LB20

A prospective study into the proportion of hospitalised cancer patients at risk of refeeding syndrome

Liz Graham, Seema Gupta, Haleema Sadia, Nabil El-Mahdawi, Vijay Agarwal, Mohammad Butt

The Queens Oncology Centre, East Yorkshire, UK

Background
Refeeding syndrome (RFS) has been recognised as a serious biochemical condition resulting from the sudden re-feeding of malnourished patients (Crook and Swaminathan 1996). Little exists in the oncologic literature about RFS (Marinella 2008). The aim of this study was to identify the proportion of cancer inpatients who were at risk from RFS.

Method
In this study, RFS was defined as A collection of electrolyte disturbances, including one or more of the following: hypophosphataemia (<0.7mmol/l), hypokalaemia (<3.5mmol/l), hypomagnesia (<0.5mmol/l) occurring 2-4days post dietetic intervention i.e. oral nutrition support, enteral or parenteral nutrition. A prospective observational study was undertaken over a 3 month period. During this time approximately 1400 cancer patients were admitted and screened for risk of malnutrition using a Trust validated screening tool based on Birmingham Heartlands (Validated by McDougall et al 2008). High risk patients were reviewed by dietitians and blood result were accessed from electronic patient records.

Results
Eleven percent (154/1400) of patients had a nutritional risk score >10 (high risk); 62% (95/154) were included in the study, 10% (16/154) of patients were excluded due to terminal stages of illness or death (unrelated to RFS) and data for 28% (43/154) patients was unobtainable. Thirty two percent (31/95) of patients were at a high risk of developing RFS (NICE 2006) of which 45% (14/31) developed RFS. Amongst patients who developed RFS; 2 had refractory myeloma, 2 lymphoma, 3 head and neck cancer, 3 rectal cancer, 3 lung cancer and 1 prostate cancer. Mean weight was 57kg (SD 12.3), mean BMI 20 (SD 3.3) and mean weight loss over 3-6 months was 11.6% (SD 7.7).

Conclusion
This study found that RFS could occur in 45% of high-risk malnourished cancer patients. Recognition and appropriate management is mandatory in the treatment of this potentially fatal condition.