Nutritional Implications of Esophageal Cancer

Cancer of the esophagus has a high mortality rate of greater than 82% within five years of diagnosis. There is little difference in mortality rate between the two main subtypes of esophageal cancer (EC), esophageal squamous cell cancer (ESCC) and esophageal adenocarcinoma (EAC). When symptoms develop and a diagnosis made, EC is often in the late stages of the disease and weight loss leading to malnutrition is common. The treatment of EC, which includes radiation therapy, chemotherapy, and the esophagectomy, can further contribute to gastrointestinal side effects, weight loss, and inflammation contributing to high rates of malnutrition. Malnutrition in EC is associated with longer hospital stays and higher mortality rates after esophagectomy. Due to the high incidence and consequence of malnutrition, nutrition assessment and intervention should be an essential component of EC treatment and outcomes. Nutritional risk assessment throughout treatment can be determined using nutritional screen tools such as the Subjective Global Assessment (SGA), Patient-Generated Subjective Global Assessment, and the Nutrition Risk Screening tool (NRS). Indirect calorimetry should be used to determine basal energy requirements but, if unavailable, the Harris Benedict equation can be used to estimate energy requirements with the use of disease and physical activity factors to prevent weight loss and promote lean mass accretion. Dietitian driven nutritional assessment and implementation of nutrition support protocols; including the provision adequate nutrition prior to as well as soon after surgery, can improve nutritional status and post-surgery outcomes. Three to five days prior to the esophagectomy, supplemental immune enhanced nutrition (IEN) containing eicosapentaenoic acid (EPA) should be given orally or enterally and should commence 24 to 48 hours postoperatively. If parenteral nutrition (PN) is needed it should be administered concurrently with EN if possible. Lipid emulsions containing Ω-3 fatty acids for PN administration should be used. Dietitian driven nutrition therapy should continue postoperatively, and follow up should continue after discharge until dietary intake is adequate to meet nutritional goals.