Nutrition and Cancer: An Epidemiological Study in France. Focus in Hematology.
Authors: Michallet Mauricette , Beauvillain Claude , Goldwasser François , Hébuterne Xavier , Lemarié François , Chambrier Cécile , Nicolini Franck E. 
Published: October 2019

An epidemiological study was performed over a single day in France in 28 centers in 24 distinct cities, with, as a primary endpoint, an overview of the nutritional status and nutritional care of cancer patients over 18. This study involved 2068 patients (879 female, 1189 male), 100 investigators and 86 clinical departments, including hematology departments with 419 patients corresponding to 21% of the studied population either hospitalized or ambulatory. Among the total population for patients aged from 18 to 74 and patients over 75 years old, the body mass index (BMI) was 18.5 for 12.2% and 25.9% of cases, 18.5–25 for 50.7% and 36.4%, ≥25 for 37.2% and 37.7%. Weight loss since diagnosis of the malignant disease was between 0 and 5% for 33% of cases, 5 to 10% for 19%, 10 to 15% for 13%, 15 to 20% for 9%, > 20% for 10%. The nutrition risk index (NRI) was <83.5 for 22.5% of cases implying high risk of complications during hospitalization, between 83.5 and 97.5 for 37.3% with moderate complication risk and > 97.5 for 40.2% with no risk of complications. Among 1903 patients evaluated, 39% of patients presented severe malnutrition estimated by a BMI ≤18.5 (18–74 years) / BMI ≤21 (≥75 years) or a weight loss ≥10% of initial weight before hematological malignancy diagnosis. When we considered the performans status (PS), there was a correlation between PS and malnutrition with 14% of malnourished patients for PS 0 (n=388), 31.4% for PS 1 (n=560), 52.3% for PS 2 (n=451), 54.6% for PS 3 (n=249) and 65.3% for PS 4 (n=124). Among 377 patients who presented a hematological malignancy, 1/3 of them (34%) presented severe malnutrition (37% for females and 32% for males), as measured by BMI+weight loss. The prevalence of malnutrition was particularly high in patients harboring lymphoid malignancies: 48% of ALL patients (n=31), 39% of B- and T-NHLs (n=108), 36% of myeloma patients (n=69), 44% of CLL patients (n=16) and 13% of Hodgkin’s disease patients (n=15). This is probably related to the addition of steroids in most of the standard chemotherapy treatments used in these malignancies that worsen the malnutrition already induced by the tumor. However, in myeloid malignancies severe malnutrition was observed in a quite large proportion of patients as well: 25% severe malnutrition of AML patients (n=118), and 11% for CML patients (n=9), and 55% (other, n=11). Among all the severely malnourished patients, 35.3% of patients did not receive any nutritional support and 34.1% were re-nourished (30.5% unknown). In the cancer patients harboring hematological malignancies (n=143) who received nutritional support, 25.9% had enteral nutrition, 39.9% parenteral nutrition, and 53.8% oral supplements with 65.2% compliance. This one-day epidemiological study points out that one third of the cancer patients harboring hematological malignancies present severe malnutrition that may favor infectious complications, impair the dose-intensity of chemo-radiotherapy, prolong intervals between chemotherapy courses, and alter the quality of life of patients. It underlines the absolute requirement for optimal nutrition care in these patients.