Impact of Clinical Markers of Nutritional Status and Feeding Jejunostomy Use on Outcomes in Esophageal Cancer Patients Undergoing Neoadjuvant Chemoradiotherapy
Background: Patients with esophageal cancer (EC) have high rates of malnutrition due to tumor location and treatment-related toxicity. Various strategies are used to improve nutritional status in patients with EC including oral and enteral support. Methods: We conducted a retrospective analysis to d...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2020-10-01
|
| Series: | Nutrients |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2072-6643/12/10/3177 |
| _version_ | 1797550639887155200 |
|---|---|
| author | Rishi Jain Talha Shaikh Jia-Llon Yee Cherry Au Crystal S. Denlinger Elizabeth Handorf Joshua E. Meyer Efrat Dotan |
| author_facet | Rishi Jain Talha Shaikh Jia-Llon Yee Cherry Au Crystal S. Denlinger Elizabeth Handorf Joshua E. Meyer Efrat Dotan |
| author_sort | Rishi Jain |
| collection | DOAJ |
| description | Background: Patients with esophageal cancer (EC) have high rates of malnutrition due to tumor location and treatment-related toxicity. Various strategies are used to improve nutritional status in patients with EC including oral and enteral support. Methods: We conducted a retrospective analysis to determine the impact of malnutrition and prophylactic feeding jejunostomy tube (FJT) placement on toxicity and outcomes in patients with localized EC who were treated with neoadjuvant chemoradiation therapy (nCRT) followed by esophagectomy. Results: We identified 125 patients who were treated with nCRT between 2002 and 2014. Weight loss and hypoalbuminemia occurred frequently during nCRT and were associated with multiple adverse toxicity outcomes including hematologic toxicity, nonhematologic toxicity, grade ≥3 toxicity, and hospitalizations. After adjusting for relevant covariates including the specific nCRT chemotherapy regimen received and the onset of toxicity, there were no significant associations between hypoalbuminemia, weight loss, or FJT placement and relapse-free survival (RFS) or overall survival (OS). FJT placement was associated with less weight loss during nCRT (<i>p</i> = 0.003) but was not associated with reduced toxicity or improved survival. Conclusions: Weight and albumin loss during nCRT for EC are important factors relating to treatment toxicity but not RFS or OS. While pretreatment FJT placement may reduce weight loss, it may not impact treatment tolerance or survival. |
| first_indexed | 2024-03-10T15:32:12Z |
| format | Article |
| id | doaj.art-1a5332832490424a930846168d935e2f |
| institution | Directory Open Access Journal |
| issn | 2072-6643 |
| language | English |
| last_indexed | 2024-03-10T15:32:12Z |
| publishDate | 2020-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Nutrients |
| spelling | doaj.art-1a5332832490424a930846168d935e2f2023-11-20T17:29:21ZengMDPI AGNutrients2072-66432020-10-011210317710.3390/nu12103177Impact of Clinical Markers of Nutritional Status and Feeding Jejunostomy Use on Outcomes in Esophageal Cancer Patients Undergoing Neoadjuvant ChemoradiotherapyRishi Jain0Talha Shaikh1Jia-Llon Yee2Cherry Au3Crystal S. Denlinger4Elizabeth Handorf5Joshua E. Meyer6Efrat Dotan7Fox Chase Cancer Center, Department of Hematology/Oncology, Philadelphia, PA 19111-2497, USAFox Chase Cancer Center, Department of Radiation Oncology, Philadelphia, PA 19111-2497, USAFox Chase Cancer Center, Department of Hematology/Oncology, Philadelphia, PA 19111-2497, USAFox Chase Cancer Center, Department of Hematology/Oncology, Philadelphia, PA 19111-2497, USAFox Chase Cancer Center, Department of Hematology/Oncology, Philadelphia, PA 19111-2497, USABiostatistics, Fox Chase Cancer Center, Philadelphia, PA 19111-2497, USAFox Chase Cancer Center, Department of Radiation Oncology, Philadelphia, PA 19111-2497, USAFox Chase Cancer Center, Department of Hematology/Oncology, Philadelphia, PA 19111-2497, USABackground: Patients with esophageal cancer (EC) have high rates of malnutrition due to tumor location and treatment-related toxicity. Various strategies are used to improve nutritional status in patients with EC including oral and enteral support. Methods: We conducted a retrospective analysis to determine the impact of malnutrition and prophylactic feeding jejunostomy tube (FJT) placement on toxicity and outcomes in patients with localized EC who were treated with neoadjuvant chemoradiation therapy (nCRT) followed by esophagectomy. Results: We identified 125 patients who were treated with nCRT between 2002 and 2014. Weight loss and hypoalbuminemia occurred frequently during nCRT and were associated with multiple adverse toxicity outcomes including hematologic toxicity, nonhematologic toxicity, grade ≥3 toxicity, and hospitalizations. After adjusting for relevant covariates including the specific nCRT chemotherapy regimen received and the onset of toxicity, there were no significant associations between hypoalbuminemia, weight loss, or FJT placement and relapse-free survival (RFS) or overall survival (OS). FJT placement was associated with less weight loss during nCRT (<i>p</i> = 0.003) but was not associated with reduced toxicity or improved survival. Conclusions: Weight and albumin loss during nCRT for EC are important factors relating to treatment toxicity but not RFS or OS. While pretreatment FJT placement may reduce weight loss, it may not impact treatment tolerance or survival.https://www.mdpi.com/2072-6643/12/10/3177nutritionesophageal cancerneoadjuvant chemoradiationenteral nutrition |
| spellingShingle | Rishi Jain Talha Shaikh Jia-Llon Yee Cherry Au Crystal S. Denlinger Elizabeth Handorf Joshua E. Meyer Efrat Dotan Impact of Clinical Markers of Nutritional Status and Feeding Jejunostomy Use on Outcomes in Esophageal Cancer Patients Undergoing Neoadjuvant Chemoradiotherapy Nutrients nutrition esophageal cancer neoadjuvant chemoradiation enteral nutrition |
| title | Impact of Clinical Markers of Nutritional Status and Feeding Jejunostomy Use on Outcomes in Esophageal Cancer Patients Undergoing Neoadjuvant Chemoradiotherapy |
| title_full | Impact of Clinical Markers of Nutritional Status and Feeding Jejunostomy Use on Outcomes in Esophageal Cancer Patients Undergoing Neoadjuvant Chemoradiotherapy |
| title_fullStr | Impact of Clinical Markers of Nutritional Status and Feeding Jejunostomy Use on Outcomes in Esophageal Cancer Patients Undergoing Neoadjuvant Chemoradiotherapy |
| title_full_unstemmed | Impact of Clinical Markers of Nutritional Status and Feeding Jejunostomy Use on Outcomes in Esophageal Cancer Patients Undergoing Neoadjuvant Chemoradiotherapy |
| title_short | Impact of Clinical Markers of Nutritional Status and Feeding Jejunostomy Use on Outcomes in Esophageal Cancer Patients Undergoing Neoadjuvant Chemoradiotherapy |
| title_sort | impact of clinical markers of nutritional status and feeding jejunostomy use on outcomes in esophageal cancer patients undergoing neoadjuvant chemoradiotherapy |
| topic | nutrition esophageal cancer neoadjuvant chemoradiation enteral nutrition |
| url | https://www.mdpi.com/2072-6643/12/10/3177 |
| work_keys_str_mv | AT rishijain impactofclinicalmarkersofnutritionalstatusandfeedingjejunostomyuseonoutcomesinesophagealcancerpatientsundergoingneoadjuvantchemoradiotherapy AT talhashaikh impactofclinicalmarkersofnutritionalstatusandfeedingjejunostomyuseonoutcomesinesophagealcancerpatientsundergoingneoadjuvantchemoradiotherapy AT jiallonyee impactofclinicalmarkersofnutritionalstatusandfeedingjejunostomyuseonoutcomesinesophagealcancerpatientsundergoingneoadjuvantchemoradiotherapy AT cherryau impactofclinicalmarkersofnutritionalstatusandfeedingjejunostomyuseonoutcomesinesophagealcancerpatientsundergoingneoadjuvantchemoradiotherapy AT crystalsdenlinger impactofclinicalmarkersofnutritionalstatusandfeedingjejunostomyuseonoutcomesinesophagealcancerpatientsundergoingneoadjuvantchemoradiotherapy AT elizabethhandorf impactofclinicalmarkersofnutritionalstatusandfeedingjejunostomyuseonoutcomesinesophagealcancerpatientsundergoingneoadjuvantchemoradiotherapy AT joshuaemeyer impactofclinicalmarkersofnutritionalstatusandfeedingjejunostomyuseonoutcomesinesophagealcancerpatientsundergoingneoadjuvantchemoradiotherapy AT efratdotan impactofclinicalmarkersofnutritionalstatusandfeedingjejunostomyuseonoutcomesinesophagealcancerpatientsundergoingneoadjuvantchemoradiotherapy |