Abstract:

Background and purpose: Malnutrition and deterioration of nutritional status are common in patients after surgery for gastric cancer, especially in the elderly, and severely affect patient prognosis. Studies have shown that oral nutritional supplements (ONS) can improve the nutritional status and clinical outcomes of patients after surgery for gastric cancer with nutritional risk. This study analyzed elderly patients who underwent radical surgery for gastric cancer in a previous randomized controlled trial to explore the impact of ONS on elderly patients after surgery for gastric cancer with nutritional risk. Methods: Patients discharged after gastric cancer radical surgery with nutritional risk who received treatment at Zhongshan Hospital affiliated with Fudan University from January 2017 to December 2018 were selected. The control group received dietary advice three months after discharge, while the ONS group received dietary advice combined with ONS three months after discharge. The weight, body mass index (BMI), hemoglobin, plasma albumin, and chemotherapy tolerance of the two groups were compared three months after discharge. The data for this study was based on a previous randomized controlled trial (ChiCTR2000029708) which had received ethical approval. This study was approved by the Ethics Committee of Zhongshan Hospital Affiliated to Fudan University (B2019-257R2). Results: A total of 125 patients who met the inclusion criteria were finally selected, including 69 in the ONS group and 56 in the control group. After 3 months of intervention, there were no significant differences in weight, BMI, hemoglobin, and plasma albumin levels between the two groups. However, the ONS group showed a significantly smaller decrease in weight change during the intervention period compared to the control group [(2.50±1.60)kg vs (4.24±1.80)kg, P<0.05]. The chemotherapy tolerance of the ONS group was significantly improved compared to the control group, with a decrease in the overall chemotherapy change rate (15.9% vs 41.1%, P=0.002), and fewer patients in the ONS group experienced chemotherapy delays, reduced drug dosages, and discontinuation of chemotherapy than those in the control group. Multivariate analysis showed that body weight, plasma albumin, hemoglobin, NRS2002, and BMI had no significant effect on the normal course of chemotherapy (P>0.05); only ONS was a significant protective factor, significantly reducing the risk of chemotherapy modification (OR=0.227, P=0.001). Conclusion: ONS helps improve the chemotherapy tolerance of elderly postoperative gastric cancer patients and to some extent enhances their nutritional outcomes. For elderly postoperative gastric cancer patients with nutritional risk, nutritional intervention after discharge has a positive impact on improving clinical outcomes.

Key words: Gastric cancer, Oral nutritional supplements, Elderly, Discharged patients, Chemotherapy tolerance