P1959 - Changes in Mini Nutritional Assessment Scores and BMI in Geriatric Oncology Patients at Days 0, 30, 90 and 180 Post Cancer Treatment

Kanwal Bains, MD¹, Erkan Ceyhan, PhD², Ponnandai Somasundar, MS^1
1Roger Williams Medical Center, Providence, RI; ²Roger Williams Medical Center, Needham, MA

Introduction: Cancer-associated malnutrition is common in older patients with cancer and is a significant cause of morbidity and mortality in advanced disease. In addition, patients with upper gastrointestinal cancers are more susceptible to malnutrition, owing to malabsorption, obstructive symptoms, and diarrhea. This study sought to evaluate nutritional status in older adults over age 65 with a cancer diagnosis.

Methods: We performed a single institutional prospective cohort study of geriatric patients with solid cancers from 2013-2018. Patients were eligible for our study if they had undergone a comprehensive geriatric assessment before starting treatment (day 0), posttreatment day 30, 90, and 180. BMI was determined electronically following established procedures. Nutrition status is indicated by scores obtained in the Mini nutritional assessment (MNA) scale. A p value of less than 0.05 was deemed statistically significant.



Results: A repeated-measures ANOVA determined that mean MNA scores differed significantly across four-time points (F (3, 103) =3.590, p= .016) (Table1a). A post hoc pairwise comparison using the Bonferroni correction showed a decrease in MNA scores between the follow-up assessment at 30 and 180 days (6.1 vs. 4.4), respectively, with a statistically significant p-value of .009 (Table1b). Likewise, the MNA scores differed significantly between 90- and 180-days posttreatment (5.6 vs. 4.4) with a p-value of 0.037 (Table1c). A similar analysis was run for BMI values, and results obtained showed significant differences at all time points (F (1.7, 59.9) =8.233, p=.001) (Table1d). A post hoc pairwise comparison using the Bonferroni correction showed a continuous decrease in BMI values from pretreatment to each subsequent visit at 30-, 90-, and 180 days (27.7, 26.5, 26,15, 25.7) which was statistically significant when compared to pretreatment with each follow-up visit respectively (p = 0.009, .021, .01) (Table4). Therefore, we can conclude that there is a significant decrease in MNA (Figure1a) and BMI (Figure1b) scores from pretreatment to posttreatment follow-up visits for cancer patients undergoing treatment therapy.



Discussion: The lesson learned from this study shows that cancer treatment affects nutrition status, and intervention can only improve it to some extent. Better intervention strategies can be developed, and further studies are needed to identify effective interventions to treat individuals at risk of cancer-related malnutrition.




Figure: Figure1a: Mean MNA Score( Y axis) Over Time (X axis) [1= Pretreatment, 2 = 30 days, 3= 90 days, 4 = 180 days], 1b Mean BMI( Y axis) Over Time (X axis) [1= Pretreatment, 2 = 30 days, 3= 90 days, 4 = 180 days]

Tests of Within-Subjects Effects (MNA, 1a)
Source		Type III Sum of Squares	df	Mean Square	F	Sig	Partial Eta Squared
Time	Sphericity Assumed	56.079	3	18.693	3.59	0.016	.095
Error(Time)	Sphericity Assumed	531.171	102	5.208
Pairwise Comparison - (MNA, 1b)
(I) Time	(J) Time	Mean Difference (I-J)	Std. Error	Sig.b	95% Confidence Interval for Differenceb
					Lower bound	Upper bound
2	1	0.886	0.598	0.887	-0.79	2.561
	3	0.543	0.491	1	-0.832	1.918
	4	1.743*	0.506	.009	0.325	3.16
3	1	0.343	0.63	1	-1.421	2.107
	2	-0.543	0.491	1	-1.918	.832
	4	1.200*	0.412	0.037	0.047	2.353
Tests of Within-Subjects Effects (BMI, 1c)
Source		Type III Sum of Squares	df	Mean Square	F	Sig	Partial Eta Squared
Time	Greenhouse-Geisser	73.137	1.763	41.49	8.233	0.001	0.195
Error (Time)	Greenhouse-Geisser	302.038	59.933	5.04
Pairwise Comparisons (BMI 1,d)
(I) Time	(J) Time	Mean Difference (I-J)	Std. Error	Sig.b	95% Confidence Interval for Differenceb
					Lower Bound	Upper Bound
1	2	1.171*	0.338	.009	0.224	2.119
	3	1.551*	0.493	0.021	0.17	2.933
	4	1.929*	0.562	0.01	0.354	3.503
Based on estimated marginal means
*. The mean difference is significant at the .05 level.
b. Adjustment for multiple comparisons: Bonferroni.

Table: Table 1: Repeated Measure ANOVA Test of Within-Subjects Effects for MNA (1a) and BMI (1c) and Pairwise Comparison for Mean (pre and post treatment) for MNA (1b) and BMI (1d)


Disclosures:
Kanwal Bains indicated no relevant financial relationships.
Erkan Ceyhan indicated no relevant financial relationships.
Ponnandai Somasundar indicated no relevant financial relationships.


Kanwal Bains, MD¹, Erkan Ceyhan, PhD², Ponnandai Somasundar, MS¹. P1959 - Changes in Mini Nutritional Assessment Scores and BMI in Geriatric Oncology Patients at Days 0, 30, 90 and 180 Post Cancer Treatment, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.