Prognostic Value of Dietary Intake and Inflammation on Survival in Patients With Advanced Cancer: Relationship With Performance Status, Pain, and Digestive Disorders

Abstract

Background: Malnutrition is common in patients with advanced cancer and associated with worse prognosis. Furthermore, these patients frequently suffer from digestive symptoms and pain. The aim of this study was to define short-term predictors of survival to help the development of an adequate nutritional care plan. Methods: Seventy-one patients (36 males and 35 females) (mean age, 68.7 ± 12.3 years) with advanced cancer entered the study. The following two groups of patients were defined: Group I (n = 34) was composed of patients who died within 3 mo, and Group II (n = 37) included patients who were alive by the end of the study. Nutritional status by means of anthropometric variables and serum proteins were assessed on Day 0 and 1 mo later. Dietary intake, performance status, pain, and digestive symptoms were recorded on admission and, thereafter, weekly during 1 mo. Results: The two groups did not differ in terms of age, sex, tumor distribution, weight loss, anthropometric variables, pain score, and digestive symptoms. On the other hand, Group I had lower energy intake (964 ± 101 vs 1,667 ± 85 kcal/day, P < 0.001), albumin and transthyretin levels (respectively, 29.2 ± 0.9 vs 34.9 ± 0.6 and 0.15 ± 0.01 vs 0.24 ± 0.02 g/l, P < 0.001) and a higher score indicating a poorer performance status (P < 0.001), higher Prognostic Inflammatory and Nutritional Index (PINI) (88.8 ± 23.4 vs 12.6 ± 12.6 ± 4.4, P < 0.01), serum C-reactive protein (98 ± 17 vs 33 ± 7 mg/l, P < 0.001), and orosomucoid (1.92 ± 0.09 vs 1.46 ± 0.08 g/l, P < 0.001) levels throughout the study period. Energy intake correlated negatively with performance status (P < 0.001) and pain scores (P < 0.01) and PINI (P < 0.01). Energy intake < 660 kcal/day and PINI > 66, which are mean value ± 2 SD in Group II, had 97% specificity to predict death. Conclusion: Three factors affected prognosis, i.e., inflammation, performance status, and energy intake. The latter two may benefit from amelioration of pain and digestive symptoms. PINI and energy intake may provide indication to identify patients close to death from those who could receive a nutritional support and active palliative therapy.