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

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.