High Prevalence and Clinical Impact of Malnutrition in Older Patients with a Hematological Malignancy—Basis for Patient Orientated Guidelines and Healthcare Interventions

Intro Malnutrition represents a frequent problem in cancer patients. However, data on the prevalence and the clinical impact of malnutrition in older patients with hematological malignancies are so far rare.

Objectives Objective of this study was to investigate prospectively the nutritional status at baseline in older patients with blood cancer and to analyze the impact of malnutrition on clinical performance and outcome. Goal was to form a rational basis for interventions and practice guidelines in this continuously growing group of patients.

Methods In 149 newly diagnosed patients with a hematological malignancy aged ≥ 70 years from the Department of Internal Medicine V (Haematology and Oncology), Innsbruck Medical University, different nutritional parameters including loss of appetite, recent weight loss, Mini Nutritional Assessment (MNA), body mass index, serum albumin and the inflammation marker C-reactive protein (CRP) were assessed and compared with status in multidimensional geriatric assessment and with overall survival (OS). SPSS (IBM Corporation, Armonk, NY, USA) was used for all statistical analyses. Two-year overall survival was analyzed with Kaplan-Meier methods and the log rank test. Hazard ratios were first analyzed in a univariate Cox proportional hazard regression. Parameters statistically significant in the univariate analyses were then included in the multivariate Cox regressions, additionally assessing the significance of the parameters with a bootstrapped model. Canoco 5.10 was used for principal component analyses (PCA).

Results A moderate or severe decrease of appetite was reported by 23 % and 40% of patients. Moreover, a recent weight loss of 1-3 or >3kg was present in 19 and 31% and a BMI <23kg/m2 was found in 29% of patients. Based on MNA-evaluation, 44% revealed a risk of malnutrition and 14% of manifest malnutrition. Prevalence of lowered serum albumin <3.5 g/dL was detected in 14% of patients. Geriatric impairments >3 were detected in about one third of the patients (36%). PCA demonstrated clustering of impairments in performance status and in IADL as well as of low appetite, low serum albumin, fatigue and depression in the first principal component accounting for a variability of 24%. Loss of appetite, recent weight loss, impaired MNA, low serum albumin and elevated CRP were significantly associated with shortened OS. Recent weight loss >3kg and low BMI remained significant predictive parameters for OS in a Cox regression analysis (HR: 2.01 (1.19-3.38), p=0.009 and HR: 2.46 (1.53-3.96), p<0.001, respectively).

Conclusion These analyses reveal malnutrition at initial diagnosis in a relevant proportion of older patients with a hematological malignancy. Importantly, impaired nutritional status is associated with shortened overall survival. The correlation between malnutrition, fatigue, impaired performance and functional capacities, and inflammation might suggest an underlying common pathway. Thus, assessment of nutritional status is essential in studies and in daily practice and forms the basis for interventions to improve nutritional status. More robust data on the clinical impact of malnutrition in hematological malignancies and the effect of geriatric interventions on essential oncologic and non-oncologic outcomes such as survival and quality of life are needed.