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Investigating the Impact of Body Composition and Nutritional Intervention Strategies in Pancreatic Cancer

Background: Pancreatic cancer is the 9th most common cancer in Ireland, and the 5th most common cause of cancer-related mortality. Despite attempts to improve outcome by centralising surgery to high volume centres, and advances in chemotherapy, the 5 year survival remains poor at 5-6%. Malnutrition and cancer cachexia are highly prevalent in pancreatic cancer patients which limits treatment options and exacerbates the risk of complications.Recent progress in classifying cancer cachexia highlight the need to include body composition analysis in treatment planning and nutritional assessment.
A literature review will be carried out initially, focusing on body composition analysis and nutritional assessment methodology, aetiology of malnutrition in pancreatic cancer, and biomarkers for cancer cachexia.
The initial aim of this research is to establish the prevalence of sarcopenia and sarcopenic obesity in the Irish pancreatic cancer population by carrying out body composition analysis on diagnostic CT scans. Data will also be collected on surgical outcome, complication rate, length of stay, baseline nutritional status and post operative weight loss, and statistical analysis performed to assess potential associations.
The second aim of this research is to explore the feasibility of a comprehensive nutritional intervention by carrying out a prospective study, comparing the intervention group to usual nutritional care. The nutritional intervention will include elements such as individualised dietetic counselling, routine pancreatic enzyme replacement therapy, immunonutrient and advice on exercise/maximising physical activity. Outcomes include post operative length of stay, surgical complication rate using International Study Group definitions, post operative weight loss, and Quality of Life. Data will also be collected on barriers to patient compliance on individual components of the intervention to establish the practical applicability in clinical practice should the results highlight a beneficial effect.