From prehab to rehab: Nutritional support for people undergoing pancreatic cancer surgery. Issue 2 (28th June 2022)

• Record Type: Journal Article
• Authors: Bibby, Neil; Rajai, Azita; O'Reilly, Derek A.
• Other Names: Burden Sorrel guestEditor.; Shaw Clare guestEditor.; Barlow Rachael guestEditor.
• Is Part Of: Journal of human nutrition and dietetics. Volume 36:Issue 2(2023)
• Page Start: 493
• Page End: 503
• Publication Date: 2022-06-28
• Subjects: dietetics -- nutrition -- nutritional screening -- nutritional support -- pancreatic cancer; Dietetics -- Periodicals; Nutrition -- Periodicals; 613.205
• DOI: 10.1111/jhn.13040
• Languages: English
• ISSNs: 0952-3871

Abstract

Abstract: Background: There is an urgent need to identify and treat potentially modifiable factors that may improve quality of life and influence survival of people with pancreatic cancer. The present study aimed to assess nutritional status at diagnosis and in the early and later stages of postoperative recovery and to evaluate the feasibility of optimising nutritional status and symptoms in patients undergoing surgery, as part of a multidisciplinary prehabilitation intervention. Methods: Nutritional data collection and intervention took place at four time points: (1) baseline at diagnosis; (2) prior to surgery; (3) first postoperative review (within 6 weeks); and (4) at 6–12 months postoperatively. The 'Patient Generated Subjective Global Assessment' (PG‐SGA) tool was used to undertake a detailed nutritional assessment and the modified 'Gastrointestinal Symptom Rating Scale' (GISRS) was completed for all patients. Handgrip strength was measured by dynamometry. Results: During the period between April 2016 and April 2018, 137 patients scheduled for pancreatic cancer surgery were included who had a baseline dietetic assessment and at least one further review. Baseline assessment demonstrated that malnutrition was highly prevalent, with 62.3% experiencing more than 5% and 29.2% experiencing more than 10% weight loss over the prior 6 months. With dietetic assessment and support for at least 14 days, these patients gained a mean 1.8% body weight during this period and a mean improved handgrip of 7.9%. Symptoms also improved, with absolute change in PG‐SGA scores reduced by a mean of 6.19 and a 6.3 reduction of GISRS. Conclusions: Dietetic assessment and intervention for all patients undergoing pancreatic resection ensures timely identification of nutritional deficiencies and correction of avoidable causes of weight loss, such as pancreatic enzyme insufficiency. Abstract : A prospective study of 137 patients who had a baseline dietetic assessment, prehabilitation and at least one further post‐operative review. Key points: Malnutrition is prevalent at diagnosis in patients undergoing pancreatic surgery and worsens in the early postoperative period. This may impact surgical complications, quality of life and ability to complete adjuvant chemotherapy. Prehabilitation has the potential to improve perioperative fitness and reduce complications, with nutritional intervention conprising a core component throughout the peri‐operative period. Further research is needed on multimodal prehabilitation within pancreatic surgery.