Multidisciplinary nutritional management improves nutritional and hospitalized outcomes of patients with esophageal cancer undergoing chemoradiotherapy: A randomized control trial

Medicine · 6 authors, 4 centres

AI SUMMARY

FIDELITY 84%

POPULATIONPatients aged 50–80 years with unresectable locally advanced esophageal cancer undergoing concurrent chemoradiotherapy, with nutritional risk (NRS-2002 score ≥ 3)

INTERVENTIONMultidisciplinary whole-course nutrition management by a nutrition support team (physicians, clinical dieticians, nutrition nurses, pharmacologists) with individualized nutrition plans targeting 30–35 kcal/kg/day and 1.2–1.5 g/kg/day protein

COMPARISONRoutine nutritional support provided by clinical tumor treatment physicians and patients' families (semiliquid/fluid diets, enteral nutrition preparations, or parenteral nutrition supplements)

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TL;DR

This randomized controlled trial of 36 patients with esophageal cancer undergoing chemoradiotherapy found that multidisciplinary whole-course nutrition management by a nutrition support team helped maintain serum albumin and hemoglobin levels and prevented a rise in C-reactive protein, whereas the control group receiving routine support experienced significant declines. The intervention group had a significantly lower incidence of grade ≥ II lymphocytopenia (16.7% vs 50.0%), shorter hospital stays (median 35 vs 47 days), and lower in-patient expenses (median 37,615 vs 58,119 CNY). These findings suggest that structured, multidisciplinary nutritional care can improve both nutritional and hospitalization outcomes in this patient population.

Full summary

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**Background:** Esophageal cancer (EC) is the 8th most common malignancy and 6th leading cause of cancer-related mortality worldwide. For patients with unresectable locally advanced EC, chemoradiotherapy (CRT) is the preferred treatment. However, at least 60% of EC patients suffer from malnutrition due to CRT side effects (odynophagia, esophageal narrowing, anorexia, vomiting), which reduces treatment tolerance, causes treatment interruptions, prolongs hospital stays, and worsens quality of life. While the European Society of Parenteral and Enteral Nutrition recommends multidisciplinary nutrition support teams (NST), high-grade evidence for such interventions in the CRT setting for EC is limited in China.

**Methods:** This randomized controlled trial was conducted at Nanjing Drum Tower Hospital (Nanjing, China) between October 2020 and July 2021. Inclusion criteria: patients aged 50–80 years with pathologically confirmed EC, no prior antitumor therapy or distant metastases, measurable target lesions, no severe cardiac/liver/kidney dysfunction, and NRS-2002 score ≥ 3. Exclusion criteria: CRT before/after surgery, unconsciousness, other malignancies, mental disorders, liver/kidney dysfunction, systemic infectious diseases, or enteral/parenteral nutrition intolerance. Of 67 initially enrolled patients, 14 were excluded, and 53 were randomized 1:1. Ultimately, 36 patients completed the trial (18 per group) after 17 dropped out (financial difficulties, CRT side effects, transfer to other hospitals). The chemotherapy regimen was weekly cisplatin + paclitaxel or cisplatin + 5-fluorouracil; radiotherapy was 2 Gy/day, 5 times/week, DT 50–60 Gy/5–8 weeks. The control group received routine nutritional support from physicians and families. The intervention group received whole-course management by an NST (physicians, clinical dieticians, nutrition nurses, pharmacologists) with individualized plans targeting 30–35 kcal/kg/day and 1.2–1.5 g/kg/day protein, using oral supplements, tube feeding, PEG, or parenteral nutrition as needed. Nutrition-related indicators (ALB, Hb, CRP) were assessed before, during, and after treatment. Complications, tumor response (RECIST criteria), length of stay, and hospital costs were recorded. Non-normally distributed continuous variables were expressed as medians (25th, 75th percentiles) and compared using Mann–Whitney U tests; categorical variables used chi-square tests.

**Key Results:** Baseline characteristics were similar between groups except for lower BMI in the intervention group (median 20.8 vs 22.7 kg/m², P = 0.02). In the control group, ALB decreased significantly from baseline [−2.6 (−5.6, 0) g/L, P = 0.01], Hb decreased [−12.0 (−27.0, −2.0) g/L, P = 0.04], and CRP increased [8.9 (2.9, 14.9) mg/L, P = 0.02]. In the intervention group, none of these indicators changed significantly (ALB: −0.9 (−2.3, 1.2), P = 0.21; Hb: −5.0 (−19.0, 1.0), P = 0.09; CRP: 4.5 (−0.6, 9.6), P = 0.84). Between-group differences in changes from baseline were not statistically significant (ALB P = 0.07, Hb P = 0.28, CRP P = 0.25). The incidence of grade ≥ II lymphocytopenia was significantly lower in the intervention group (16.7% vs 50.0%, P = 0.03). No significant differences were found for nausea/vomiting, leukopenia, radiation esophagitis, or myelosuppression. Tumor response rates were similar (overall response rate 94.4% control vs 100% intervention, P = 0.37). The intervention group had significantly shorter median hospital stay [35 (23, 40) vs 47 (40, 50) days, P = 0.001] and lower median hospital charges [37,615 (35,147, 54,123) vs 58,119 (46,414, 77,262) CNY, P = 0.004].

**Clinical Implications:** Multidisciplinary whole-course nutrition management during CRT helps maintain nutritional status (stable ALB, Hb, CRP), reduces lymphocytopenia, shortens hospital stays by a median of 12 days, and reduces costs by approximately 20,504 CNY per patient. These findings support implementation of structured NST-led nutritional care for EC patients undergoing CRT. Limitations include small sample size (36 completers from 67 enrolled, 46.3% attrition), lack of sensitive nutritional biomarkers (prealbumin, transferrin), and no long-term follow-up for body composition or survival. Larger, longer-term RCTs are needed.

PICO

PPOPULATION

Patients aged 50–80 years with unresectable locally advanced esophageal cancer undergoing concurrent chemoradiotherapy, with nutritional risk (NRS-2002 score ≥ 3)

IINTERVENTION

Multidisciplinary whole-course nutrition management by a nutrition support team (physicians, clinical dieticians, nutrition nurses, pharmacologists) with individualized nutrition plans targeting 30–35 kcal/kg/day and 1.2–1.5 g/kg/day protein

OOUTCOME

Serum albumin, hemoglobin, C-reactive protein levels; incidence of complications (lymphocytopenia, nausea/vomiting, leukopenia, radiation esophagitis, myelosuppression); length of hospital stay; hospital expenses; tumor response

STUDY TYPE

RCT

SPECIALTY

oncology

SUMMARISED BY

AI pipeline

FIDELITY CHECK

84% · B

ORIGINAL PAPER

PMC10036000

Multidisciplinary nutritional management improves nutritional and hospitalized outcomes of patients with esophageal cancer undergoing chemoradiotherapy: A randomized control trial

Medicine

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ABSTRACT

Background: This study aimed to investigate the effects of multidisciplinary whole-course nutrition management on the nutritional status and complications during the course of treatment in patients with esophageal cancer (EC) undergoing chemoradiotherapy. Methods: A total of 36 EC patients undergoing chemoradiotherapy were divided into a control group (n = 18) and an intervention group (n = 18). Participants in the control group were given routine nutritional support, whereas those in the intervention group were provided whole-course nutrition management from the nutrition support team. Nutrition-related indicators, that is, serum albumin level (ALB), hemoglobin (Hb), and C reactive protein were assessed before, during, and after treatment in both groups. The incidence of complications (e.g., lymphocytopenia, radiation esophagitis, and myelosuppression), clinical outcomes, length of hospital stay, and hospital costs were also recorded. Differences between the 2 groups were tested using the Mann–Whitney U and chi-square tests. Results: The ALB and Hb levels of the patients in the control group decreased significantly [ALB: −2.6 (−5.6, 0), P = .01; Hb: −12.0 (−27.0, −2.0), P = .04] and C reactive protein increased [8.9 (2.9, 14.9), P = .02] compared to those before treatment, while the indicators of participants in the intervention group did not change ( P > .05). The incidence of grade ≥ II lymphocytopenia was higher in the control group than that in the intervention group (33.3% vs 61.1%, P = .03). Moreover, compared with the control group, the average length of hospital stay decreased by 12 days [47 (40, 50) vs 35 (23, 40), P = .001], and in-patient expenses decreased by 20,504 CNY in the intervention group ( P = .004). Conclusion: Multidisciplinary whole-course nutrition management can maintain the nutritional status of patients with EC undergoing chemoradiotherapy. This may lower the incidence of complications, shorten hospital stays, and reduce in-patient expenses. Keywords: chemoradiotherapy, esophageal neoplasms, nutrition support, nutritional status, treatment outcome

CITATION EXPORT

Shu-An Wang, Fuchao Li, Jiayu Zhu et al.. Multidisciplinary nutritional management improves nutritional and hospitalized outcomes of patients with esophageal cancer undergoing chemoradiotherapy: A randomized control trial. Medicine. (2023). https://doi.org/10.1097/MD.0000000000033335

AUTHORS

6 · 4 CENTRES

Shu-An Wang, Fuchao Li, Jiayu Zhu, Xiaotian Chen, Wei Ren, Bo Gao

a Department of Clinic Nutrition, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
b The Cadre Health Care Ward, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
c Zhangjiagang Gangcheng Rehabilitation Hospital, Zhangjiagang, Suzhou, Jiangsu, China
d The Comprehensive Cancer Center of Drum Tower Hospital, Medical School of Nanjing University & Clinical Cancer Institute of Nanjing University, Nanjing, Jiangsu, China.