Optimizing nutrition in patients with pancreatic cancer (NUANCE study).

Abstract

696 Background: Patients (pts) with advanced pancreatic ductal adenocarcinoma (PDAC) experience significantly worse outcomes when nutritional support is inadequate; characterized by weight loss, GI symptoms, and metabolic derangements. These correlate with increased toxicity, reduced survival, and diminished quality of life. Prior prospective cohorts 1 highlight that most pts deteriorate nutritionally from baseline with a significant reduction in weight (p<0.001), albumin (p<0.001) and symptoms using the Edmonton Symptom Assessment Scale (ESAS) tool in the first months on chemotherapy. The NUANCE study was designed to evaluate a prospective interprofessional psychoeducational program by measuring routine clinical endpoints. Methods: Pts with metastatic and locally advanced (LA) unresectable PDAC were consented if undergoing systemic chemotherapy. Pts undergo comprehensive initial assessments and are then pre-emptively supported by a registered dietitian, nurse specialist and social worker to identify and optimize GI/nutritional symptoms. We report assessments of nutrition, ESAS scores and ECOG PS from baseline to 4 months. Results: Since Oct 2022, a planned 100 pts (78 metastatic, 22 LA) have consented. We report on baseline measurable nutritional parameters and symptoms and at 4-mos in pts reaching 4-mos. With a med F/U of 8 mos; med age 67.5 yrs (40-84), 44% female, the med OS on study was 12 mos (9-16). Diabetes was present in 39% at baseline, 54% were prescribed insulin. Pancreatic enzyme replacement was offered in 88%. Baseline and 4-mos clinical measures and patient reported symptoms by ESAS are described in table 1. Pain, appetite and diarrhea symptom ESAS scores improve (NS) and energy level ESAS scores are maintained. No significant worsening is observed in weight and ECOG PS, and 68% of patients at 4 mos maintain albumin levels > 36g/L. ESAS completion rate was low (50%). Conclusions: In these early NUANCE results, we observe no significant deterioration in weight, ECOG PS and in maintaining albumin, a marked improvement over the previous cohort suggesting this program helps maintain pt’s nutrition and wellbeing during the critical first 4 months on chemotherapy. This supports the integration of nutritional screening and interprofessional support as a critical component of PDAC routine care to mitigate chemotherapy toxicity and improve patient-centered outcomes. Next steps include building the NUANCE design into a smart-app, providing more accessible support to pts with advanced PDAC. Ref: 1. Knox et al. COMPASS unpublished data. Characteristic/Symptom (ESAS score) N=100(baseline) Baseline value med (range) n(4 mons) 4 mos med (range) P value Weight (Kg) 100 67.0(37.0 – 105.9) 47 63.2(40.6 – 109.2) 0.33 Pain scores 52 3 (0 – 8) 45 1.0 (0 – 8) 0.18 Energy 51 5 (1 – 10) 46 5 (0 – 9) 0.95 Appetite 51 5 (0 – 10) 45 4 (0 – 9) 0.27 Diarrhea 50 1 (0 – 8) 43 0 (0 – 7) 0.67 Baseline n 4 mos n ECOG PS 0/1/2/3 100 13 / 73 / 12 / 2 39 4 / 31 / 3 / 1 0.95