ANN ARBOR, MI – Up to 80% of advanced cancer patients are suffering from malnutrition, although its presence and effects generally are determined by tumor type and stage, according to the National Cancer Institute.

Inadequate nutrition also has negative surgical and oncologic impacts, according to research available at the 2021 American Society of Clinical Oncology (ASCO) annual meeting.1

University of Michigan Health System-led researchers sought to study the effect of pre-op weight and albumin on postoperative complications in veterans with colorectal cancer (CRC) at a tertiary care VA hospital. The study team opted to use data from the VHA because it provides comprehensive care to patients in a single-payer system, making it easier to capture peri-operative data and to implement interventions to improve outcomes.

The retrospective review involved 105 patients with colorectal malignancies treated with curative intent surgery at the VA Ann Arbor Healthcare System between January 2015 and January 2020. Excluded were patients with distant metastatic disease, neoadjuvant therapy, non-adenocarcinoma histology, or those receiving majority of care outside of the VHA. At the time of CRC diagnosis, participants’ mean age was 70.3 ± 9.1 and the median stage was T2N0. Most of the patients had laparoscopic surgical resections.

Researchers examined body mass index (BMI) trends from one year prior to one year post-surgery, also assessing rates of nutrition consultations. The focus was on post-op complications, defined as abnormal clinical developments, including issues such as infection and delayed wound healing.

The study documented pre-op weight loss from six months prior to diagnosis to time of surgery in the majority, 64%, of patients, with 45% having significant weight loss, defined as 3% or more weight reduction.

Results also indicated that one-fourth of patients had low pre-op albumin of less than 3.5. That was important, according to the authors, because significant weight loss and low pre-op albumin were each independently associated with increased post-op complications (p < 0.01).

Weight loss after surgery was noted in 81% and 69% of patients at 30- and 60-days post-op, respectively, but did not appear to be associated with post-op complications.

While inpatient post-op nutrition consultation was performed in 96% of the study participants, researchers pointed out, only 23% were advised to take nutritional supplements. For patients with significant weight loss, pre-op nutrition evaluation was performed in 15% of cases and post-op outpatient nutrition follow up occurred in 18% of cases.

The authors emphasized that pre-op weight loss and low albumin levels contributed to a greater risk of post-operative complications, adding, “An intensive nutrition pre-habilitation program to address weight loss and low albumin prior to surgery for CRC is needed and may reduce associated complications.”

 

  1. Mitbander U, Frankel T, Dobrosotskaya IY. (June 4-8, 2021) Nutritional status and outcomes of veterans undergoing curative surgery for colorectal cancer. ASCO 2021 annual meeting. Virtual. https://meetinglibrary.asco.org/record/199415/abstract