Nurses Call for More Research on Nutrition Challenges for Patients With AML/MDS

Patients with acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS) are at an increased risk of nutrition complications, according to findings presented at the 48th Annual Oncology Nursing Society (ONS) Congress. Investigators conducted a literature review analysis, which demonstrated that these patients face challenges with eating, malnutrition, sarcopenia, impaired body mass index (BMI), weight loss, and impaired renal function.

Unfortunately, these challenges are often associated with impairments to physical functioning, and increased number of comorbidities, and in select cases, poor survival outcomes. Moreover, despite these findings, significant gaps remain in understanding the effect that nutrition challenges pose on these patients, according to Victoria R. Crowder, BSN, RN, who presented findings in a poster presentation.

“We did not find studies assessing effects of challenges on psychosocial outcomes or health of caregivers,” Crowder, a nurse at the University of North Caroline at Chapel Hill, said. “Only one study reported race and ethnicity of participants.”

AML and MDS are 2 related hematological cancers that predominately affect patients who are 60 years or older. The disease and the therapies used to treat them are associated with decreased food intake or taste preferences. Patients with these malignancies may find themselves unable to prepare meals or find their ability to absorb nutrients has been impaired. For example, chemotherapy-related adverse events (AEs), such as nausea, vomiting, and diarrhea, contribute to these ailments. Fatigue, which affects 46% to 98% of patients with AML and MDS, also deters patients from mealtimes and food intake.

In addition to affecting a patient’s physical health, nutrition has a negative effect on psychosocial health and quality of life, Crowder explained. It is important that nurses understand the full range of challenges that their patients experience to better help them mitigate these difficulties, she added.

To that end, nurse investigators sought to synthesize the existing literature surrounding challenges for older patients with nutritional struggles. Their literature review included 12 articles from PubMed, CINAHL, and SCOPUS. These articles were found using PRISMA-ScR guidelines. Patients eligible for assessment included those who were age 60 years or older with a diagnosis of AML/MDS. Studies had to be centered on gastrointestinal symptoms, nutritional conditions, or parenteral/enteral nutrition. Studies were excluded if they were assessing a clinical trial drug or assessing future cancer risk. Reviews, editorials, and qualitative designs were also excluded.

Overall, the synthesis included 8 retrospective studies, 3 prospective studies, and 1 that was not specified. Eight studies included patients with AML, 3 studies of patients with MDS, and 1 with a mix of both patients.

Nutritional status was assessed at the time of diagnosis in 4 studies and during induction chemotherapy in 3 studies. In 1 study, it was assessed during admission for hematopoietic stem cell transplantation. Two studies used a longitudinal assessment design.

Overall, across all the studies, 1 out of 3 patients with AML had a risk of malnutrition (mini-nutritional assessment [MNA] < 23.5) at baseline. Similarly, 1 out of 3 patients had already had 2% of greater weight loss before being admitted to stem cell transplantation.

Studies consistently demonstrated that increases in nutritional challenged worsen physical functioning. The studies also showed that patients with higher comorbidity index scores were more likely to experience gastrointestinal complications, such as mucositis, anal fissure, anal fistula, or hemorrhoids. No relationship was identified between MNA scores and severe (grade 3 or 4) treatment-related toxicities. Soy interventions were not shown to have an impact on clinical labs.

Furthermore, BMI showed no relationship to survival and MNAs showed mixed results: controlled nutritional status (CONUT) showed no relationship to survival but simplified CONUT scores did demonstrate a significant relationship. For patients with sarcopenia, being 60 years or older was linked to worse survival outcomes than being younger than 60 years.

As Crowder mentioned, the literature review did not identify any studies assessing the effects of these nutritional challenges on psychological outcomes or the health of the patient caregivers. Only one study reported on the race and ethnicity of the enrolled patients.

“We hope that a greater understanding of the challenges facing patients with AML and MDS may inform practice, [by] helping clinicians screen and address these challenges and to help them address the role these challenges can play in health and quality of life,” Crowder concluded.

Reference

Crowder VR, Bankole AO, Holliday AS, Fogle R, Leak Bryant A. Nutrition and eating in adults and older adults with acute myeloid leukemia and myelodysplastic syndromes: a scoping review. Poster Presented at: 48th Annual Oncology Nursing Society Congress; April 26-30, 2023; San Antonio, Texas. Accessed April 25, 2023. https://ons.confex.com/ons/2023/meetingapp.cgi/Paper/13277