A medically tailored meal (MTM) delivery program to reduce nutritional decline and improve treatment tolerance in patients with colorectal cancer (CRC): A pilot study.

Abstract

3564 Background: Colorectal cancer (CRC CA) is the 3 rd most common CA among US adults. Over 50% of CRC patients (pts) present with advanced disease, necessitating adjuvant or palliative chemotherapy. Nearly 50% CRC pts will be diagnosed with malnutrition (MN) during their CA journey. MN is associated with reduced quality of life, poorer response to chemotherapy, and reduced survival. The provision of medically tailored meals (MTM) improves access to nutritious foods to support pts’ caloric/nutrient needs and preferences. Remote delivery of MTMs could serve as an impactful intervention for pts at highest risk of MN and to improve treatment tolerance. Methods: Primary outcomes were feasibility (enrollment/adherence/retention) and acceptability of an MTM program in pts undergoing 5-FU based therapy for CRC; secondary included weight maintenance, MN measured by PG-SGA (Patient-Generated Subjective Global Assessment), HEI (Healthy Eating Index) score generated by VioScreen, a validated computerized food frequency tool, QOL measured by FACT-C/FACT-G, and treatment disruption. The MTM program included daily meals delivered weekly and nutritional counseling at 4 timepoints . Results: Among 100 eligible CRC pts approached, 48 consented and 52 declined, primarily due to lack of interest in MTMs (35/52, 67%). 40/48 (83%) initiated the MTM program and 32/40 (80%) completed it, including 13 (41%) Stage II/III and 19 (59%) Stage IV patients. 16/48 (33%) consented pts discontinued the study due to non-compliance (n = 4), post-consent refusal (n = 4), dissatisfaction w/meals (n = 7) or death (n = 1). Pts had mean age of 56 yrs (range 32-78), with 51% female, 20% African American, and 15% Hispanic. 34% had < HS diploma, and 56% reported income of <$50,000. Enrollment (44%, goal > 50%, minimum 40%), counseling adherence (52.5%, goal > 66%, minimum 50%) and study retention rate (81%, goal > 70%) measured by end-of-study survey completion all surpassed a priori unfavorable result threshold (lower feasibility limit), but only retention met its target. Acceptability was high: 92% were satisfied with the MTM program and 91% would recommend it. Mean weight was maintained during study (181.2 lbs start, 181.6 lbs end) and mean PG-SGA score declined (7.5 to 5.4, indicating lower risk of MN at the end of the study). Mean HEI scores decreased slightly (63.3 start, 61.6 end, indicating a slight reduction in dietary quality) throughout the program; however, more than half of pts (56%, n = 14) demonstrated an increase in their HEI scores, suggesting improved quality of food consumed. Conclusions: Our MTM delivery program was highly acceptable and was associated with weight maintenance and improved PG-SGA scores in CRC pts receiving 5-FU based therapy. Further research of MTM delivery programs should consider retention challenges among pts facing advanced GI cancers.