Current use of clinical nutrition in oncology patients: Real world evidence from big data in Italy

Background: Incancer patients, research indicates that approximately half of selected patients may suffer from malnutrition. Insufficient nutritional intake, muscle protein depletion and systemic inflammation are key clinical problems. Little is known about the current use of clinical nutrition (CN) in the real world. We set out to investigate the use of CN in patients with metastasized cancer in Italy. Methods: Thisobservational, retrospective study used an integrated administrative database from 10 Italian Local Health Units covering 5.9 million people. Between 2009 and2015, CNuse,basedonAnatomical Therapeutic Chemical Classification codesand ICD-9-CM procedural codes for Enteral/Parenteral Infusion of Concentrated Nutritional Substances and at home nutritional product prescription was examined in patients with metastatic head and neck, gastrointestinal, respiratory, genitourinary or hematologic malignancies (ICD-9-CM diagnosis). Results: Out of 58,468 metastatic cancer patients with the diagnoses of interest, only 8.2%received clinical nutrition (89% had parenteral nutrition (PN)). Only 4.9% of patients who received CN had concomitant chemotherapy.Among thosewhoreceived CN,only11%ofpatientswerediagnosed withmalnutrition. The mean timebetween the diagnosis of metastasis and first use of CN and between the first use of CN and death were 6.6 and 3.5 months,respectively. About half of the patients commenced CNther apy in their last 20 days. Receiving PN was associated with a statistically significant improvementin survival of over 3 months in patients with gastrointestinal and genito urinary cancer who were diagnosed with malnutrition. Conclusions: CN isunder-utilized among cancer patients with metastasis and there is a discrepancy between malnutrition diagnosis rates and uptake of clinical nutrition, which appearsto have been used mainly as an end of lifemeasure. Overall, our big data highlights an important unmet need and potential for improved procedures for malnu trition diagnosis and earlier nutritional care, which may improve outcomes of cancer patients.