Anaemia is of prognostic significance in patients with oesophageal adenocarcinoma.

Anaemia is common in a wide range of malignancies and individual studies have demonstrated it to be an independent prognostic marker for survival in certain cancer types. The study population consisted of 171 patients: 77 anaemic and 94 non-anaemic. Sixty per cent of the study population had adenocarcinoma with 37% having squamous cell carcinoma. Late-stage disease occurred in 80% of individuals. There was no significant difference in survival times between the two groups (p=0.1), and after adjusting for confounding factors including age, sex, stage and physical status (p=0.8). Anaemic individuals with adenocarcinoma suffered a poorer survival probability compared to those with normal haemoglobon level (p=0.02). Anaemia is common at diagnosis in oesophageal cancer and was found to be a significant prognostic indicator of survival in adenocarcinoma, but not squamous cell carcinoma.

Assessment by a multidisciplinary clinical nutrition team before percutaneous endoscopic gastrostomy placement reduces early postprocedure mortality.

BACKGROUND: The purpose of this study was to determine whether preassessment by a multidisciplinary nutrition team before percutaneous endoscopic gastrostomy (PEG) placement can reduce postprocedure mortality. This was a prospective single-center audit. METHODS: Patients who had been referred to the Gastroenterology Department for consideration of PEG placement between 1995 and 2004 were included. In the index year, 2003-2004, where a formal nutrition team assessment was commenced, 79 patients were enrolled into our study group on a consecutive basis. These patients were subdivided into 3 groups; group A, PEG placed (51 patients); group B, PEG not placed due to severe comorbidity (19 patients); and group C, PEG not placed as deemed unnecessary (9 patients). Comparison was made with previous years where no formal preassessment had occurred. At Staffordshire General Hospital, a comparison of mortality post-PEG placement was made between the index group and previous years. Secondary measures included complication rates and frequency of biochemical monitoring. RESULTS: One week post-PEG mortality fell from 10%-20% in previous years to 0% in the index year (p < .02). This improved survival extended to 3 months postprocedure (p < .016). Three patients (6%) had biochemical evidence of refeeding syndrome postplacement. Biochemical monitoring was inadequate, with only 27/51 (53%) patients being completely monitored. No complications pertaining to the endoscopy were reported. CONCLUSIONS: This study demonstrates that early post-PEG mortality can be reduced by preassessment of patients by a multidisciplinary nutrition team and is evidence supporting the recommendations of the National Confidential Enquiry into Patient Outcome and Death report.