Impact of protein energy malnutrition on hospitalized patients with breast cancer: A United States population-based cohort study.

Abstract

11067 Background: Advances in chemotherapeutics and surgical options have improved survival in patients with breast cancer. With prolonged survival, these patients are often predisposed to comorbidities affecting their quality of life. Patients with breast cancer suffer from varying degrees of protein-energy malnutrition (PEM) due to multiple factors, including cachexia, sarcopenia, and adverse effects of chemotherapeutics. However, the impact of PEM on outcomes among patients with breast cancer needs further exploration. Methods: We utilized the 2020 National Inpatient Sample (NIS) Database in conducting this retrospective cohort study. We identified patients with breast cancer and PEM using appropriate ICD-10 diagnostic codes. We stratified patients with breast cancer based on the presence or absence of PEM. A survey multivariable logistic and linear regression analysis was used to calculate adjusted odds ratios (ORs) for the primary and secondary outcomes. A p value of <0.05 was considered statistically significant. The aim of this study was to investigate the impact of PEM on in-hospital mortality, hospital length of stay (LOS), and total hospitalization charge among hospitalized patients with breast cancer. Results: We identified a total of 24770 hospitalized patients with breast cancer, of which 6.17% (1530/24770) had comorbid PEM. The overall in-hospital mortality among patients with breast cancer was 3.37% (835/24770). Among those with concomitant PEM, the mortality rate was significantly higher at 12.74% (195/1530, p<0.001). Utilizing a stepwise survey multivariable logistic regression model that adjusted for patient and hospital level confounders, PEM was found to be an independent predictor of increased in-hospital mortality (adjusted OR 2.74; 95% (confidence interval [CI] 1.74-4.30; p<0.001), longer LOS (coefficient 3.56 days; CI 2.67-4.45; p<0.001), but not higher total hospitalization charge ($4400; CI -$9818-$18620; p=0.544) or increased need for mechanical ventilation (adjusted OR 2.26; CI 0.89-5.69; p=0.084). Conclusions: Our analysis demonstrated that PEM was widely prevalent in hospitalized patients with breast cancer and was associated with significantly worsened in-hospital mortality and longer LOS. Efforts should be made to promote nutritional assessment and screening mechanisms to include early nutritional support as indicated. Further prospective studies with larger sample sizes are warranted to understand these associations better.