cancer J