Integrating Multimodal Supportive Care in Digestive Oncology: Nutritional Frailty Score and Lessons from ParcoursDig and PrePOP studies

Integrating Multimodal Supportive Care in Digestive Oncology: Nutritional Frailty Score and Lessons from ParcoursDig and PrePOP studies | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Integrating Multimodal Supportive Care in Digestive Oncology: Nutritional Frailty Score and Lessons from ParcoursDig and PrePOP studies Eva Ester MOLINA BELTRAN, Lucie GENTILHOMME, Anne-Laure VEDIE, and 16 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8028101/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Frailty, malnutrition, and sarcopenia are highly prevalent in digestive oncology and adversely affect treatment tolerance, toxicity, and survival. The integration of multimodal, multidisciplinary supportive care may mitigate these risks, but feasibility and clinical impact in routine practice remain uncertain. Methods We conducted two complementary single-center studies at a French cancer center. We developed a Nutritional Frailty Score to assess the risk of nutritional deterioration in patients receiving first-line chemotherapy for digestive cancers. ParcoursDig (NCT04478175) prospectively assessed the feasibility of systematic multimodal supportive care (dietitian, physiotherapist, palliative care) using risk stratification based on this score in patients with localized or advanced digestive cancers. PrePOP was a retrospective observational study of patients with pancreatic or esophagogastric cancers receiving perioperative chemotherapy and surgery. Outcomes included treatment completion, nutritional changes, toxicities, surgical complications, and survival. Results In ParcoursDig, only 44% of patients completed the full supportive care pathway (63% in sensitivity analysis), falling short of the predefined feasibility threshold. No significant improvements were seen in health-related quality of life or survival, highlighting real-world implementation challenges. In PrePOP, baseline malnutrition prevalence was 71% (31% severe). Malnutrition was clinically associated with higher rates of chemotherapy dose reduction but not with surgical complications or survival. Weight loss during systemic therapy was common, but early nutritional intervention appeared to prevent further deterioration for some patients. Muscle mass loss during follow-up correlated with poorer prognosis, emphasizing the need for longitudinal, muscle-specific assessment. Conclusions Low intensity interventions are not sufficient to improve patient outcomes. High-intensity modalities and individualized care trajectories with longitudinal follow-up warrant further evaluation in this population. frailty sarcopenia nutritional status supportive care prehabilitation digestive oncology Full Text Additional Declarations No competing interests reported. Supplementary Files Appendix1STROBEchecklistv4cohort.pdf SupplementaryFile2.pdf SupplementaryFile3completeReport.pdf Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8028101","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":557675949,"identity":"c477b60c-7795-4d10-bf34-150877a84c7e","order_by":0,"name":"Eva Ester MOLINA 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studies","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"frailty, sarcopenia, nutritional status, supportive care, prehabilitation, digestive oncology","lastPublishedDoi":"10.21203/rs.3.rs-8028101/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8028101/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eFrailty, malnutrition, and sarcopenia are highly prevalent in digestive oncology and adversely affect treatment tolerance, toxicity, and survival. The integration of multimodal, multidisciplinary supportive care may mitigate these risks, but feasibility and clinical impact in routine practice remain uncertain.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe conducted two complementary single-center studies at a French cancer center. We developed a Nutritional Frailty Score to assess the risk of nutritional deterioration in patients receiving first-line chemotherapy for digestive cancers. ParcoursDig (NCT04478175) prospectively assessed the feasibility of systematic multimodal supportive care (dietitian, physiotherapist, palliative care) using risk stratification based on this score in patients with localized or advanced digestive cancers. PrePOP was a retrospective observational study of patients with pancreatic or esophagogastric cancers receiving perioperative chemotherapy and surgery. Outcomes included treatment completion, nutritional changes, toxicities, surgical complications, and survival.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eIn ParcoursDig, only 44% of patients completed the full supportive care pathway (63% in sensitivity analysis), falling short of the predefined feasibility threshold. No significant improvements were seen in health-related quality of life or survival, highlighting real-world implementation challenges. In PrePOP, baseline malnutrition prevalence was 71% (31% severe). Malnutrition was clinically associated with higher rates of chemotherapy dose reduction but not with surgical complications or survival. Weight loss during systemic therapy was common, but early nutritional intervention appeared to prevent further deterioration for some patients. Muscle mass loss during follow-up correlated with poorer prognosis, emphasizing the need for longitudinal, muscle-specific assessment.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eLow intensity interventions are not sufficient to improve patient outcomes. High-intensity modalities and individualized care trajectories with longitudinal follow-up warrant further evaluation in this population.\u003c/p\u003e","manuscriptTitle":"Integrating Multimodal Supportive Care in Digestive Oncology: Nutritional Frailty Score and Lessons from ParcoursDig and PrePOP studies","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-10 17:40:37","doi":"10.21203/rs.3.rs-8028101/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c1a52809-2aff-44ff-bd68-21e85d1b4474","owner":[],"postedDate":"December 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-27T14:09:13+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-10 17:40:37","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8028101","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8028101","identity":"rs-8028101","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}