Predictors of Pancreatic Cancer-Associated Weight Loss and Nutritional Interventions

Laura Nemer; Somashekar G. Krishna; Zarine K. Shah; Darwin L. Conwell; Zobeida Cruz-Monserrate; Mary Dillhoff; Denis C. Guttridge; Alice Hinton; Andrei Manilchuk; Timothy M. Pawlik; Carl R. Schmidt; Erin E. Talbert; Tanios Bekaii-Saab; Phil A. Hart

doi:10.1097/MPA.0000000000000898

Predictors of Pancreatic Cancer-Associated Weight Loss and Nutritional Interventions

Laura Nemer, Somashekar G. Krishna, Zarine K. Shah, Darwin L. Conwell, Zobeida Cruz-Monserrate, Mary Dillhoff, Denis C. Guttridge, Alice Hinton, Andrei Manilchuk, Timothy M. Pawlik, Carl R. Schmidt, Erin E. Talbert, Tanios Bekaii-Saab, Phil A. Hart

Internal Medicine

Research output: Contribution to journal › Article › peer-review

43 Scopus citations

Abstract

Objectives Pancreatic ductal adenocarcinoma (PDAC) is often accompanied by weight loss. We sought to characterize factors associated with weight loss and observed nutritional interventions, as well as define the effect of weight loss on survival. Methods Consecutive subjects diagnosed with PDAC (N = 123) were retrospectively evaluated. Univariate analysis was used to compare subjects with and without substantial (>5%) weight loss. Multivariate logistic regression was performed to identify factors associated with weight loss, and survival analyses were performed using Kaplan-Meier curves and Cox survival models. Results Substantial weight loss at diagnosis was present in 71.5% of subjects and was independently associated with higher baseline body mass index, longer symptom duration, and increased tumor size. Recommendations for nutrition consultation and pancreatic enzyme replacement therapy occurred in 27.6% and 36.9% of subjects, respectively. Weight loss (>5%) was not associated with worse survival on multivariate analysis (hazard ratio, 1.32; 95% confidence interval, 0.76-2.30), unless a higher threshold (>10%) was used (hazard ratio, 1.77; 95% confidence interval, 1.09-2.87). Conclusions Despite the high prevalence of weight loss at PDAC diagnosis, there are low observed rates of nutritional interventions. Weight loss based on current criteria for cancer cachexia is not associated with poor survival in PDAC.

Original language	English
Pages (from-to)	1152-1157
Number of pages	6
Journal	Pancreas
Volume	46
Issue number	9
DOIs	https://doi.org/10.1097/MPA.0000000000000898
State	Published - Oct 1 2017

Bibliographical note

Funding Information:
From the *Division of Gastroenterology, Hepatology, and Nutrition, †Department of Radiology, ‡Division of Surgical Oncology, §Department of Cancer Biology and Genetics, ||Division of Biostatistics, College of Public Health, ¶Division of General Surgery, #Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH; and **Division of Medical Oncology and Hematology, Mayo Clinic, Phoenix, AZ. Received for publication January 27, 2017; accepted July 13, 2017. Address correspondence to: Phil A. Hart, MD, Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, 410 W Tenth Ave, Columbus, OH 43210 (e‐mail: philip.hart@osumc.edu). This study was supported by the National Cancer Institute and National Institute of Diabetes and Digestive and Kidney Diseases under award number U01DK108327 (D.C. and P.H.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors declare no conflict of interest. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.pancreasjournal.com). Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/MPA.0000000000000898

Publisher Copyright:
Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

Keywords

cachexia
pancreatic cancer
pancreatic enzyme replacement therapy
weight loss

ASJC Scopus subject areas

Internal Medicine
Endocrinology, Diabetes and Metabolism
Hepatology
Endocrinology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1097/MPA.0000000000000898

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Nemer, L., Krishna, S. G., Shah, Z. K., Conwell, D. L., Cruz-Monserrate, Z., Dillhoff, M., Guttridge, D. C., Hinton, A., Manilchuk, A., Pawlik, T. M., Schmidt, C. R., Talbert, E. E., Bekaii-Saab, T., & Hart, P. A. (2017). Predictors of Pancreatic Cancer-Associated Weight Loss and Nutritional Interventions. Pancreas, 46(9), 1152-1157. https://doi.org/10.1097/MPA.0000000000000898

@article{244341f3912048d09cfd37e5c7c934c5,

title = "Predictors of Pancreatic Cancer-Associated Weight Loss and Nutritional Interventions",

abstract = "Objectives Pancreatic ductal adenocarcinoma (PDAC) is often accompanied by weight loss. We sought to characterize factors associated with weight loss and observed nutritional interventions, as well as define the effect of weight loss on survival. Methods Consecutive subjects diagnosed with PDAC (N = 123) were retrospectively evaluated. Univariate analysis was used to compare subjects with and without substantial (>5%) weight loss. Multivariate logistic regression was performed to identify factors associated with weight loss, and survival analyses were performed using Kaplan-Meier curves and Cox survival models. Results Substantial weight loss at diagnosis was present in 71.5% of subjects and was independently associated with higher baseline body mass index, longer symptom duration, and increased tumor size. Recommendations for nutrition consultation and pancreatic enzyme replacement therapy occurred in 27.6% and 36.9% of subjects, respectively. Weight loss (>5%) was not associated with worse survival on multivariate analysis (hazard ratio, 1.32; 95% confidence interval, 0.76-2.30), unless a higher threshold (>10%) was used (hazard ratio, 1.77; 95% confidence interval, 1.09-2.87). Conclusions Despite the high prevalence of weight loss at PDAC diagnosis, there are low observed rates of nutritional interventions. Weight loss based on current criteria for cancer cachexia is not associated with poor survival in PDAC.",

keywords = "cachexia, pancreatic cancer, pancreatic enzyme replacement therapy, weight loss",

author = "Laura Nemer and Krishna, {Somashekar G.} and Shah, {Zarine K.} and Conwell, {Darwin L.} and Zobeida Cruz-Monserrate and Mary Dillhoff and Guttridge, {Denis C.} and Alice Hinton and Andrei Manilchuk and Pawlik, {Timothy M.} and Schmidt, {Carl R.} and Talbert, {Erin E.} and Tanios Bekaii-Saab and Hart, {Phil A.}",

note = "Funding Information: From the *Division of Gastroenterology, Hepatology, and Nutrition, †Department of Radiology, ‡Division of Surgical Oncology, §Department of Cancer Biology and Genetics, ||Division of Biostatistics, College of Public Health, ¶Division of General Surgery, #Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH; and **Division of Medical Oncology and Hematology, Mayo Clinic, Phoenix, AZ. Received for publication January 27, 2017; accepted July 13, 2017. Address correspondence to: Phil A. Hart, MD, Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, 410 W Tenth Ave, Columbus, OH 43210 (e‐mail: philip.hart@osumc.edu). This study was supported by the National Cancer Institute and National Institute of Diabetes and Digestive and Kidney Diseases under award number U01DK108327 (D.C. and P.H.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors declare no conflict of interest. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal{\textquoteright}s Web site (www.pancreasjournal.com). Copyright {\textcopyright} 2017 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/MPA.0000000000000898 Publisher Copyright: Copyright {\textcopyright} 2017 Wolters Kluwer Health, Inc. All rights reserved.",

year = "2017",

month = oct,

day = "1",

doi = "10.1097/MPA.0000000000000898",

language = "English",

volume = "46",

pages = "1152--1157",

number = "9",

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TY - JOUR

T1 - Predictors of Pancreatic Cancer-Associated Weight Loss and Nutritional Interventions

AU - Nemer, Laura

AU - Krishna, Somashekar G.

AU - Shah, Zarine K.

AU - Conwell, Darwin L.

AU - Cruz-Monserrate, Zobeida

AU - Dillhoff, Mary

AU - Guttridge, Denis C.

AU - Hinton, Alice

AU - Manilchuk, Andrei

AU - Pawlik, Timothy M.

AU - Schmidt, Carl R.

AU - Talbert, Erin E.

AU - Bekaii-Saab, Tanios

AU - Hart, Phil A.

N1 - Funding Information: From the *Division of Gastroenterology, Hepatology, and Nutrition, †Department of Radiology, ‡Division of Surgical Oncology, §Department of Cancer Biology and Genetics, ||Division of Biostatistics, College of Public Health, ¶Division of General Surgery, #Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH; and **Division of Medical Oncology and Hematology, Mayo Clinic, Phoenix, AZ. Received for publication January 27, 2017; accepted July 13, 2017. Address correspondence to: Phil A. Hart, MD, Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, 410 W Tenth Ave, Columbus, OH 43210 (e‐mail: philip.hart@osumc.edu). This study was supported by the National Cancer Institute and National Institute of Diabetes and Digestive and Kidney Diseases under award number U01DK108327 (D.C. and P.H.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors declare no conflict of interest. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.pancreasjournal.com). Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/MPA.0000000000000898 Publisher Copyright: Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

PY - 2017/10/1

Y1 - 2017/10/1

N2 - Objectives Pancreatic ductal adenocarcinoma (PDAC) is often accompanied by weight loss. We sought to characterize factors associated with weight loss and observed nutritional interventions, as well as define the effect of weight loss on survival. Methods Consecutive subjects diagnosed with PDAC (N = 123) were retrospectively evaluated. Univariate analysis was used to compare subjects with and without substantial (>5%) weight loss. Multivariate logistic regression was performed to identify factors associated with weight loss, and survival analyses were performed using Kaplan-Meier curves and Cox survival models. Results Substantial weight loss at diagnosis was present in 71.5% of subjects and was independently associated with higher baseline body mass index, longer symptom duration, and increased tumor size. Recommendations for nutrition consultation and pancreatic enzyme replacement therapy occurred in 27.6% and 36.9% of subjects, respectively. Weight loss (>5%) was not associated with worse survival on multivariate analysis (hazard ratio, 1.32; 95% confidence interval, 0.76-2.30), unless a higher threshold (>10%) was used (hazard ratio, 1.77; 95% confidence interval, 1.09-2.87). Conclusions Despite the high prevalence of weight loss at PDAC diagnosis, there are low observed rates of nutritional interventions. Weight loss based on current criteria for cancer cachexia is not associated with poor survival in PDAC.

AB - Objectives Pancreatic ductal adenocarcinoma (PDAC) is often accompanied by weight loss. We sought to characterize factors associated with weight loss and observed nutritional interventions, as well as define the effect of weight loss on survival. Methods Consecutive subjects diagnosed with PDAC (N = 123) were retrospectively evaluated. Univariate analysis was used to compare subjects with and without substantial (>5%) weight loss. Multivariate logistic regression was performed to identify factors associated with weight loss, and survival analyses were performed using Kaplan-Meier curves and Cox survival models. Results Substantial weight loss at diagnosis was present in 71.5% of subjects and was independently associated with higher baseline body mass index, longer symptom duration, and increased tumor size. Recommendations for nutrition consultation and pancreatic enzyme replacement therapy occurred in 27.6% and 36.9% of subjects, respectively. Weight loss (>5%) was not associated with worse survival on multivariate analysis (hazard ratio, 1.32; 95% confidence interval, 0.76-2.30), unless a higher threshold (>10%) was used (hazard ratio, 1.77; 95% confidence interval, 1.09-2.87). Conclusions Despite the high prevalence of weight loss at PDAC diagnosis, there are low observed rates of nutritional interventions. Weight loss based on current criteria for cancer cachexia is not associated with poor survival in PDAC.

KW - cachexia

KW - pancreatic cancer

KW - pancreatic enzyme replacement therapy

KW - weight loss

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Predictors of Pancreatic Cancer-Associated Weight Loss and Nutritional Interventions

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

UN SDGs

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