Login to Access Video or Poster Abstract: MP54-13
Sources of Funding: The trial was supported by grant IRG-09-062-05 from the American Cancer Society (Jill Hamilton-Reeves), a Nestle ? HealthCare Nutrition Research Grant (Jill Hamilton-Reeves), and the KL2 Scholars Award KL2 TR000119-04 (Jill Hamilton-Reeves). Support for B. Barnes was provided by the Roberts Foundation

Introduction

Underdiagnosing malnutrition in high-risk surgical patients is problematic. Rapid skeletal muscle wasting is a serious and common complication following radical cystectomy (RC) to treat muscle-invasive bladder cancer. Specialized immunonutrition (SIM) intake before and after RC may help counteract muscle wasting in the post-operative period.

Methods

Men with muscle-invasive cancer scheduled for radical cystectomy were randomly assigned to oral SIM providing supplemental L-arginine, fish oil, vitamin A, and nucleotides (n = 14) or a calorie- and nitrogen-matched oral nutrition supplement [ONS (n = 15)] for 5 days before and 5 days after RC. Malnutrition was assessed by a trained research team using the Patient-Generated Subjective Global Assessment (PG-SGA) tool. Dual Energy X-Ray Absorptiometry scans were obtained at baseline, 14 days, and 30 days after surgery to calculate relative skeletal muscle index (RSMI). Discrepancies between the malnutrition diagnoses using the PG-SGA tool and the UHC Billing database on the same patients were compared.

Results

Using the PG-SGA tool, 21% of patients were identified as well nourished, 66% were moderately malnourished, and 14% were severely malnourished prior to RC. Billed and coded data showed 86% of patients were well nourished, 7% were moderately malnourished, and 7% were severely malnourished prior to RC. Relative Skeletal Muscle Index (RSMI) was better preserved in the SIM group at 14 days (7% vs. 17% in the ONS group).

Conclusions

The large discrepancy between patients identified as malnourished using the PG-SGA as compared to the billing data suggests a problem of underdiagnosing malnutrition in this population. Improving nutrition status through specialized immunonutrition could be a low risk, high-impact means of counteracting muscle wasting after RC for bladder cancer

Funding

The trial was supported by grant IRG-09-062-05 from the American Cancer Society (Jill Hamilton-Reeves), a Nestle ? HealthCare Nutrition Research Grant (Jill Hamilton-Reeves), and the KL2 Scholars Award KL2 TR000119-04 (Jill Hamilton-Reeves). Support for B. Barnes was provided by the Roberts Foundation