esophageal cancer is one of the most common cancers in the world , with diagnoses of more than 480,000 patients and 400,000 deaths annually . the incidence and mortality rate of esophageal cancer rises continuously , especially in the mainland of china . surgery and chemoradiotherapy ( crt ) are the important strategies for the treatment of esophageal cancer . it is reported that 79% of esophageal cancer patients experience malnutrition , which is caused mainly by anorexia and dysphagia , before the treatment starts . the dysphagia - related nutrition deficiency could be even worse during the treatment and as a result , weight lost would occur . furthermore , malnutrition is a sign of poor outcomes in cancer patients , which negatively affected the response to therapy , the length of hospital stay ( los ) , the quality of life , complications , infections , and the survival rate . therefore , it is necessary to implement cancer patients treatment on malnutrition . nutritional intervention could improve clinical outcomes of cancer patients , including esophageal cancer . besides , nutritional support was mainly given to patients by the routes of oral nutritional supplements ( ons ) , the enteral nutrition ( en ) , and the parenteral nutrition ( pn ) . it has been shown clinical benefits of nutritional intervention via en in esophageal cancer patients who are undergoing radiochemotherapy ( rct ) , which guiding clinicians using en to enhance the nutritional status and functional capacity . the rationale for nutritional support is to improve nutritional status , modulate inflammatory responses , decrease the risk of infection , and enhance the quality of life . in order to provide more reasonable and effective nutritional intervention , besides , in order to provide nutrition supports , the european society of parenteral and enteral nutrition ( espen ) recommends the contribution of multidisciplinary nst . nst has been found to reduce the incidence of complications , in - patient costs , and mortality rates . based on our knowledge , few randomized control trials have evaluated the effect of nst in esophageal cancer patients with concurrent crt . nst was established in the huanxing hospital ( beijing , china ) in april 2012 . team members includes : physicians , registered dietitians , pharmacologists , nurses , and managers . the major goals of the nst were to normalize the medical nutrition therapy ( mnt ) and to emphasize on the nutrition care process during the mnt . the functional area includes the office , the metabolism laboratory , and configured rooms for dietary , en , pn , etc . the purpose of this study was to investigate the clinical therapy effects of nst and to provide nst services to esophageal patients , who are treated with crt . the patients were recruited in department of comprehensive oncology , chinese academy of medical sciences cancer hospital ( camsch ) , including a total of 50 esophageal cancer in - patients , between june 2012 and april 2014 . the study was designed and conducted in accordance with the declaration of helsinki and was approved by the institutional board and ethics committee of camsch . the patients were eligible to participate in the study if they had confirmed pathological result of primarily phase iii esophageal cancer ( squamous cell carcinomas ) with a planned treatment by radiotherapy combined chemotherapy , weight loss < 10% and diet decrease ( but > 60% targeted feeding volume ) , the patient - generated subjective global assessment ( pg - sga ) score 4 points , and accepted written informed consent . exclusion criteria were being severe malnutrition ( weight loss > 10% , blood albumin [ alb ] < 30 g / l , or body mass index [ bmi ] < 18.5 kg / m ) , having serious heart , lung or brain disease , with chronic hepatitis , cirrhosis , chronic nephritis or renal insufficiency , complicated with infectious fever , and en or pn intolerance . based on the different nutrition intervention methods , 50 eligible patients were randomly assigned into the nst group and the control group , all of whom received the same crt treatment for two cycles of chemotherapy followed by the radiotherapy . the standard anti - cancer therapy included concurrent crt with cisplatin / carboplatin with paclitaxel and radiotherapy according to the center 's current practice 5060 gy/2 gy/2530 f. nutritional support included diet counseling , ons , en , and pn . the patients in the nst group met with a member of the nst , which consisted of board - certified dietitians and advanced - practice nurses . specific attention was paid to nutrition risk screening , nutrition assessment , nutrition intervention , nutrition monitoring , and evaluation via standardized clinical nutrition process . the energy intake goal was 3035 kcalkgd and the macronutrient intakes were protein : 1.5 g / kg ( 20% ) , fat : 1.3 g / kg ( 40% ) , and carbohydrates : 3 g / kg ( 40% ) . the patients in the control group were conducted by chief physicians and were not scheduled to meet with the nst service . the nutrition therapy for the control group mainly included ons and pn without intake goals . all the following parameters were measured in the beginning and the end of the study . nutritional and blood determinations height ( m ) and weight ( kg ) were measured and bmi were calculated as bmi = kg / m . the quantity of prealbumin ( palb ) , transferrin , and alb were tested from the peripheral blood . incidence of complications the number of hemoglobin ( hgb ) , leukocyte , platelet ( plt ) were counted automatically . infections related to complications were identified and recorded , including catheter related infection , pulmonary infection , local skin infection , and mucosal inflammation infection . bone marrow depression were observed and graded according to the national cancer institute - common toxicity criteria version 3.0 . the completion rates of therapy , the los , and the in - patient cost were recorded during the study . all statistical analysis was performed with spss , version 20.0 ( spss inc . , chicago , il , usa ) . continuous variables were described by mean  standard deviation ( sd ) and compared using two - sample student 's t - test or analysis of variance ( anova ) , when appropriate . the patients were recruited in department of comprehensive oncology , chinese academy of medical sciences cancer hospital ( camsch ) , including a total of 50 esophageal cancer in - patients , between june 2012 and april 2014 . the study was designed and conducted in accordance with the declaration of helsinki and was approved by the institutional board and ethics committee of camsch . the patients were eligible to participate in the study if they had confirmed pathological result of primarily phase iii esophageal cancer ( squamous cell carcinomas ) with a planned treatment by radiotherapy combined chemotherapy , weight loss < 10% and diet decrease ( but > 60% targeted feeding volume ) , the patient - generated subjective global assessment ( pg - sga ) score 4 points , and accepted written informed consent . exclusion criteria were being severe malnutrition ( weight loss > 10% , blood albumin [ alb ] < 30 g / l , or body mass index [ bmi ] < 18.5 kg / m ) , having serious heart , lung or brain disease , with chronic hepatitis , cirrhosis , chronic nephritis or renal insufficiency , complicated with infectious fever , and en or pn intolerance . based on the different nutrition intervention methods , 50 eligible patients were randomly assigned into the nst group and the control group , all of whom received the same crt treatment for two cycles of chemotherapy followed by the radiotherapy . the standard anti - cancer therapy included concurrent crt with cisplatin / carboplatin with paclitaxel and radiotherapy according to the center 's current practice 5060 gy/2 gy/2530 f. nutritional support included diet counseling , ons , en , and pn . the patients in the nst group met with a member of the nst , which consisted of board - certified dietitians and advanced - practice nurses . specific attention was paid to nutrition risk screening , nutrition assessment , nutrition intervention , nutrition monitoring , and evaluation via standardized clinical nutrition process . the energy intake goal was 3035 kcalkgd and the macronutrient intakes were protein : 1.5 g / kg ( 20% ) , fat : 1.3 g / kg ( 40% ) , and carbohydrates : 3 g / kg ( 40% ) . the patients in the control group were conducted by chief physicians and were not scheduled to meet with the nst service . the nutrition therapy for the control group mainly included ons and pn without intake goals . all the following parameters were measured in the beginning and the end of the study . nutritional and blood determinations height ( m ) and weight ( kg ) were measured and bmi were calculated as bmi = kg / m . the quantity of prealbumin ( palb ) , transferrin , and alb were tested from the peripheral blood . incidence of complications the number of hemoglobin ( hgb ) , leukocyte , platelet ( plt ) were counted automatically . infections related to complications were identified and recorded , including catheter related infection , pulmonary infection , local skin infection , and mucosal inflammation infection . bone marrow depression were observed and graded according to the national cancer institute - common toxicity criteria version 3.0 . the completion rates of therapy , the los , and the in - patient cost were recorded during the study . continuous variables were described by mean  standard deviation ( sd ) and compared using two - sample student 's t - test or analysis of variance ( anova ) , when appropriate . baseline characteristics of patients were shown in table 1 . there were 25 patients in the nst group ( 18 males , 7 females ) and 25 patients in the control group ( 17 males , 8 females ) . homogeneity analyses for baseline characteristics were performed for all the patients data sets [ table 1 ] . baseline characteristics ( age , gender , weight , bmi , pg - sga value , cancer diagnosis , treatment protocols , and hematological parameters ) were well - balanced between the two groups . however , comparing with the control group , during the crt treatment course , more patients in the nst group used tube feedings ( 68% vs. 32% , p = 0.023 ) . baseline characteristics of the esophageal cancer patients undergoing concurrent crt in both nst and control groups values are expressed as n or mean  sd . * crt : chemoradiotherapy ; pg - sga : patient - generated subjective global assessment ; bmi : body mass index ; wbc : white blood cell ; hgb : hemoglobin ; plt : platelets ; palb : prealbumin ; alb : albumin ; ons : oral nutritional supplements ; spn : supplementary parenteral nutrition ; nst : nutrition support team ; sd : standard deviation . the results showed that the nst group had better weight maintenance data compared to the control group ( nst group : 0.36  2.16 , p = 0.412 ; and control group : 2.44  2.60 , p = 0.000 ) . besides , changes of weight between the two groups had a significant difference [ p = 0.000 ; table 2 ] . changes in the characteristics of patients before and after the treatments values are expressed as mean  sd . * p<0.05 when compared with baseline values in each group ; p<0.05 when compared with control group . palb : prealbumin ; alb : albumin ; wbc : white blood cell ; hgb : hemoglobin ; plt : platelets ; sd : standard deviation ; nst : nutrition support team . after treatment , palb in both groups increased . however , a significant increase in palb was observed in nst group ( 79.98  57.54 , p = 0.000 ) while no significant difference ( 17.43  66.52 , p = 0.203 ) was found in the control group . in addition , changes of palb between the two groups had a significant difference [ p = 0.001 ; table 2 ] . compared with baseline , the transferrin of the nst group increased significantly ( 0.36  0.67 , p = 0.013 ) , whereas transferrin in the control group decreased significantly ( 0.43  0.61 , p = 0.002 ) . the changes of transferrin between the two groups had a significant difference [ p = 0.000 ; table 2 ] . alb in nst group remained almost the same ( 0.00  4.57 , p = 1.000 ) . in contrast , alb in the control group decreased significantly ( 5.80  4.79 , p = 0.000 ) . the changes in alb had a significant difference between both groups [ p = 0.000 ; table 2 ] . in the nst group , white blood cell ( wbc ) , hgb , and plt did not decline significantly ( p = 0.238 , 0.145 , and 0.178 , respectively ) . on the contrary , all these three levels in the control group had a significant decrease ( p = 0.000 , 0.000 , and 0.001 , respectively ) . furthermore , the changes of wbc and plt had a significant difference between these two groups ( wbc : 0.56  2.30 vs. 2.69  3.13 , p = 0.008 ; plt : 19.21  69.24 vs. 76.44  98.09 , p = 0.021 ) , and the nst group tended to have a greater hgb than control group after the treatment ( 0.59  1.96 vs. 1.15  0.99 , p = 0.205 ) [ table 2 ] . the incidences of bone marrow suppression ( grade ii and above ) and complications related infection were both lower in the nst group than in the control group . there were significant differences in the percentage of patients experienced bone marrow suppression ( 20% vs. 48% , p = 0.037 ) and complications related infection ( 12% vs. 44% , p = 0.012 ) [ table 3 ] . complication incidence and completion rates of therapy values are expressed as n ( % ) . there was only one patient in the nst group who did not complete the treatment plan while 6 patients in control group experienced treatment interruptions ( dose reductions or delays ) . although there was no significantly difference between the two groups , the completion rates of therapy was higher in the nst group than control group ( 96% vs. 76% , p = 0.103 ) [ table 3 ] . at last , the average los and the in - patient cost were compared between the two groups . by comparing to the control group , the average los of patients in the nst group decreased by 4.5 days ( 45.68  3.87 vs. 50.16  5.38 days , t = 3.382 , p = 0.001 ) and the in - patient cost reduced 1.3 thousand dollars person - times ( 16.95  2.50 vs. 18.22  2.80 thousand dollars , t = 1.683 , p = 0.099 ) ( student 's t - test ) . baseline characteristics of patients were shown in table 1 . there were 25 patients in the nst group ( 18 males , 7 females ) and 25 patients in the control group ( 17 males , 8 females ) . homogeneity analyses for baseline characteristics were performed for all the patients data sets [ table 1 ] . baseline characteristics ( age , gender , weight , bmi , pg - sga value , cancer diagnosis , treatment protocols , and hematological parameters ) were well - balanced between the two groups . however , comparing with the control group , during the crt treatment course , more patients in the nst group used tube feedings ( 68% vs. 32% , p = 0.023 ) . baseline characteristics of the esophageal cancer patients undergoing concurrent crt in both nst and control groups values are expressed as n or mean  sd . * crt : chemoradiotherapy ; pg - sga : patient - generated subjective global assessment ; bmi : body mass index ; wbc : white blood cell ; hgb : hemoglobin ; plt : platelets ; palb : prealbumin ; alb : albumin ; ons : oral nutritional supplements ; spn : supplementary parenteral nutrition ; nst : nutrition support team ; sd : standard deviation . the results showed that the nst group had better weight maintenance data compared to the control group ( nst group : 0.36  2.16 , p = 0.412 ; and control group : 2.44  2.60 , p = 0.000 ) . besides , changes of weight between the two groups had a significant difference [ p = 0.000 ; table 2 ] . changes in the characteristics of patients before and after the treatments values are expressed as mean  sd . * p<0.05 when compared with baseline values in each group ; p<0.05 when compared with control group . palb : prealbumin ; alb : albumin ; wbc : white blood cell ; hgb : hemoglobin ; plt : platelets ; sd : standard deviation ; nst : nutrition support team . after treatment , palb in both groups increased . however , a significant increase in palb was observed in nst group ( 79.98  57.54 , p = 0.000 ) while no significant difference ( 17.43  66.52 , p = 0.203 ) was found in the control group . in addition , changes of palb between the two groups had a significant difference [ p = 0.001 ; table 2 ] . compared with baseline , the transferrin of the nst group increased significantly ( 0.36  0.67 , p = 0.013 ) , whereas transferrin in the control group decreased significantly ( 0.43  0.61 , p = 0.002 ) . the changes of transferrin between the two groups had a significant difference [ p = 0.000 ; table 2 ] . alb in nst group remained almost the same ( 0.00  4.57 , p = 1.000 ) . in contrast , alb in the control group decreased significantly ( 5.80  4.79 , p = 0.000 ) . the changes in alb had a significant difference between both groups [ p = 0.000 ; table 2 ] . in the nst group , white blood cell ( wbc ) , hgb , and plt did not decline significantly ( p = 0.238 , 0.145 , and 0.178 , respectively ) . on the contrary , all these three levels in the control group had a significant decrease ( p = 0.000 , 0.000 , and 0.001 , respectively ) . furthermore , the changes of wbc and plt had a significant difference between these two groups ( wbc : 0.56  2.30 vs. 2.69  3.13 , p = 0.008 ; plt : 19.21  69.24 vs. 76.44  98.09 , p = 0.021 ) , and the nst group tended to have a greater hgb than control group after the treatment ( 0.59  1.96 vs. 1.15  0.99 , p = 0.205 ) [ table 2 ] . the incidences of bone marrow suppression ( grade ii and above ) and complications related infection were both lower in the nst group than in the control group . there were significant differences in the percentage of patients experienced bone marrow suppression ( 20% vs. 48% , p = 0.037 ) and complications related infection ( 12% vs. 44% , p = 0.012 ) [ table 3 ] . complication incidence and completion rates of therapy values are expressed as n ( % ) . there was only one patient in the nst group who did not complete the treatment plan while 6 patients in control group experienced treatment interruptions ( dose reductions or delays ) . although there was no significantly difference between the two groups , the completion rates of therapy was higher in the nst group than control group ( 96% vs. 76% , p = 0.103 ) [ table 3 ] . at last , the average los and the in - patient cost were compared between the two groups . by comparing to the control group , the average los of patients in the nst group decreased by 4.5 days ( 45.68  3.87 vs. 50.16  5.38 days , t = 3.382 , p = 0.001 ) and the in - patient cost reduced 1.3 thousand dollars person - times ( 16.95  2.50 vs. 18.22  2.80 thousand dollars , t = 1.683 , p = 0.099 ) ( student 's t - test ) . the prevalence of malnutrition , caused by dysphagia and anorexia , is high in patients with esophageal cancer . during the crt , some patients experienced malnutrition / cachexia - related complications , which affected the therapy outcomes negatively . in our study , a significant difference between the two groups on nutritional status and blood parameters after crt for about 45 days was occurred . normalized nutritional support through the nst has showed more effective roles on improving treatment compliances and nutritional status than through the control group . in - patients nutritional status in the nst group were improved or maintained , yet the status decreased significantly in the control group during crt . as we known , palb was associated with dietary intake when synthetic functions were normal in the liver . moreover , palb is suggested as a sensitive nutritional biomarker for evaluating the nutritional status of esophageal cancer patients undergoing concurrent crt . the patients in both groups had a low level of palb and transferrin with normal liver function before treatment , which was caused by inadequate intake . after treatment , palb and transferrin increased significantly in the patients of nst group while decreased or did not change in control group , suggesting nst has benefits on dietary intake and nutritional status . bone marrow suppression was one of the most common complications during crt due to the decreasing production of blood cells . in the control group , wbc , hgb , and plt decreased significantly , associated with the high incidence of bone marrow suppression . in stark contrast , these three parameters corresponded to low incidence in the nst group . the results suggested that the incidence of bone marrow suppression decreased significantly in patients with better nutritional status , although simple nutrition support could not improve bone marrow suppression during crt . our results also showed clearly that less patients in nst group experienced complications related infection compared with the control group . furthermore , the los and the in - patient cost were both increased because of the complications related infection in the control group . the outcomes of locally advanced esophageal cancer patients by concurrent rct were related to the nutritional status and the dosage of rct . however , chemotherapy or radiotherapy for cancer patients were often delayed or terminated due to complications , significantly affecting the outcomes . besides , the prolonged treatment caused by interrupting radiotherapy was also associated with a poor prognosis . compared with 76% patients in the control group , 96% patients in nst group completed the rct plan , suggesting that normalized nutritional support through nst provided better rct compliance . more patients in nst group used tube feeding than in the control group . en via tube feeding was recommended by espen for esophageal cancer patients , who could not eat regular food , were likely to have mucositis in the course of radiotherapy , which was benefit to nutritional status and to improve prognosis . , our results indicated that nutrition management via nst was conducive to maintain nutritional status , improve rct compliance and tolerability , and reduce the los and the in - patient cost for esophageal cancer patients concurrent rct . in future , we will pay more attention to the comparison of prognosis between the two groups . our study suggests that the nst is necessary for the proper administration of nutrition intervention for the hospitalized esophageal cancer patients with rct to achieve the best therapeutic effect . this work was supported by a grant of the national high - tech research and development program ( 863 program ) ( no . this work was supported by a grant of the national high - tech research and development program ( 863 program ) ( no .
background : the prevalence of malnutrition is very high in patients with cancer . the purpose of this study was to investigate whether or not a nutrition support team ( nst ) could benefit esophageal cancer patients undergoing chemoradiotherapy ( crt).methods : between june 2012 and april 2014 , 50 esophageal cancer patients undergoing concurrent crt were randomly assigned into two groups : the nst group and the control group . 
 the nutritional statuses of 25 patients in the nst group were managed by the nst . 
 the other 25 patients in the control group underwent the supervision of radiotherapy practitioners . at the end of the crt , nutritional status , 
 the incidence of complications , and completion rate of radiotherapy were evaluated . besides , the length of hospital stay ( los ) and the in - patient cost were also compared between these two groups.results:at the completion of crf , the nutritional status in the nst group were much better than those in the control group , as evidenced by prealbumin ( alb ) , transferrin , and alb parameters ( p = 0.001 , 0.000 , and 0.000 , respectively ) . 
 the complication incidences , including bone marrow suppression ( 20% vs. 48% , p = 0.037 ) and complications related infections ( 12% vs. 44% , p = 0.012 ) , in the nst group were lower and significantly different from the control group . 
 in addition , only one patient in the nst group did not complete the planned radiotherapy while 6 patients in the control group had interrupted or delayed radiotherapy ( 96% vs. 76% , p = 0.103 ) . 
 furthermore , the average los was decreased by 4.5 days ( p = 0.001 ) and in - patient cost was reduced to 1.26  0.75 thousand us dollars person - times ( p > 0.05 ) in the nst group.conclusions:a nst could provide positive effects in esophageal cancer patients during concurrent crt on maintaining their nutrition status and improving the compliance of crf . 
 moreover , the nst could be helpful on reducing los and in - patient costs .