Malnutrition prevalence in cancer patients in Belgium: The ONCOCARE study.

RATIONALE: Unintentional weight loss and malnutrition are common among cancer patients. Malnutrition has been associated with impaired health-related quality of life, less well-tolerated chemotherapy regimens and shorter life duration. In Belgium there is a lack of epidemiological data on malnutrition in oncology patients at advanced stages of the disease. METHODS: Malnutrition assessment data was collected through a prospective, observational study in 328 patients who started a neoadjuvant anticancer therapy regimen or who started 1st, 2nd or 3rd line anticancer therapy for a metastatic cancer via 3 visits according to regular clinical practice (baseline visit (BV) maximum 4 weeks before start therapy, 1st Follow up visit (FUV1) ± 6 weeks after start therapy, FUV2 ± 4 months after start therapy). Malnutrition screening was evaluated using the Nutritional Risk Screening score 2002 (NRS-2002)and the diagnosis of malnutrition by the GLIM criteria. In addition, SARC-F questionnaire and Fearon criteria were used respectively to screen for sarcopenia and cachexia. RESULTS: Prevalence of malnutrition risk at BV was high: 54.5% of the patients had a NRS ≥ 3 (NRS 2002) and increased during the study period (FUV1: 73.2%, FUV2: 70.1%). Prevalence of malnutrition based on physician subjective assessment (PSA) remained stable over the study period but was much lower compared to NRS results (14.0%-16.5%). At BV, only 10% of the patients got a nutrition plan and 43.9% received ≤ 70% of nutritional needs, percentage increased during FU period (FUV1: 68.4%, FUV2: 67.6%). Prevalence of sarcopenia and cachexia were respectively 12.4% and 38.1% at BV and without significant variation during the study period, but higher than assessed by PSA (11.6% and 6.7% respectively). Figures were also higher compared to PSA. There were modifications in cancer treatment at FUV1 (25.2%) and at FUV2 (50.8%). The main reasons for these modifications at FUV1 were adverse events and tolerability. Patient reported daily questionnaires of food intake showed early nutritional deficits, preceding clinical signs of malnutrition, and therefore can be very useful in the ambulatory setting. CONCLUSIONS: Prevalence of malnutrition and cachexia was high in advanced cancer patients and underestimated by physician assessment. Earlier and rigorous detection of nutritional deficit and adjusted nutritional intake could lead to improved clinical outcomes in cancer patients. Reporting of daily caloric intake by patients was also very helpful with regards to nutritional assessment.

Stewart-Treves syndrome in an older woman successfully treated by metronomic chemotherapy: case report and literature survey.

The authors present the case of a 94-year-old woman suffering from a right arm angiosarcoma developed after primary breast cancer and treated with success by oral metronomic chemotherapy based on daily low doses of cyclophosphamide and prednisone. The case description is followed by a short review of actual knowledge on the subject.

Interest for a Systematic Rehabilitation Program Including Physical Exercise and Lifestyle Accompaniment for Women Recently Treated for Early Breast Cancer: A Comparative Study.

BACKGROUND/AIM: A prospective non-randomized study was performed on 68 women who had recently undergone curative treatment (surgery +/- adjuvant radio/chemotherapy) for breast cancer. PATIENTS AND METHODS: Patients were distributed into 2 subgroups, control (C) group (n=21) and experimental (E) group (n=47). The last group participated in a 12-week rehabilitation program associating physical activity and psychoeducational workshops, including management of stress, diet, and sleep disorders. RESULTS: Despite the initial imbalance between the groups (patients from C group were older and had received less chemotherapy than those from the E group), at the end of the rehabilitation program, we observed a significant improvement in global health feeling and in objective physical tests (distance covered in 6 min and objective measures of ergospirometry), and a decrease in pathological fatigue, while these different items remained quite stable over time in the control group. CONCLUSION: It is suggested to recommend structured rehabilitation to any patient who does not have a contraindication to it. In addition, the scientific literature encourages us to extend the spectrum of oncological rehabilitation to pathologies other than breast cancer.