3718 - Malnutrition Screening Gaps and Nutritional Intervention Disparities in GI Cancer Patients Receiving Radiation Therapy: A National Inpatient Analysis
Presenter(s)
J. Lasington1, L. S. Mathew Lasington2, S. Umamaheshwaran3, and D. Patel1; 1New York Medical College at St. Mary's and St. Clare's, Denville, NJ, 2Rutger's University, East Hanover, NJ, 3Personio, Manhattan, NY
Purpose/Objective(s): Malnutrition is common in GI cancer patients receiving radiation therapy (RT), yet national data on coding rates, mortality impact, and equitable access to nutritional interventions are lacking. We hypothesized that malnutrition is under-recognized and that nutritional intervention access varies by socioeconomic status.
Materials/Methods: Using the NIS (2019-2022), we identified adult hospitalizations with GI cancer (ICD-10: C15-C25) and radiation exposure markers. Malnutrition was identified via E40-E44, E46; cachexia via R63.4, R64. Multivariable logistic regression identified predictors of mortality and TPN receipt, adjusting for demographics, comorbidities, cancer site, insurance, income, and hospital type.
Results: We identified 30,315 weighted hospitalizations. Malnutrition was coded in 26.0%, varying by site: esophageal (43.6%), gastric (34.4%), anal (30.6%), pancreatic (26.6%), rectal (23.6%), and colon (17.7%). Overall mortality was 2.2%. Cachexia independently predicted mortality (OR 2.50, 1.94-3.22, p<0.001), along with metastatic disease (OR 4.04), sepsis (OR 7.44), dehydration (OR 3.33), and CKD (OR 2.23; all p<0.001). Esophageal cancer had the highest site-specific mortality (OR 3.53 vs rectal). Rural hospitals had higher mortality (OR 1.74, 1.14-2.65). Among malnourished patients, TPN receipt was 10.2% (private) versus 3.9% (Medicaid) and 4.2% (self-pay). Medicaid (OR 0.28, 0.20-0.39) and self-pay (OR 0.26, 0.13-0.50) independently predicted reduced TPN access. Lowest income quartile had 41% lower TPN odds (OR 0.59, 0.46-0.77). Asian/PI patients had reduced TPN access (OR 0.54, 0.37-0.80). TPN rates among malnourished: 8.7% White, 6.3% Black, 6.4% Hispanic, 2.4% Asian/PI.
Conclusion: One-quarter of GI cancer patients hospitalized with radiation exposure have coded malnutrition, approaching 44% in esophageal cancer. Cachexia doubles mortality risk. Medicaid and uninsured patients are 70-74% less likely to receive TPN when malnourished, with racial minorities also having reduced access. These findings support standardized malnutrition screening in radiation oncology and equitable nutritional intervention access.
| TPN ACCESS DISPARITIES AMONG MALNOURISHED PATIENTS | ||||||||
| Group | N (weighted) | Malnutrition % | TPN % (all) | TPN % (if malnutrition) | TPN OR | 95% CI | p-value | Interpretation |
| Private insurance | 8,330 | 25.3% | 3.7% | 10.2% | ref | - | - | Reference |
| Medicare | 13,130 | 29.6% | 3.3% | 8.5% | 1.04 | 0.85-1.29 | 0.688 | No difference |
| Medicaid | 5,965 | 23.5% | 1.2% | 3.9% | 0.28 | 0.20-0.39 | <0.001 | 72% less likely |
| Self-pay | 1,045 | 23.0% | 1.0% | 4.2% | 0.26 | 0.13-0.50 | <0.001 | 74% less likely |
| White | 17,340 | 27.2% | 3.1% | 8.7% | ref | - | - | Reference |
| Black | 4,605 | 29.1% | 2.2% | 6.3% | 0.88 | 0.68-1.14 | 0.329 | No difference |
| Hispanic | 4,975 | 18.9% | 1.6% | 6.4% | 0.74 | 0.56-0.99 | 0.040 | 26% less likely |
| Asian/PI | 1,600 | 25.6% | 2.2% | 2.4% | 0.54 | 0.37-0.80 | 0.002 | 46% less likely |
| Q1 income (lowest) | - | 25.8% | 2.0% | - | 0.59 | 0.46-0.77 | <0.001 | 41% less likely |
| Q4 income (highest) | - | 26.6% | 3.6% | - | ref | - | - | Reference |