{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T12:57:06Z","timestamp":1781873826986,"version":"3.54.5"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T00:00:00Z","timestamp":1781740800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Nutritional deterioration (ND) during radiotherapy (RT) for esophageal cancer is common, yet the optimal timing for proactive supportive care remains unclear. We characterized time-resolved nutritional trajectories, examined baseline factors associated with deterioration, and translated the findings into a patient-facing digital prototype.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this prospective longitudinal cohort, 123 patients underwent nutritional assessment at five timepoints (admission, RT1, RT14, RT20, and discharge) using the Patient-Generated Subjective Global Assessment (PG-SGA), serum albumin, and total protein. ND was defined as an upward shift in PG-SGA risk category (0\u20133\/4\u20138\/\u22659) from admission to discharge. Sleep was assessed by baseline interview, the Pittsburgh Sleep Quality Index (PSQI), and exploratory wearable measures. Logistic regression was used to identify baseline factors associated with ND. Complementary continuous-change analysis and linear mixed-effects modeling were additionally performed to characterize deterioration magnitude and longitudinal trajectories. Exploratory correlations assessed sleep\u2013nutrition associations. Based on the findings, a digital prototype (\u201cEsophageal Care Companion\u201d) was developed with risk-aware onboarding and phase-specific monitoring prompts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      PG-SGA increased from 4.59\u202f\u00b1\u202f3.66 at admission to 6.95\u202f\u00b1\u202f3.48 at RT20 (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001), with concordant declines in albumin and total protein. ND occurred in 40.7% (50\/123). In the primary categorical model, baseline sleep problems were associated with higher odds of ND [adjusted odds ratio (aOR) 2.48;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.034], as was N3 nodal stage (aOR 3.56;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.022). In complementary analyses, N3 remained associated with greater PG-SGA worsening and a distinct longitudinal nutritional trajectory, whereas the sleep signal was less consistent across continuous and longitudinal models. Sleep measures showed exploratory phase-specific associations with nutritional biomarkers, including RT14 rapid eye movement sleep duration with albumin (\n                      <jats:italic>r<\/jats:italic>\n                      \u202f=\u202f0.258;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.004) and discharge PSQI with PG-SGA (\n                      <jats:italic>r<\/jats:italic>\n                      \u202f=\u202f0.276;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.002).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Nutritional risk worsened during esophageal cancer RT, particularly in the mid-to-late treatment phase, supporting RT14\u2013RT20 as a clinically relevant window for intensified assessment and supportive-care escalation. Advanced nodal stage emerged as a robust marker of less favorable nutritional trajectory. Baseline sleep problems may serve as a low-burden observational risk signal but should be interpreted cautiously. The prototype demonstrates the feasibility of translating phase-aware risk monitoring into digital supportive care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2026.1828784","type":"journal-article","created":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T04:35:38Z","timestamp":1781757338000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Dynamic nutritional trajectories and deterioration risk in esophageal cancer radiotherapy: a prospective study"],"prefix":"10.3389","volume":"13","author":[{"given":"Jiayi","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Shenzhen Hospital, National Cancer Center\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Shenzhen, Guangdong, China"]},{"name":"School of Medicine, The Chinese University of Hong Kong","place":["Shenzhen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng","family":"Feng","sequence":"additional","affiliation":[{"name":"Department of Thyroid and Galactophore Surgery, People\u2019s Hospital of Longhua","place":["Shenzhen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinmei","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Shenzhen Hospital, National Cancer Center\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Di","family":"Qin","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Shenzhen Hospital, National Cancer Center\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lihong","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Shenzhen Hospital, National Cancer Center\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qi","family":"An","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Shenzhen Hospital, National Cancer Center\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siyuan","family":"Qu","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Shenzhen Hospital, National Cancer Center\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tianyu","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Shenzhen Hospital, National Cancer Center\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Shenzhen Hospital, National Cancer Center\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meng","family":"He","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Shenzhen Hospital, National Cancer Center\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,18]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"649","DOI":"10.1053\/j.gastro.2022.05.054","article-title":"The global landscape of esophageal squamous cell carcinoma and esophageal adenocarcinoma incidence and mortality in 2020 and projections to 2040: new estimates from GLOBOCAN 2020","volume":"163","author":"Morgan","year":"2022","journal-title":"Gastroenterology"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"3108","DOI":"10.1097\/CM9.0000000000003420","article-title":"Global esophageal cancer epidemiology in 2022 and predictions for 2050: a comprehensive analysis and projections based on GLOBOCAN data","volume":"137","author":"Qi","year":"2024","journal-title":"Chin Med J"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"992","DOI":"10.1016\/j.annonc.2022.07.003","article-title":"Oesophageal cancer: ESMO clinical practice guideline for diagnosis, treatment and follow-up","volume":"33","author":"Obermannov\u00e1","year":"2022","journal-title":"Ann Oncol Off J Eur Soc Med Oncol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1038\/bjc.2016.129","article-title":"Role of nutritional status and intervention in oesophageal cancer treated with definitive chemoradiotherapy: outcomes from SCOPE1","volume":"115","author":"Cox","year":"2016","journal-title":"Br J Cancer"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"3847","DOI":"10.31557\/APJCP.2021.22.12.3847","article-title":"Impact of weight loss on patients with locally advanced esophageal and Esophagogastric junction cancers treated with Chemoradiotherapy","volume":"22","author":"Wiwitkeyoonwong","year":"2021","journal-title":"Asian Pac J Cancer Prev"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"S86","DOI":"10.1016\/j.ijrobp.2009.05.070","article-title":"Radiation dose-volume effects in the esophagus","volume":"76","author":"Werner-Wasik","year":"2010","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"e42273","DOI":"10.1097\/MD.0000000000042273","article-title":"Research progress of radiation esophagitis: a narrative review","volume":"104","author":"Wu","year":"2025","journal-title":"Medicine"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"2898","DOI":"10.1016\/j.clnu.2021.02.005","article-title":"ESPEN practical guideline: Clinical Nutrition in cancer","volume":"40","author":"Muscaritoli","year":"2021","journal-title":"Clin Nutr"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1080\/01635581.2024.2406999","article-title":"Dietary counseling interventions during radiation therapy: a systematic review of feasibility, safety, and efficacy","volume":"77","author":"Oppermann","year":"2025","journal-title":"Nutr Cancer"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1141","DOI":"10.1093\/annonc\/mdy114","article-title":"Systematic review and meta-analysis of the evidence for oral nutritional intervention on nutritional and clinical outcomes during chemo(radio)therapy: current evidence and guidance for design of future trials. Ann Oncol off J Eur Soc","volume":"29","author":"de","year":"2018","journal-title":"Med Oncol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"2315","DOI":"10.31557\/APJCP.2020.21.8.2315","article-title":"Nutritional status in patients with esophageal Cancer receiving Chemoradiation and assessing the efficacy of usual Care for Nutritional Managements","volume":"21","author":"Movahed","year":"2020","journal-title":"Asian Pac J Cancer Prev"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"255","DOI":"10.5090\/jcs.25.048","article-title":"The impact of Chemoradiotherapy on nutritional status and quality of life in esophageal Cancer patients during the COVID-19 pandemic: a retrospective study in Taiwan","volume":"58","author":"Chiu","year":"2025","journal-title":"J Chest Surg"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1107","DOI":"10.1177\/10547738221092146","article-title":"Prevalence of sleep disturbance in patients with Cancer: a systematic review and Meta-analysis","volume":"31","author":"Al Maqbali","year":"2022","journal-title":"Clin Nurs Res"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"845","DOI":"10.1007\/s00520-019-04834-w","article-title":"Sleep disturbance and cancer-related fatigue symptom cluster in breast cancer patients undergoing chemotherapy","volume":"28","author":"Fox","year":"2020","journal-title":"Support Care Cancer Off J Multinatl Assoc Support Care Cancer"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"174","DOI":"10.37268\/mjphm\/vol.21\/no.3\/art.900","article-title":"Association between nutritional status and sleep quality among patients with Cancer. Malays","volume":"21","author":"Vanoh","year":"2021","journal-title":"J Public Health Med"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"322","DOI":"10.1097\/MCO.0000000000000389","article-title":"Assessing nutritional status in cancer: role of the patient-generated subjective global assessment","volume":"20","author":"Jager-Wittenaar","year":"2017","journal-title":"Curr Opin Clin Nutr Metab Care"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1016\/0165-1781(89)90047-4","article-title":"The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research","volume":"28","author":"Buysse","year":"1989","journal-title":"Psychiatry Res"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"e42073","DOI":"10.2196\/42073","article-title":"Quality of sleep data validation from the Xiaomi mi band 5 against polysomnography: comparison study","volume":"25","author":"Concheiro-Moscoso","year":"2023","journal-title":"J Med Internet Res"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1016\/s0261-5614(02)00214-5","article-title":"Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials","volume":"22","author":"Kondrup","year":"2003","journal-title":"Clin Nutr"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1186\/1472-6947-13-72","article-title":"Appraisal of the Karnofsky performance status and proposal of a simple algorithmic system for its evaluation","volume":"13","author":"P\u00e9us","year":"2013","journal-title":"BMC Med Inform Decis Mak"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"779","DOI":"10.1038\/sj.ejcn.1601412","article-title":"Use of the scored patient-generated subjective global assessment (PG-SGA) as a nutrition assessment tool in patients with cancer","volume":"56","author":"Bauer","year":"2002","journal-title":"Eur J Clin Nutr"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"e49089","DOI":"10.2196\/49089","article-title":"Examining the effectiveness of electronic patient-reported outcomes in people with cancer: systematic review and meta-analysis","volume":"26","author":"Perry","year":"2024","journal-title":"J Med Internet Res"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"dju244","DOI":"10.1093\/jnci\/dju244","article-title":"Development of the National Cancer Institute\u2019s patient-reported outcomes version of the common terminology criteria for adverse events (PRO-CTCAE)","volume":"106","author":"Basch","year":"2014","journal-title":"JNCI J Natl Cancer Inst"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1426","DOI":"10.1200\/OP.24.00066","article-title":"Engagement among diverse patient backgrounds in a remote symptom monitoring program","volume":"20","author":"Rocque","year":"2024","journal-title":"JCO Oncol Pract"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1001\/jama.2017.7156","article-title":"Overall survival results of a trial assessing patient-reported outcomes for symptom monitoring during routine Cancer treatment","volume":"318","author":"Basch","year":"2017","journal-title":"JAMA"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"596","DOI":"10.1080\/0284186X.2018.1560496","article-title":"The use of PRO in adverse event identification during cancer therapy \u2013 choosing the right questions to ask","volume":"58","author":"Nissen","year":"2019","journal-title":"Acta Oncol"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"119","DOI":"10.2147\/LCTT.S96443","article-title":"Radiation-induced esophagitis in lung cancer","volume":"7","author":"Baker","year":"2016","journal-title":"Lung Cancer"},{"key":"ref28","volume-title":"StatPearls","author":"Nesheiwat","year":"2025"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"102047","DOI":"10.1016\/j.esmoop.2023.102047","article-title":"Insomnia in adult patients with cancer: ESMO clinical practice guideline","volume":"8","author":"Grassi","year":"2023","journal-title":"ESMO Open"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1149","DOI":"10.1089\/jpm.2010.0507","article-title":"Cancer symptom clusters: clinical and research methodology","volume":"14","author":"Kirkova","year":"2011","journal-title":"J Palliat Med"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"791","DOI":"10.1093\/annonc\/mdt506","article-title":"Sleep disturbance in adults with cancer: a systematic review of evidence for best practices in assessment and management for clinical practice","volume":"25","author":"Howell","year":"2014","journal-title":"Ann Oncol Off J Eur Soc Med Oncol."},{"key":"ref32","doi-asserted-by":"publisher","first-page":"3363","DOI":"10.1007\/s11136-024-03778-x","article-title":"Symptom clusters and impact on quality of life in lung cancer patients undergoing chemotherapy","volume":"33","author":"Luo","year":"2024","journal-title":"Qual Life Res Int J Qual Life Asp Treat Care Rehabil"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"1791776","DOI":"10.3389\/fimmu.2026.1791776","article-title":"Plasma PFDN2 suppresses head and neck squamous cell carcinoma progression by restricting CD64 on monocyte-driven inflammatory microenvironments","volume":"17","author":"Feng","year":"2026","journal-title":"Front Immunol"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"2413","DOI":"10.1001\/jama.2022.9265","article-title":"Effect of electronic symptom monitoring on patient-reported outcomes among patients with metastatic cancer: a randomized clinical trial","volume":"327","author":"Basch","year":"2022","journal-title":"JAMA"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"1644","DOI":"10.1016\/j.cmet.2024.06.014","article-title":"Cyclic fasting-mimicking diet in cancer treatment: preclinical and clinical evidence","volume":"36","author":"Vernieri","year":"2024","journal-title":"Cell Metab"}],"container-title":["Frontiers in Nutrition"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2026.1828784\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T12:39:12Z","timestamp":1781872752000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2026.1828784\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,18]]},"references-count":35,"alternative-id":["10.3389\/fnut.2026.1828784"],"URL":"https:\/\/doi.org\/10.3389\/fnut.2026.1828784","relation":{},"ISSN":["2296-861X"],"issn-type":[{"value":"2296-861X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,18]]},"article-number":"1828784"}}