Patients with advanced pancreatic ductal adenocarcinoma (PDAC) are at high risk for nutritional decline, including weight loss, negative gastrointestinal symptoms, and metabolic disturbances that can occur after chemotherapy. However, new findings from the NUANCE study suggest that structured, interdisciplinary nutritional support could help optimize nutrition and nutrition-related health outcomes for patients with PDAC.
Ronan McLaughlin, MRCPATH, MBBCh, of the Princess Margaret Cancer Center at the University of Toronto, and colleagues conducted the study and presented their findings during the American Society of Clinical Oncology (ASCO) 2026 Gastrointestinal Cancers Symposium.
It was important to conduct the study because inadequate nutritional support is associated with increased toxicity, decreased survival, and poorer quality of life. In previous prospective cohorts of the NUANCE study, findings have shown that “most patients deteriorate nutritionally from baseline with a significant reduction in weight (P<0.001), albumin (P<0.001), and symptoms using the Edmonton Symptom Assessment Scale (ESAS) tool in the first months on chemotherapy.”
Eligible patients included individuals with locally advanced or metastatic unresectable PDAC who were undergoing systemic chemotherapy. Recruited participants received “comprehensive initial assessments” and were “pre-emptively supported by a registered dietitian, nurse specialist, and social worker.” In addition, evaluation of nutrition ESAS scores and Eastern Cooperative Oncology Group Performance Status (ECOG PS) scores was performed from baseline to four months.
According to the results, 100 patients have been recruited to the NUANCE study since October 2022, including 78 patients with metastatic PDAC and 22 patients with locally advanced PDAC. The results included “baseline measurable nutritional parameters and symptoms,” and 4-month measurements of the same metrics.
The median follow-up time was eight months, and the median age of participants was 67.5 years. Forty-four percent of patients were female. The results revealed a median overall survival (OS) of 12 months and showed that diabetes was observed in 39% of patients at baseline. Fifty-four percent of patients with diabetes were prescribed insulin, while 88% of participants were offered pancreatic enzyme replacement.
Pain, appetite, and diarrhea were among the symptoms that showed improvement after the nutritional intervention was implemented. In contrast, ESAS energy level scores showed no changes. Moreover, “no significant worsening” was observed across weight and ECOG PS categories. Overall, the investigators also noted that completion of ESAS scores was low at 50%.
In reflecting on the results, the researchers explained that no significant deteriorations in weight, ECOG PS, or albumin maintenance were observed, signifying “a marked improvement over the previous cohort suggesting this program helps maintain patients’ nutrition and wellbeing during the critical first four months of chemotherapy.” They also outlined next steps for the NUANCE study, including building the study design into an app, along with “accessible support to patients with advanced PDAC.”
“This supports the integration of nutritional screening and interprofessional support as a critical component of PDAC routine care to mitigate chemotherapy toxicity and improve patient-centered outcomes,” the investigators concluded.
