17541 Background: The Subjective Global Assessment (SGA) which is an easy-to-use, inexpensive, and non-invasive validated clinical instrument to assess nutritional status, combines data from subjective and objective aspects of medical history and physical examination. Since malnutrition can be a frequent manifestation in breast cancer, we investigated the prognostic role of SGA in patients with breast cancer treated in an integrative cancer treatment setting. Methods: We evaluated 305 histologically confirmed case series of breast cancer patients treated at Cancer Treatment Centers of America. Using SGA, patients were classified as well nourished (SGA A), moderately malnourished (SGA B) or severely malnourished (SGA C). Kaplan Meier method was used to calculate survival. Cox proportional hazard models were constructed to evaluate the prognostic effect of SGA independent of stage at diagnosis and prior treatment history. Results: Of 305 patients, 91 were newly diagnosed at our hospital while 214 had received prior treatment elsewhere. 69 had stage I disease at diagnosis, 131 had stage II, 51 had stage III and 41 had stage IV. The median age at diagnosis was 49 years (range 25 - 74 years). 216 patients were well-nourished (SGA A) while 89 were malnourished (SGA B or C). Well nourished patients had a median survival of 49.9 months (95% CI: 29.9 to 69.9), while malnourished patients had a median survival of 15.7 months (95% CI: 8.7 to 22.6); the difference being statistically significant (p < 0.001). Multivariate Cox modeling, after adjusting for stage at diagnosis and prior treatment history found that malnourished status was associated with a relative risk (RR) of 2.7 (95% CI: 1.8 to 4.0, p < 0.001). Stage at diagnosis was associated with a RR of 1.9 (95% CI: 1.3 to 3.0; p = 0.002) and prior treatment history was associated with a RR of 8.8 (95% CI: 4.6 to 16.9; p = 0.002). Conclusions: In this cohort, we found that low SGA scores (well-nourished status) versus high SGA scores (moderate to severe malnourished status) identified patients with better survival outcomes. At our center, we continue to investigate the role of nutritional intervention in improving prognosis in patients with breast cancer. No significant financial relationships to disclose.
e16546 Background: The role of baseline serum CA125 as a prognostic indicator in ovarian cancer is well documented. However, little is known about the impact of change in CA125 on survival after 3 months of therapy. We conducted survival analysis to answer the question “what is the prognostic impact of change in serum CA125 after 3 months of therapy in ovarian cancer?” Methods: A case series of 170 ovarian cancer patients treated at Cancer Treatment Centers of America between Jan 01 and May 06. Based on CA125 levels at baseline and 3 months, patients were classified into 4 groups: 1) Normal (0–35U/ml) at baseline and three months; 2) High (>35U/ml) at baseline, normal at three months; 3) Normal at baseline, high at 3 months; 4) High at baseline and three months. Kaplan Meier method was used to calculate survival across the 4 categories, which was defined as the time interval between date of patient visit at 3 months from first visit and date of death from any cause or date of last contact. Results: Of 170 patients, 36 were newly diagnosed while 134 had received prior treatment. 25 had stage I disease at diagnosis, 15 stage II, 106 stage III and 14 stage IV. The median age at presentation was 54.2 years (range 23.1 - 82.5 years). At baseline, 31 patients had normal (0–35U/ml) serum CA125 levels while 138 had high (>35U/ml) levels. At 3 months, 59 had normal while 111 had high levels. In this cohort, patients with a reduced CA125 at 3 months (stratum 2) had a significantly better survival than those with increased CA125 at 3 months (stratum 3). Patients with normal values of CA125 at both baseline and 3 months (stratum 1) had the best overall survival. Conclusions: These data show that reduction in CA125 after 3 months of therapy is associated with better overall survival in ovarian cancer. Patients without a significant decline in CA125 after 3 months of therapy have a particularly poor prognosis. [Table: see text] No significant financial relationships to disclose.
6121 Background: Malnutrition is a strong predictor of morbidity and mortality in cancer. Serum albumin is one of the most commonly used single measures to assess nutritional status in clinical oncology. At our integrative treatment center, we use serum albumin in conjunction with bioelectrical impedance analysis (BIA) to assess nutritional status in cancer patients. BIA is a simple non-invasive technique to assess body composition, which provides an estimate of body cell mass. BIA however, has not been extensively validated in clinical cancer settings and little is known about the relationship between BIA and serum albumin. The goal of this study was to investigate if baseline body cell mass could provide useful information to detect malnutrition in advanced colorectal cancer. Methods: We evaluated a case series of 81 histologically confirmed stages III -IV colorectal cancer patients treated at Cancer Treatment Centers of America at Midwestern Regional Medical Center between January 2000 and March 2003. Percent ideal body cell mass (IBCM) was calculated for each patient by dividing the actual body cell mass by the ideal body cell mass specific for gender, height and weight. The percent IBCM was divided into three mutually exclusive tertiles (below 102.3%, 102.3 to 109.7%, and above 109.7%). The mean scores of serum albumin were compared across the three categories of percent IBCM using analysis of variance (ANOVA). The correlation between percent IBCM and serum albumin was studied using Pearson's correlation coefficient. Results: We found a modest statistically significant positive correlation between percent IBCM and serum albumin (r = 0.24; p = 0.037). ANOVA revealed statistically significant differences in the mean values of serum albumin across the 3 percent IBCM categories; the higher the percent IBCM, the greater the serum albumin levels (p = 0.044). Conclusions: These results suggest that BIA could be a useful tool in assessing nutritional status in patients with advanced colorectal cancer. Further studies need to focus on more extensive validation of this technique in the cancer treatment settings. No significant financial relationships to disclose.
Abstract Background A frequent manifestation of advanced lung cancer is malnutrition, timely identification and treatment of which can lead to improved patient outcomes. Bioelectrical impedance analysis (BIA) is an easy-to-use and non-invasive technique to evaluate changes in body composition and nutritional status. We investigated the prognostic role of BIA-derived phase angle in advanced non-small cell lung cancer (NSCLC). Methods A case series of 165 stages IIIB and IV NSCLC patients treated at our center. The Kaplan Meier method was used to calculate survival. Cox proportional hazard models were constructed to evaluate the prognostic effect of phase angle, independent of stage at diagnosis and prior treatment history. Results 93 were males and 72 females. 61 had stage IIIB disease at diagnosis while 104 had stage IV. The median phase angle was 5.3 degrees (range = 2.9 – 8). Patients with phase angle <= 5.3 had a median survival of 7.6 months (95% CI: 4.7 to 9.5; n = 81), while those with > 5.3 had 12.4 months (95% CI: 10.5 to 18.7; n = 84); (p = 0.02). After adjusting for age, stage at diagnosis and prior treatment history we found that every one degree increase in phase angle was associated with a relative risk of 0.79 (95% CI: 0.64 to 0.97, P = 0.02). Conclusion We found BIA-derived phase angle to be an independent prognostic indicator in patients with stage IIIB and IV NSCLC. Nutritional interventions targeted at improving phase angle could potentially lead to an improved survival in patients with advanced NSCLC.
3761 Background: Patients with advanced cancer are greatly concerned about their ability to carry out the activities of daily living. Eastern Cooperative Oncology Group (ECOG) scale has been widely used to quantify the performance status of cancer patients. ECOG captures patient-derived functional status data on a scale of 0 through 4; 0 being normal with no limitations and 4 being completely disabled and bedridden. The purpose of this investigation was to assess the impact of baseline ECOG scores on survival in patients with advanced colorectal cancer. Methods: A retrospective chart review was performed on a consecutive case series of 233 stages III and IV colorectal cancer patients treated at Cancer Treatment Centers of America at Midwestern Regional Medical Center between January 1995 and March 2001. The patient cohort was divided into 2 categories; newly diagnosed (63) and recurrent disease (170). Patients were also divided into 2 mutually exclusive classes of functional status, good (ECOG scores of 0 to 1) and poor (ECOG scores of 2 to 4). The Kaplan-Meier method was used to calculate survival which was defined as the time interval between date of first patient visit to the hospital and date of death from any cause or date of last contact. The log rank test statistic was used to evaluate the equality of survival distributions across the two ECOG strata. Results: Newly diagnosed patients with good ECOG scores had a median survival of 30.5 months (95% CI, 17.8 to 43.3; n = 47) while those with poor scores had 15.1 months (95% CI, 1 to 29.1; n = 10), the difference being statistically significant (p = 0.01). Similarly, patients with recurrent disease demonstrated a statistically significantly (p = 0.0002) better median survival for good ECOG scores (10.1 months; 95% CI, 8.1 to 12; n = 104) as compared to those with poor ECOG scores (5.1 months; 95% CI, 3.1 to 7.1; n = 53). Conclusions: In this cohort, we found that low ECOG scores (good performance status) versus high ECOG scores (poor performance status) identified patients with better survival outcomes. Further studies need to focus on more extensive investigation of the prognostic importance of the ECOG scores in clinical cancer settings. No significant financial relationships to disclose.
3761 Background: Patients with advanced cancer are greatly concerned about their ability to carry out the activities of daily living. Eastern Cooperative Oncology Group (ECOG) scale has been widely used to quantify the performance status of cancer patients. ECOG captures patient-derived functional status data on a scale of 0 through 4; 0 being normal with no limitations and 4 being completely disabled and bedridden. The purpose of this investigation was to assess the impact of baseline ECOG scores on survival in patients with advanced colorectal cancer. Methods: A retrospective chart review was performed on a consecutive case series of 233 stages III and IV colorectal cancer patients treated at Cancer Treatment Centers of America at Midwestern Regional Medical Center between January 1995 and March 2001. The patient cohort was divided into 2 categories; newly diagnosed (63) and recurrent disease (170). Patients were also divided into 2 mutually exclusive classes of functional status, good (ECOG scores of 0 to 1) and poor (ECOG scores of 2 to 4). The Kaplan-Meier method was used to calculate survival which was defined as the time interval between date of first patient visit to the hospital and date of death from any cause or date of last contact. The log rank test statistic was used to evaluate the equality of survival distributions across the two ECOG strata. Results: Newly diagnosed patients with good ECOG scores had a median survival of 30.5 months (95% CI, 17.8 to 43.3; n = 47) while those with poor scores had 15.1 months (95% CI, 1 to 29.1; n = 10), the difference being statistically significant (p = 0.01). Similarly, patients with recurrent disease demonstrated a statistically significantly (p = 0.0002) better median survival for good ECOG scores (10.1 months; 95% CI, 8.1 to 12; n = 104) as compared to those with poor ECOG scores (5.1 months; 95% CI, 3.1 to 7.1; n = 53). Conclusions: In this cohort, we found that low ECOG scores (good performance status) versus high ECOG scores (poor performance status) identified patients with better survival outcomes. Further studies need to focus on more extensive investigation of the prognostic importance of the ECOG scores in clinical cancer settings. No significant financial relationships to disclose.
Bioelectrical Impedance (BIA) derived phase angle is increasingly being used as an objective indicator of nutritional status in advanced cancer. Subjective Global Assessment (SGA) is a subjective method of nutritional status. The objective of this study was to investigate the association between BIA derived phase angle and SGA in advanced colorectal cancer.We evaluated a case series of 73 stages III and IV colorectal cancer patients. Patients were classified as either well-nourished or malnourished using the SGA. BIA was conducted on all patients and phase angle was calculated. The correlation between phase angle and SGA was studied using Spearman correlation coefficient. Receiver Operating Characteristic curves were estimated using the non-parametric method to determine the optimal cut-off levels of phase angle.Well-nourished patients had a statistically significantly higher (p = 0.005) median phase angle score (6.12) as compared to those who were malnourished (5.18). The Spearman rank correlation coefficient between phase angle and SGA was found to be 0.33 (p = 0.004), suggesting better nutritional status with higher phase angle scores. A phase angle cut-off of 5.2 was 51.7% sensitive and 79.5% specific whereas a cut-off of 6.0 was 82.8% sensitive and 54.5% specific in detecting malnutrition. Interestingly, a phase angle cut-off of 5.9 demonstrated high diagnostic accuracy in males who had failed primary treatment for advanced colorectal cancer.Our study suggests that bioimpedance phase angle is a potential nutritional indicator in advanced colorectal cancer. Further research is needed to elucidate the optimal cut-off levels of phase angle that can be incorporated into the oncology clinic for better nutritional evaluation and management.
3689 Background: Bioelectrical impedance analysis (BIA) is widely used in the clinical setting to assess changes in body composition. Phase angle, determined by BIA, detects changes in tissue electrical properties, which is an indicator of cellular health and integrity. Phase angle has been found to be a prognostic indicator in several chronic conditions, such as human immunodeficiency virus, liver cirrhosis, COPD, lung cancer, and patients receiving dialysis. This study was conducted to investigate the prognostic role of baseline phase angle measurements in advanced colorectal cancer. Methods: We evaluated a case series of 81 histologically confirmed stages III-IV colorectal cancer patients treated at Cancer Treatment Centers of America at Midwestern Regional Medical Center between January 2000 and March 2003. A dietitian conducted bioelectrical impedance analysis on all patients during their first admission for treatment. Resistance and reactance were measured, and phase angle was then calculated. Phase angle measurements were divided into three mutually exclusive tertiles with cut-offs of 5.17 and 6.19. Kaplan Meier method was used to calculate survival across the three categories of phase angle. Survival analyses for phase angle were also conducted after adjusting for tumor stage. Log-Rank test was used to study the equality of survival distributions across the strata. Results: Patients with phase angle below 5.17 had a median survival of 10.1 months (95% CI, 6.2 to 13.9; n = 25), those between 5.17 and 6.19 had 22.6 months (95% CI, 16.4 to 28.7; n = 29), and those above 6.19 had 25.6 months (95% CI, 21.4 to 29.8; n = 27); the difference being statistically significant (p = 0.003). Phase angle continued to be statistically significantly associated with survival even after adjusting for tumor stage (p = 0.012). Conclusions: This study demonstrates that a phase angle < 5.17, independent of tumor stage, is an adverse prognostic indicator in patients with advanced colorectal cancer. Similar studies in other cancer types with larger sample sizes are needed to further validate the prognostic significance of phase angle in the cancer treatment setting. No significant financial relationships to disclose.
3728 Background: Malnutrition is a frequent complication in advanced colorectal cancer and is a significant cause of morbidity and mortality. While nutritional status has been hypothesized to have a positive impact on Quality of Life (QoL), little is known about the relationship between the two. We investigated if nutritional status is associated with QoL in advanced colorectal cancer. Methods: A case series of 58 stage III-IV colorectal cancer treated at Cancer Treatment Centers of America between 03/01 and 01/03. Nutritional status was evaluated using Subjective Global Assessment (SGA). QoL was evaluated using European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC). EORTC has 5 functional scales, 9 symptom scales, and a global health scale. Possible scores range from 0 - 100. Higher scores in global and functional scales and lower scores in symptom scales indicate better QoL. Median QoL scores were compared across 2 classes of nutritional status using nonparametric t test owing to non-normal distribution of QoL scores. Results: 34 patients were identified well nourished and 24 malnourished by the SGA. Well-nourished patients had significantly better QoL scores on global, physical and role functions as compared to malnourished patients (Table 1). Interestingly, median role function score in well-nourished patients was 40 points > than that in malnourished patients, indicating “much better” QoL from patients’ perspective. Similarly, QoL on multiple symptom scales was significantly better in well-nourished patients. Conclusions: This study suggests that malnutrition is associated with poor QoL, as measured by EORTC in advanced colorectal cancer. Prospective studies are required to determine whether nutritional intervention can have any positive impact on QoL outcomes of these patients. Table 1. QoL stratified by nutritional status. No significant financial relationships to disclose.
Abstract Background: Malnutrition can be a frequent manifestation of breast cancer and its treatment. Several nutritional assessment tools have varying levels of association with survival, and have been tested individually with different patient populations, sometimes making it difficult to assess the impact of one tool relative to the others. We therefore conducted a single-institution multivariate analysis of 3 most commonly used nutritional tools - Body Mass Index (BMI), Subjective Global Assessment (SGA) and bioimpedance-derived phase angle (PA).Material and Methods: A case series of 234 breast cancer patients treated at Cancer Treatment Centers of America. Using SGA, patients were classified as well nourished (SGA A), moderately malnourished (SGA B) or severely malnourished (SGA C). Cox proportional hazard models were used to evaluate the independent prognostic effects of SGA, PA and BMI after controlling for each other, stage at diagnosis and prior treatment history (newly diagnosed versus previously treated).Results: Of 234 patients, 74 were newly diagnosed while 160 had received prior treatment. 159 had early stage (I/II) disease at diagnosis, while 75 had late stage (III/IV). The median age at presentation was 52.8 years (range 25-75 years). The mean PA and BMI scores were 5.5 (std. dev = 1.1) and 28.7 (std. dev = 6.2) respectively. 171 patients were well-nourished (SGA A) while 63 were malnourished (SGA B/C). Multivariate Cox modeling, after adjusting for stage at diagnosis, prior treatment history and other nutritional variables, found that malnourished status (SGA B/C) was associated with a relative risk (RR) of 2.4 (95% CI: 1.5-3.9, p < 0.001). Late stage at diagnosis was associated with a RR of 2.0 (95% CI: 1.3-3.2; p = 0.003) and previously treated category was associated with a RR of 7.9 (95% CI: 3.9-15.8; p < 0.001). PA and BMI were found to be statistically non-significant.Discussion: We found that SGA A (well-nourished status) versus SGA B/C (moderate to severe malnourished status) identified patients with better survival outcomes independent of BMI, PA, stage at diagnosis and prior treatment history. Among the nutritional assessment tools evaluated, SGA emerged as the strongest predictor of survival in breast cancer. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6048.
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