Are gastrointestinal problems, nutritional care, and nutritional care needs associated with quality of life in patients with advanced cancer? Results of the observational eQuiPe study.

PURPOSE: To assess the association of gastrointestinal problems, received nutritional care, and nutritional care needs with quality of life (QoL) in patients with advanced cancer. METHODS: A cross-sectional analysis within the observational prospective eQuiPe cohort study on experienced quality of care and QoL in patients with advanced cancer was performed. QoL and gastrointestinal problems were measured using the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ)-C30. Received nutritional care (yes/no) and nutritional care needs (yes/a little bit/no) were measured by two questions. Gastrointestinal problems were categorized as clinically important based on the Giesinger thresholds. Univariable and multivariable linear regression analyses adjusted for age, gender, and treatment were used to analyze the association of gastrointestinal problems, received nutritional care, and nutritional care needs with QoL. RESULTS: Half of the 1080 patients with advanced cancer had clinically important gastrointestinal problems, 17% experienced nutritional care needs, and 14% received nutritional care. Multivariable analyses revealed that the presence of clinically important gastrointestinal problems (ß (95% CI): -13.0 (-15.6; -10.4)), received nutritional care (ß (95% CI): -5.1 (-8.5; -1.7)), and nutritional care needs (ß (95% CI): -8.7 (-11.9; -5.5)) were associated with a low QoL. CONCLUSION: Many patients with advanced cancer experience gastrointestinal problems, while only few patients receive nutritional care. These gastrointestinal problems, nutritional care needs, and nutritional care are associated with lower QoL, probably due to reversed causality or the irreversible nature of these problems in the palliative phase. More research on the relation of nutritional care, gastrointestinal problems, and QoL is needed to optimize nutritional support in end-of-life care.

[Unintentional weight loss]. / Onbedoeld gewichtsverlies.

In this article we describe the causes and diagnostic work-up of unintentional weight loss. It is defined as loss of weight of at least 5% in 6 months. There is both attention to somatic and functional causes of weight loss, as well as iatrogenic causes like side-effects of medication. Referrals to medical specialists for diagnostics are discussed and also the role of dieticians in screening and treatment. Special attention is given to weight loss by malabsorption. Although malignancies as a reason of weight loss is rare in primary care, in secondary care it may be present up to 30%. Treatment of unintentional weight loss may be necessary by high caloric dietary foods when functional decline is obvious, although there is hardly indication for prescribed medication, guidelines for treatment is given.