Current use of clinical nutrition in oncology patients: Real world evidence from big data in Italy

Abstract

Background: In cancer patients, research indicates that approximately half of selected patients may suffer from malnutrition. Insufficient nutritional intake, muscle protein depletion and systemic inflammation are key clinical problems. Little is known about the current use of clinical nutrition (CN) in the real world. We set out to investigate the use of CN in patients with metastasized cancer in Italy. Methods: This observational, retrospective study used an integrated administrative database from 10 Italian Local Health Units covering 5.9 million people. Between 2009 and 2015, CN use, based on Anatomical Therapeutic Chemical Classification codes and ICD-9-CM procedural codes for Enteral/Parenteral Infusion of Concentrated Nutritional Substances and at home nutritional product prescription was examined in patients with metastatic head and neck, gastrointestinal, respiratory, genitourinary or hematologic malignancies (ICD-9-CM diagnosis). Results: Out of 58,468 metastatic cancer patients with the diagnoses of interest, only 8.2% received clinical nutrition (89% had parenteral nutrition (PN)). Only 4.9% of patients who received CN had concomitant chemotherapy. Among those who received CN, only 11% of patients were diagnosed with malnutrition. The mean time between the diagnosis of metastasis and first use of CN and between the first use of CN and death were 6.6 and 3.5 months, respectively. About half of the patients commenced CN therapy in their last 20 days. Receiving PN was associated with a statistically significant improvement in survival of over 3 months in patients with gastrointestinal and genitourinary cancer who were diagnosed with malnutrition. Conclusions: CN is under-utilized among cancer patients with metastasis and there is a discrepancy between malnutrition diagnosis rates and uptake of clinical nutrition, which appears to have been used mainly as an end of life measure. Overall, our big data highlights an important unmet need and potential for improved procedures for malnutrition diagnosis and earlier nutritional care, which may improve outcomes of cancer patients.