Nutrition support improves patient outcomes, treatment tolerance and admission characteristics in oesophageal cancer

Aims: Patients with oesophageal cancer undergoing chemoradiation with curative intent are at high risk of malnutrition and its complications, including increased side effects of treatment. We have developed a nutrition pathway (NP), involving the early then periodic nutrition assessment of all patients presenting to the multidisciplinary oesophageal clinic who were planned to receive definitive chemoradiation. Materials and methods: Patients were assessed as at 'low', 'moderate' or 'severe' nutrition risk, and were provided with appropriate nutrition intervention ranging from preventative advice (low risk), oral nutrition support (moderate risk) to enteral feeding (severe risk). Outcomes for 24 patients treated before implementation of the NP were compared with those of 24 patients treated using the NP. Results: Patients managed using the NP experienced less weight loss (mean weight change -4.2 kg +/- 6.4 cf. -8.9 kg +/- 5.9, P = 0,03), greater radiotherapy completion rates (92% cf 50%, P = 0.001), fewer patients had an unplanned hospital admission (46% cf 75%, P = 0.04), and those that did had a shorter length of stay (3.2 days +/- 5.4 cf 13.5 days +/- 14.1, P = 0.002). Conclusion: Early and regular nutrition assessment/intervention and a multidisciplinary approach to nutrition care results in improved treatment tolerance for patients with oesophageal cancer receiving chemoradiation.