Skip to main content

Advertisement

SpringerLink
Log in

Treatment of malnutrition decreases complication rates and shortens the length of hospital stays in a radiation oncology department

Therapie der Mangelernährung verringert Komplikationsraten und Krankenhausverweildauern in einer radioonkologischen Universitätsklinik

  • Original Article
  • Published:
Strahlentherapie und Onkologie Aims and scope Submit manuscript

Abstract

Purpose

The nutritional status of inpatients influences the therapeutic outcome. Malnutrition is a common comorbidity in oncological patients. Both radio- and radiochemotherapy may contribute to the additional deterioration of the nutritional status. The aim of this study was to evaluate the impact of specialized treatment of malnutrition as a clinical routine.

Methods

The nutritional status of inpatients was assessed by the Nutritional risk screening (NRS-2002) on the day of admission to the University Department of Radiation Oncology. In case of significantly elevated NRS-2002 (NRS ≥ 3), a guideline-compliant, individual nutritional treatment was initiated by a specialized nutrition support team. The influence of the nutritional status and nutritional treatment on length of stay and complication rate was assessed.

Results

Of 840 included patients, 344 patients (40.95%) were at risk for malnutrition. Malnutrition was a significant, independent risk factor for both prolonged hospital stay, represented by the deviation between the actual length of stay and the DRG-associated mean length of stay (dLOS at risk: 0.88 days, dLOS not at risk: −0.88 days, p = 0.0047), as well as for the occurrence of complications (OR: 1.758 CI: [1.286–2.402], p = 0.0006). In the group of 337 (40.12%) rehospitalized patients the nutritional management was able to assimilate the values of length of stay as well as the complication rates to standard values.

Conclusions

The high risk for malnutrition and the negative consequences for patients and hospitals underline the urgent need for malnutrition screening on admission and treatment of malnutrition. A specialized, interdisciplinary nutrition support team positively influences patient outcome and should be established routinely in all oncological disciplines.

Zusammenfassung

Zweck

Der Ernährungszustand spielt für den Behandlungserfolg von stationären Patienten eine wichtige Rolle. Mangelernährung stellt bei onkologischen Patienten eine häufige Komorbidität dar. Sowohl Radiotherapien als auch Radiochemotherapien können zur zusätzlichen Verschlechterung des Ernährungszustands beitragen. Das primäre Ziel der Studie war es, den Einfluss eines in die klinische Routine eingebundenen standardisierten Ernährungsmanagements zu evaluieren.

Methoden

Bei stationären Patienten der Universitätsklinik für Radioonkologie wurde am Tag der Aufnahme der Ernährungszustand mittels des Nutritional Risk Score (NRS-2002) bewertet. Bei auffälligem Screening (NRS ≥ 3) wurde eine leitlinienkonforme individuelle Ernährungstherapie durch ein spezialisiertes Ernährungsteam eingeleitet. Der Einfluss des Ernährungszustands sowie der Ernährungstherapie auf Verweildauer und Komplikationsrate wurde bewertet.

Ergebnisse

Von 840 Patienten wiesen 344 (40,95%) ein erhöhtes Mangelernährungsrisiko auf. Mangelernährung wurde als signifikanter unabhängiger Risikofaktor sowohl für einen längeren Krankenhausaufenthalt, abgebildet durch die Differenz zwischen der tatsächlichen und der zur diagnosebezogenen Fallgruppe (DRG) gehörenden mittleren Verweildauer („DRG-associated mean length of stay“, dLOS mit Risiko: 0,88 Tage; dLOS ohne Risiko: −0,88 Tage; p = 0,0047), als auch für das Auftreten von Komplikationen nachgewiesen (Odds Ratio, OR: 1,758; 95%-Konfidenzintervall, 95%-KI: 1,286–2,402; p = 0,0006). Durch das Ernährungsmanagement wurden bei den 337 (40,12%) Patienten mit stationärer Wiederaufnahme im weiteren Verlauf sowohl die Verweildauer als auch die Komplikationsrate an Normwerte angeglichen.

Schlussfolgerung

Das hohe Mangelernährungsrisiko und die negativen Konsequenzen für Patienten und Klinik unterstreichen die Notwendigkeit eines Mangelernährungsscreenings bei Aufnahme sowie die anschließende Ernährungstherapie. Ein spezialisiertes, interdisziplinär arbeitendes Ernährungsteam beeinflusst das Patientenergebnis positiv und sollte in sämtlichen onkologischen Fachdisziplinen standardmäßig etabliert werden.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Working Group on Prevention and Integrative Oncology (PRIO) (2016) Improving nutritional care for cancer patients in Germany. Joint position paper from the German Cancer Society‘s (GCS) Working Group on Prevention and Integrative Oncology (PRIO), in collaboration with other associations. Ernahr Umsch 63(02):43–47. https://doi.org/10.4455/eu.2016.011

    Article  Google Scholar 

  2. Cepton Strategies (2007) Mangelernährung in Deutschland

    Google Scholar 

  3. Pirlich M, Schutz T, Norman K, Gastell S, Lubke HJ, Bischoff SC, Bolder U, Frieling T, Guldenzoph H, Hahn K, Jauch KW, Schindler K, Stein J, Volkert D, Weimann A, Werner H, Wolf C, Zurcher G, Bauer P, Lochs H (2006) The German hospital malnutrition study. Clin Nutr 25(4):563–572. https://doi.org/10.1016/j.clnu.2006.03.005

    Article  PubMed  Google Scholar 

  4. Thomas MN, Kufeldt J, Kisser U, Hornung HM, Hoffmann J, Andraschko M, Werner J, Rittler P (2016) Effects of malnutrition on complication rates, length of hospital stay, and revenue in elective surgical patients in the G‑DRG-system. Nutrition 32(2):249–254. https://doi.org/10.1016/j.nut.2015.08.021

    Article  PubMed  Google Scholar 

  5. Kisser U, Kufeldt J, Adderson-Kisser C, Becker S, Baumeister P, Reiter M, Harreus U, Thomas MN, Rittler P (2016) Clinical impact of malnutrition on complication rate and length of stay in elective ENT patients: a prospective cohort study. Eur Arch Otorhinolaryngol. https://doi.org/10.1007/s00405-016-3974-9

    Article  PubMed  Google Scholar 

  6. Rosenbaum A, Piper S, Riemann JF, Schilling D (2007) Mangelernährung bei internistischen Patienten – eine Screeninguntersuchung von 1308 Patienten mit Verlaufsbeobachtung. Aktuel Ernahrungsmed 32(04):181–184. https://doi.org/10.1055/s-2007-970921 (Malnutrition in Medical Patients – Screening of 1308 Patients and Follow-Up)

    Article  Google Scholar 

  7. Bonetti L, Terzoni S, Lusignani M, Negri M, Froldi M, Destrebecq A (2017) Prevalence of malnutrition among older people in medical and surgical wards in hospital and quality of nutritional care: a multicenter, cross-sectional study. J Clin Nurs. https://doi.org/10.1111/jocn.14051

    Article  PubMed  Google Scholar 

  8. Planas M, Alvarez-Hernandez J, Leon-Sanz M, Celaya-Perez S, Araujo K, Garcia de Lorenzo A, PREDyCES® researchers (2016) Prevalence of hospital malnutrition in cancer patients: a sub-analysis of the PREDyCES(R) study. Support Care Cancer 24(1):429–435. https://doi.org/10.1007/s00520-015-2813-7

    Article  PubMed  Google Scholar 

  9. Unsal D, Mentes B, Akmansu M, Uner A, Oguz M, Pak Y (2006) Evaluation of nutritional status in cancer patients receiving radiotherapy: a prospective study. Am J Clin Oncol 29(2):183–188. https://doi.org/10.1097/01.coc.0000198745.94757.ee

    Article  PubMed  Google Scholar 

  10. Pressoir M, Desne S, Berchery D, Rossignol G, Poiree B, Meslier M, Traversier S, Vittot M, Simon M, Gekiere JP, Meuric J, Serot F, Falewee MN, Rodrigues I, Senesse P, Vasson MP, Chelle F, Maget B, Antoun S, Bachmann P (2010) Prevalence, risk factors and clinical implications of malnutrition in French Comprehensive Cancer Centres. Br J Cancer 102(6):966–971. https://doi.org/10.1038/sj.bjc.6605578

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Sorensen J, Kondrup J, Prokopowicz J, Schiesser M, Krahenbuhl L, Meier R, Liberda M, EuroOOPS study group (2008) EuroOOPS: an international, multicentre study to implement nutritional risk screening and evaluate clinical outcome. Clin Nutr 27(3):340–349. https://doi.org/10.1016/j.clnu.2008.03.012

    Article  PubMed  Google Scholar 

  12. Harter J, Orlandi SP, Gonzalez MC (2017) Nutritional and functional factors as prognostic of surgical cancer patients. Support Care Cancer 25(8):2525–2530. https://doi.org/10.1007/s00520-017-3661-4

    Article  PubMed  Google Scholar 

  13. Burgos R, Sarto B, Elio I, Planas M, Forga M, Canton A, Trallero R, Munoz MJ, Perez D, Bonada A, Salo E, Lecha M, Enrich G, Salas-Salvado J, Group for the Study of Malnutrition in Hospitals in Catalonia (2012) Prevalence of malnutrition and its etiological factors in hospitals. Nutr Hosp 27(2):469–476. https://doi.org/10.1590/S0212-16112012000200018

    Article  CAS  PubMed  Google Scholar 

  14. Correia MI, Waitzberg DL (2003) The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr 22(3):235–239

    Article  Google Scholar 

  15. Silver HJ, Dietrich MS, Murphy BA (2007) Changes in body mass, energy balance, physical function, and inflammatory state in patients with locally advanced head and neck cancer treated with concurrent chemoradiation after low-dose induction chemotherapy. Head Neck 29(10):893–900. https://doi.org/10.1002/hed.20607

    Article  PubMed  Google Scholar 

  16. Bozzetti F (2013) Nutritional support of the oncology patient. Crit Rev Oncol Hematol 87(2):172–200. https://doi.org/10.1016/j.critrevonc.2013.03.006

    Article  PubMed  Google Scholar 

  17. van den Berg MG, Rutten H, Rasmussen-Conrad EL, Knuijt S, Takes RP, van Herpen CM, Wanten GJ, Kaanders JH, Merkx MA (2014) Nutritional status, food intake, and dysphagia in long-term survivors with head and neck cancer treated with chemoradiotherapy: a cross-sectional study. Head Neck 36(1):60–65. https://doi.org/10.1002/hed.23265

    Article  PubMed  Google Scholar 

  18. Korner P, Ehrmann K, Hartmannsgruber J, Metz M, Steigerwald S, Flentje M, van Oorschot B (2017) Patient-reported symptoms during radiotherapy: clinically relevant symptom burden in patients treated with palliative and curative intent. Strahlenther Onkol 193(7):570–577. https://doi.org/10.1007/s00066-017-1146-5

    Article  PubMed  Google Scholar 

  19. Alterio D, Gerardi MA, Cella L, Spoto R, Zurlo V, Sabbatini A, Fodor C, D’Avino V, Conson M, Valoriani F, Ciardo D, Pacelli R, Ferrari A, Maisonneuve P, Preda L, Bruschini R, Cossu Rocca M, Rondi E, Colangione S, Palma G, Dicuonzo S, Orecchia R, Sanguineti G, Jereczek-Fossa BA (2017) Radiation-induced acute dysphagia: prospective observational study on 42 head and neck cancer patients. Strahlenther Onkol 193(11):971–981. https://doi.org/10.1007/s00066-017-1206-x

    Article  CAS  PubMed  Google Scholar 

  20. Martin L, Senesse P, Gioulbasanis I, Antoun S, Bozzetti F, Deans C, Strasser F, Thoresen L, Jagoe RT, Chasen M, Lundholm K, Bosaeus I, Fearon KH, Baracos VE (2015) Diagnostic criteria for the classification of cancer-associated weight loss. J Clin Oncol 33(1):90–99. https://doi.org/10.1200/JCO.2014.56.1894

    Article  Google Scholar 

  21. Kondrup J, Rasmussen HH, Hamberg O, Stanga Z, Ad Hoc ESPEN Working Group (2003) Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr 22(3):321–336

    Article  Google Scholar 

  22. Arends J, Bertz H, Bischoff SC, Fietkau R, Herrmann HJ, Holm E, Horneber M, Hütterer E, Körber J, Schmid I, und das DSC (2015) S3-Leitline der Deutschen Gesellschaft für Ernährungsmedizin e. V. (DGEM) in Kooperation mit der Deutschen Gesellschaft für Hämatologie und Onkologie e. V. (DGHO), der Arbeitsgemeinschaft „Supportive Maßnahmen in der Onkologie, Rehabilitation und Sozialmedizin“ der Deutschen Krebsgesellschaft (ASORS) und der Österreichischen Arbeitsgemeinschaft für klinische Ernährung (AKE) (S3-Guideline of the German Society for Nutritional Medicine (DGEM) in Cooperation with the DGHO, the ASORS and the AKE). Aktuel Ernahrungsmed 40 (05):e1–e74. https://doi.org/10.1055/s-0035-1552741

    Article  Google Scholar 

  23. Kufeldt J, Kovarova M, Adolph M, Staiger H, Bamberg M, Haring HU, Fritsche A, Peter A (2017) Prevalence and distribution of diabetes mellitus in a maximum care hospital: urgent need for HbA1c-screening. Exp Clin Endocrinol Diabetes. https://doi.org/10.1055/s-0043-112653

    Article  PubMed  Google Scholar 

  24. Deutsches Institut für Medizinische Dokumentation und Information (DIMDI) im Auftrag des Bundesministeriums für Gesundheit (BMG) unter Beteiligung der Arbeitsgruppe ICD des Kuratoriums für Fragen der Klassifikation im Gesundheitswesen (2018) ICD-10-GM Version 2018. Systematisches Verzeichnis Internationale statistische Klassifikation der Krankheiten und verwandter Gesundheitsprobleme (10. Revision, German modification). https://www.dimdi.de/static/de/klassifikationen/icd/icd-10-gm/kode-suche/htmlgm2018/

  25. Kuppinger D, Hartl WH, Bertok M, Hoffmann JM, Cederbaum J, Bender A, Küchenhoff H, Rittler P (2013) Nutritional screening for risk prediction in patients scheduled for extra-abdominal surgery. Nutrition 29(2):399–404. https://doi.org/10.1016/j.nut.2012.06.013

    Article  PubMed  Google Scholar 

  26. Fietkau R (2016) Einfluss der Ernährung bei Strahlen- und Radiochemotherapie. Onkologe 22(4):268–274. https://doi.org/10.1007/s00761-016-0012-x

    Article  Google Scholar 

Download references

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or non-profit sectors.

Author information

Authors and Affiliations

  1. Nutrition Support Team, University Hospital Tuebingen, Tuebingen, Germany

    Johannes Kufeldt, Daniela Schweikert, Andreas Fritsche & Michael Adolph

  2. Department of Radiation Oncology, University Hospital Tuebingen, Tuebingen, Germany

    Marén Viehrig

  3. Department of Internal Medicine IV, Nutritional Medicine and Prevention, University Hospital of Tuebingen, Tuebingen, Germany

    Andreas Fritsche

  4. Managing Medical Director and Chairman of the Board, University Hospital Tuebingen, Tuebingen, Germany

    Michael Bamberg

  5. Department of Anesthesiology and Intensive Care Medicine, University Hospital of Tuebingen, Tuebingen, Germany

    Michael Adolph

Authors
  1. Johannes Kufeldt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marén Viehrig
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Daniela Schweikert
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Andreas Fritsche
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael Bamberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Michael Adolph
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael Adolph.

Ethics declarations

Conflict of interest

J. Kufeldt reports a doctoral scholarship from B. Braun Melsungen AG, during the conduct of the study and outside the submitted work. No other potential conflicts of interest relevant to this article were reported. B. Braun had no involvement in the study design, data collection and analysis or writing of the manuscript. M. Viehrig, D. Schweikert, A. Fritsche, M. Bamberg and M. Adolph declare that they have no competing interests.

Caption Electronic Supplementary Material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kufeldt, J., Viehrig, M., Schweikert, D. et al. Treatment of malnutrition decreases complication rates and shortens the length of hospital stays in a radiation oncology department. Strahlenther Onkol 194, 1049–1059 (2018). https://doi.org/10.1007/s00066-018-1360-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00066-018-1360-9

Keywords

Schlüsselwörter

Search

Navigation