Malnutrition Is Perceived Differently By Patients, Relatives and Physicians In Routine Hematology Practice. Subgroup Analysis Of The French Cross-Sectional Nutricancer 2012 Survey
Authors: Gyan Emmanuel , Raynard Bruno , Saint Guily Jean Lacau , Goldwasser François , Hebuterne Xavier 
Published: October 2019

Abstract

Background
Malnutrition is a critical condition in patients with cancer, since impaired nutritional status may be associated with worse outcomes. The NutriCancer 2005 survey had shown a prevalence of malnutrition of 39% among oncology patients and of 34% among patients treated for hematologic malignancies, with 51.3% of haematology patients receiving nutritional support.

Aims
The objective of the Nutricancer 2012 study was to compare the perception of malnutrition between patients, relatives and physicians in oncology practice. The purpose of this substudy is to focus on patients treated for hematologic malignancies.

Methods
A one-day cross-sectional survey was conducted in 30 French hospitals, treating adult in- or outpatient patients diagnosed with cancer. Malnutrition was defined as (i) weight loss equal to or above 5 kg during one month or 10 kg during 6 months, (ii) Body Mass Index (BMI) ≤18.5 under 70 years of age or ≤ 21.5 above 70 years, (iii) albuminemia strictly under 35 g/L and/or (iv) Mini Nutritional Assessment (MNA) ≤ 17. Patients, relatives and physicians filled specific questionnaires collecting weight, albuminemia, food intakes, functional capacity and nutritional support. Malnutrition evaluation by the three groups was compared to the standard definition. Additional evaluations was compared between groups. This study was approved by the competent authority (Comité consultatif sur le traitement de l'information en matière de recherche).

Results
For all cancer patients, 2197 questionnaires were filled by 193 physicians, 94% of patients and 44% of relatives filled the questionnaires. The overall prevalence of malnutrition was 39%, with a closest estimation by physicians (44%) than patients themselves (24%, p<0.05). 213 patients followed for hematological malignancies were identified, most of them (71%) being hospitalized in hematology wards. The diagnoses were NHL (45%), AML (24%), multiple myeloma (15%), ALL (9%), Hodgkin’s lymphoma (6%) and Waldenström’s macroglobulinemia (1%), with a median age of 62 years. 63% of patients were receiving their first line of treatment, which was chemotherapy in 83% of cases. The prevalence of malnutrition according to the standard definition was 46%. Physicians identified malnutrition in 35% of cases, patients in 18% and relatives in 14%. Sensitivity of the detection of malnutrition by physicians was 55% and specificity 81%. Most notably, physicians detected weight loss and less often than patients (p<0.05) and would overestimate the food intake compared to patient evaluation (p< 0.05). Nutritional counseling was provided to 72% of patients according to responding patients, and 28% according to relatives, whereas nutritional interventions were acknowledged by 38% and 33% according to patients relatives, respectively. Most nutritional interventions were oral nutrition complements (87% according to patients and 61% according to relatives, p<0.05). Among patients declaring no nutritional intervention, 33% were diagnosed with malnutrition.

Conclusions
Malnutrition detected by physicians has a low sensitivity. The perception of malnutrition and nutritional interventions between physicians, patients and relatives is different. Cooperation between physicians, patients and relatives in the management of malnutrition is advisable to further optimize nutritional support.

Disclosures:
Gyan: FRESENIUS KABI: Consultancy, Research Funding. Raynard:FRESENIUS KABI: Consultancy. Lacau Saint Guily:FRESENIUS KABI: Consultancy. Goldwasser:FRESENIUS KABI: Consultancy. Hebuterne:FRESENIUS KABI: Consultancy.