title: Chemotherapy dose intensity predicted by baseline nutrition assessment in gastrointestinal malignancies: A multicentre analysis.
abstract: Malnutrition is prevalent in cancer patients and is associated with inferior outcomes. We examined the association between malnutrition, as measured by the Subjective Global Assessment (SGA), and chemotherapy dose reduction in patients with gastrointestinal malignancies. We hypothesised that malnutrition, defined by a patient's baseline SGA, would be associated with a greater degree of chemotherapy dose-reduction, with the implication of greater chemotherapy related toxicity.
  
  
  
  We reviewed chemotherapy dosing and treatment related toxicity for patients enrolled in a prospective Gastrointestinal Cancer Registry over their first 8 weeks of treatment. We compared results between well-nourished and malnourished patients.
  
  
  
  Malnourished patients were more likely than well-nourished patients to have their starting chemotherapy dose reduced from standard published dosing (67% versus 35%, p=0.0001). Despite attenuated initial dosing, malnourished patients received a smaller fraction of planned chemotherapy (mean 80±23% versus 90±15% of cycle 1, p=0.005), primarily due to toxicity-related dose reductions. After controlling for age, gender, Eastern Cooperative Oncology Group performance status (ECOG), albumin, smoking status, body habitus, and weight loss, malnutrition remained the strongest independent predictor of the magnitude of chemotherapy dose reduction (estimate -10.3%, 95% confidence interval -19.0 to -0.1.6%, p=0.020).
  
  
  
  Malnutrition is an independent predictor of chemotherapy dose-reduction for toxicity. This study highlights the practical significance of malnutrition in gastrointestinal malignancies and provides a baseline for future nutrition intervention studies to improve chemotherapy tolerability in malnourished patients.
authors.affiliation: Weill Cornell Medical College, Division of Hematology and Medical Oncology, 1305 York Ave, 7th Floor, New York, NY 10021, USA. Electronic address: kak9084@nyp.org.
authors.forename: Kelsey A
authors.initials: KA
authors.lastname: Klute
authors.affiliation: Weill Cornell Medical College, Division of Hematology and Medical Oncology, USA. Electronic address: jub2024@med.cornell.edu.
authors.forename: Julianna
authors.initials: J
authors.lastname: Brouwer
authors.affiliation: Englewood Hospital and Medical Center, 350 Engle Street, Englewood, NJ 07631, USA. Electronic address: jhawerm@gmail.com.
authors.forename: Minaxi
authors.initials: M
authors.lastname: Jhawer
authors.affiliation: Tufts University School of Dental Medicine (previously Weill Cornell Medical College, Division of Hematology and Medical Oncology), 1 Kneeland Street, Boston, MA 02111, USA. Electronic address: hayley.sachs@tufts.edu.
authors.forename: Hayley
authors.initials: H
authors.lastname: Sachs
authors.affiliation: Weill Cornell Medical College, Division of Hematology and Medical Oncology, 1305 York Avenue, 12th Floor, New York, NY 10021, USA. Electronic address: ang2045@med.cornell.edu.
authors.forename: Anatasia
authors.initials: A
authors.lastname: Gangadin
authors.affiliation: Weill Cornell Medical College, Division of Hematology and Medical Oncology, 1305 York Avenue, 12th Floor, New York, NY 10021, USA. Electronic address: ajo9001@med.cornell.edu.
authors.forename: Allyson
authors.initials: A
authors.lastname: Ocean
authors.affiliation: Weill Cornell Medical College, Division of Hematology and Medical Oncology, 1305 York Avenue, 12th Floor, New York, NY 10021, USA. Electronic address: ecp2006@med.cornell.edu.
authors.forename: Elizabeta
authors.initials: E
authors.lastname: Popa
authors.affiliation: Weill Cornell Medical College, Division of Hematology and Medical Oncology, 1305 York Avenue, 12th Floor, New York, NY 10021, USA. Electronic address: tod9013@med.cornell.edu.
authors.forename: Tong
authors.initials: T
authors.lastname: Dai
authors.affiliation: Weill Cornell Medical College, Division of Biostatistics and Epidemiology, 425 East 61st Street, New York, NY 10065, USA. Electronic address: guw2007@med.cornell.edu.
authors.forename: Guojiao
authors.initials: G
authors.lastname: Wu
authors.affiliation: Weill Cornell Medical College, Division of Biostatistics and Epidemiology, 402 East 67th Street, 10065, USA. Electronic address: pac2001@med.cornell.edu.
authors.forename: Paul
authors.initials: P
authors.lastname: Christos
authors.affiliation: Weill Cornell Medical College, Division of Hematology and Medical Oncology, 1305 York Avenue, 12th Floor, New York, NY 10021, USA. Electronic address: Mas9313@med.cornell.edu.
authors.forename: Manish A
authors.initials: MA
authors.lastname: Shah
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D015992:Body Mass Index; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D044342:Malnutrition / Q000175:diagnosis* / Q000209:etiology; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D015995:Prevalence; D011446:Prospective Studies; D012709:Serum Albumin / Q000032:analysis
chemical_list: D000970:Antineoplastic Agents; D012709:Serum Albumin
keywords: Chemotherapy toxicity; Gastrointestinal malignancy; Malnutrition