Nutritional intervention during a teleprehabilitation pilot study in high-risk patients with colorectal cancer: adherence, motivators, and barriers.

PURPOSE: The preoperative period provides a window of opportunity to improve modifiable risk factors for treatment complications such as malnutrition, the so-called prehabilitation. Identifying factors related to adherence to nutritional interventions is essential for optimizing prehabilitation programs. The aim of this study is to evaluate a nutritional support module as part of a teleprehabilitation program in high-risk patients with colorectal cancer (CRC). METHODS: A secondary analysis with a mixed method design of the nutritional support module of a pre-post teleprehabilitation pilot study was performed. Change in weight, complaints with intake, motivation, and subjective and objective adherence were evaluated. RESULTS: Eleven patients were included. Subjectively, six patients (55%) were able to adhere to the nutritional advice. Despite that, nine of eleven (82%) patients experienced difficulties with the amount of food that was advised by the dietician. Six of eleven (55%) patients gained weight during the prehabilitation program. After prehabilitation, nine of eleven (82%) were able to reach 100% of their energy requirement and six of eleven (55%) were able to reach 100% of their protein requirement. Differences between patients in motivation and/or having complaints did not seem to be associated with protein and energy intake. CONCLUSION: This secondary analysis of a pilot study provides insights into understanding patients' experiences with a nutritional support module as part of a teleprehabilitation program. With 82% of patients who were able to reach 100% of their energy requirement, teleprehabilitation seems to be feasible, while there is still room for improvement with respect to protein intake as only 55% of patients reached a sufficient intake.

Associations between pretreatment nutritional assessments and treatment complications in patients with stage I-III non-small cell lung cancer: A systematic review.

BACKGROUND: Patients with stage I-III non-small cell lung cancer (NSCLC) are often nutritionally depleted and therefore at high-risk for treatment complications. Identifying these patients before the start of treatment is important to initiate preventive interventions for better treatment outcomes. This study aimed to evaluate which outcome variables of pretreatment nutritional assessments are associated with posttreatment complications in patients with stage I-III NSCLC, as well as to identify cut-off values for clinical risk stratification. METHODS: In this systematic review, PubMed, Embase, and Cinahl databases were searched for eligible studies published up to March 2021. Studies describing the association between pretreatment nutritional assessment and treatment complications in patients with NSCLC were included. Methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale for cohort studies. RESULTS: A total of 23 studies were included, which merely focused on surgical treatment for NSCLC. Methodological quality was poor in thirteen studies (57%). Poor outcomes of body mass index, sarcopenia, serum albumin, controlling nutritional status, prognostic nutrition index, nutrition risk score, and (geriatric) nutrition risk index were associated with a higher risk for treatment complications. Cut-off values for pretreatment nutritional assessment were reported in a limited number of studies and were inconsistent. CONCLUSION: Poor outcomes of pretreatment nutritional assessments are associated with a higher risk for posttreatment complications. Further research is needed on the ability of easy-to-use pretreatment nutritional assessments to accurately identify patients who are at high risk for treatment complications, as high-risk patients may benefit from pretreatment interventions to improve their nutritional status.

Associations between the Geriatric-8 and 4-meter gait speed test and subsequent delivery of adjuvant chemotherapy in older patients with colon cancer.

OBJECTIVES: Feasible screening methods are important to identify older patients who might benefit from adjuvant chemotherapy. The aim of this study was to investigate the associations between the outcomes of screening for frailty with the Geriatric-8 questionnaire (G8) and the 4-meter gait speed test (4MGST) and subsequent delivery of adjuvant chemotherapy and treatment tolerance in older patients with colon cancer. MATERIAL AND METHODS: This retrospective multicentre study included all patients aged ≥70 with primary colon carcinoma who underwent elective surgery between May 2016 and December 2018 and for whom adjuvant chemotherapy was indicated. Data were analysed using multivariate regression models. RESULTS: 97 (73.5%) of 132 eligible patients were screened by the G8 and 85 (64.4%) by the 4MGST. In univariate analyses, patients who scored indicative for frailty on both the G8 (≤14) and the 4MGST (>4 s) significantly more often did not proceed with adjuvant chemotherapy than patients who scored fit on both instruments (OR = 5.10, p = 0.01). After adjustment for gender, stage, and postoperative complications, the OR decreased to 4.22 (p = 0.04). Tolerance of treatment was very high (93%) and did not differ between screening groups. CONCLUSION: Although patients who scored indicative for frailty on both the G8 and the 4MGST significantly more often did not proceed with adjuvant chemotherapy, it is still unknown whether the G8 and the 4MGST are reliable tools for identifying patients who are at high risk for severe chemotoxicity. Nonetheless, this study shows that current selection for adjuvant chemotherapy among older patients with colon cancer is safe with low rates of severe chemotoxicity.