Clinical usefulness of the patient-generated subjective global assessment short form© for nutritional screening in patients with head and neck cancer: a multicentric study.

Nutritional screening and assessment are considered essential steps in nutritional care for cancer patients, malnutrition remains underreported in clinical practice. The aim of this study was to analyse the clinical usefulness of the Patient-Generated Subjective Global Assessment short form (PG-SGA SF©) for nutritional screening in patients with head and neck cancer (HNC). This is a multicentre, cross-sectional study involving patients with HNC. The final score of the PG-SGA SF© was obtained and the nutritional status was diagnosed using the Patient-Generated Subjective Global Assessment (PG-SGA)®, classifying them as well-nourished or malnourished. Receiver operating characteristic curve, ordinal logistic regression, and C-statistic were used. In total, 353 patients with HNC were enrolled and the prevalence of malnutrition, according to the PG-SGA®, was 64.02% and the median final score of PG-SGA SF© was 11 points. The final score of the PG-SGA SF© had high accuracy (area under the curve = 0.915), and scores ≥9 had the best performance in diagnosing malnutrition. PG-SGA SF© final score ≥9 was associated with malnutrition (odds ratio = 28.32, 95% confidence interval= 15.98-50.17), with excellent discriminatory power (C-statistic = 0.872). In conclusion, the PG-SGA SF© demonstrated excellent performance for nutritional screening in patients with HNC. Given that it is a simple instrument that is faster to administer than the PG-SGA®, we recommend its use in clinical practice among such patients.

Predictive validity of GLIM malnutrition diagnosis in patients with colorectal cancer.

BACKGROUND: Considering that the validation of the Global Leadership Initiative on Malnutrition (GLIM) remains unclear in patients with colorectal cancer, the present study aimed to assess the agreement, accuracy, sensitivity, specificity, and prognostic effect of the GLIM on survival when compared with the Patient-Generated Subjective Global Assessment (PG-SGA). METHODS: Patients with colorectal cancer who were scheduled to undergo a routine abdominal computed tomography (CT) scan were recruited. Using the GLIM two-step approach, the patients were first screened for malnutrition by using the PG-SGA Short Form (score ≥3). The malnutrition diagnosis was based on the etiologic (disease burden [cancer] or reduced food intake) and phenotypic GLIM criteria, including weight loss, body mass index, and skeletal muscle index at the third lumbar vertebra when using the CT scans. The food intake was assessed by the PG-SGA. RESULTS: This study included 191 patients (age, 60.5 ± 11.3 years; 57% men), and 23% and 32% were malnourished according to the GLIM and the PG-SGA, respectively. The GLIM revealed fair sensitivity (64%), good agreement (kappa = 0.65), specificity (96%), and diagnostic accuracy for detecting malnutrition (area under the receiver operating characteristic curve = 0.80; 95% CI, 0.72-0.88) when compared with the PG-SGA. The malnutrition value according to the GLIM and the PG-SGA was associated with short-term survival. However, only the PG-SGA was associated with long-term survival. CONCLUSIONS: Although showing fair sensitivity, the GLIM had good agreement, specificity, and diagnostic accuracy for malnutrition detection and was an independent predictor of short-term survival in patients with colorectal cancer.

A poorer nutritional status impacts quality of life in a sample population of elderly cancer patients.

RATIONALE: Quality of Life (QoL) is impaired in cancer, and the elderly are particularly vulnerable to malnutrition. A diagnosis of cancer in elderly patients further exacerbates risks of negative health outcomes. Here we investigated associations between QoL and nutritional status in a sample population of mostly socially deprived elderly cancer patients. METHOD: 432 cancer patients were recruited for this cross-sectional study at point of admission to a tertiary referral hospital for cancer treatment. Patient-generated subjective global assessment (PG-SGA) assessed nutritional status. Functional assessment of cancer therapy- general (FACT-G) quantified QoL. Relationship between PG-SGA and QoL was assessed by Spearman correlation. PG-SGA outcomes were compared against FACT-G scores employing Mann-Whitney test. Bivariate Linear Regression Model was employed to investigate influences of sociodemographic, clinical and nutritional status upon QoL. RESULTS: 37.5% of participants were malnourished or at risk. 39% were illiterate and 54.6% had family income lower than minimum wage. Malnourished patients showed lower FACT-G scores (76.8 vs. 84.7; p = 0.000). Poor nutritional diagnosis was inversely correlated with all QoL domains. Bivariate regression analysis showed that lower PG-SGA scores (ßo = - 1.00; p = 0.000) contributed to FACT-G score deterioration, the male gender showed better QoL scores, and other clinical and sociodemographic variables did not show relationship. CONCLUSION: Poorer nutritional status was significantly associated with worsened physical, social, emotional and functional well-being QoL domains in elderly cancer patients. Poorer nutritional status is an independent risk factor for worsened QoL. Future policies aimed at particularly vulnerable populations may improve QoL and health outcomes.

Nutritional assessment by subjective methods versus computed tomography to predict survival in oncology patients.

OBJECTIVES: The aim of this study was to analyze the association between survival and two validated methods of nutritional assessment: body composition through computed tomography (CT) scans and Patient-Generated Subjective Global Assessment (PG-SGA). METHODS: Cancer-bearing patients (n = 103) hospitalized in the Oncology Ward of Clínica Alemana in Santiago, Chile, for palliative or curative treatment were assessed by both methods. Images from abdominal CT scans at the L3 level were analyzed by SliceOmatic (version 5.0), to measure muscle and fat areas and densities. Skeletal muscle mass index (MMI) was calculated using total abdominal mass area (psoas + rest of muscles)/ height2. These were compared with those obtained for assessment of trauma of 130 healthy young adults (18-40 y of age), as reference control values. Sarcopenia was established as MMI<1 SD compared with control participants. RESULTS: Patients with cancer had less muscle and higher abdominal fat areas compared with controls (P < 0.05). According to the PG-SGA, ~50% were classified as malnourished. Patients were followed for 38 mo, when 53% had died. Survival time was significantly and negatively correlated with PG-SGA score, cancer stage, and sarcopenia, independent of age and sex. Multivariate analysis included both cancer stage and nutritional assessment variables. CONCLUSIONS: Together with cancer stage, both CT measurements and subjective assessment of nutritional status through PG-SGA can adequately identify cancer patients with a higher mortality risk, independent of age and sex. However, the latter is less costly and simple to use; it should be included as a valuable tool during management of patients with cancer.

High prevalence of malnutrition and nutrition impact symptoms in older patients with cancer: Results of a Brazilian multicenter study.

BACKGROUND: Malnutrition in cancer is an independent factor associated with negative clinical outcomes. The objective of this study was to evaluate the prevalence of malnutrition across different age groups in patients with cancer in Brazil and to identify associations with nutrition impact symptoms (NIS). METHODS: In this observational, cross-sectional, multicenter study, the authors evaluated 4783 patients with cancer aged ≥20 years who were admitted to 45 public hospitals in Brazil. Nutritional status, nutritional risk, and NIS were evaluated using the Patient-Generated Subjective Global Assessment. RESULTS: More than one-fourth (25.5%) of all participants were aged ≥65 years. In patients aged ≥65 years, the prevalence of moderate/suspected and severe malnutrition was 55%, it was 45.4% in those aged 51 to 64 years, and it was 36.1% in those aged ≤50 years. Among the NIS with a higher risk of occurrence in patients aged ≥65 years were no appetite (odds ratio [OR], 1.90; 95% CI, 1.62-2.22; P < .05) and dry mouth (OR, 1.40; 95% CI, 1.1-1.67; P < .05). In patients between ages 51 and 64 years, compared with those aged ≤50 years, the NIS with a higher risk of occurrence were no appetite (OR, 1.45; 95% CI, 1.23-1.69; P < .05), dry mouth (OR, 1.22; 95% CI, 1.02-1.45; P < .05), and problems with swallowing (OR, 1.56; 95% CI, 1.25-1.96; P < .05). CONCLUSIONS: The prevalence of malnutrition and the occurrence of NIS are high in hospitalized Brazilian patients aged ≥65 years who have cancer. The occurrence of NIS was higher in the population aged >50 years than in those aged ≤50 years. Nutritional screening and assessment should be performed immediately after hospitalization to enable early diagnosis and multidisciplinary or interdisciplinary intervention(s).

Malnutrition associated with nutrition impact symptoms and localization of the disease: Results of a multicentric research on oncological nutrition.

BACKGROUND & AIMS: Malnutrition in cancer is an independent factor associated with negative clinical outcomes. The aim was to evaluate the prevalence and independent risk factors for malnutrition in hospitalized cancer patients using the Patient-Generated Subjective Global Assessment (PG-SGA). METHODS: We evaluated 4783 cancer patients, aged ≥20 years, in a hospital-based, multicenter, cross-sectional study. Patients were classified as well-nourished (PG-SGA Stage A), moderate/suspected malnutrition (PG-SGA Stage B), or severely malnourished (PG-SGA Stage C), and provided a score to define required nutritional interventions. Multivariate analysis was composed of the odds ratio (OR) estimated by ordinal polytomous logistic regression. RESULTS: 45.3% were classified as Stage B and 11.8% as Stage C. Moreover, 45.3% of the patients presented a need for nutritional intervention. The variables that presented the highest ORs for Stage B or Stage C were: problems with swallowing (OR 2.8, 95% confidence interval (CI) 2.2-3.4, p < 0.001), loss of appetite (OR 1.9, 95% CI 1.6-2.3, p < 0.001), vomiting (OR 1.8, 95% CI 1.5-2.3, p < 0.001), presence of more than 3 nutrition impact symptoms (OR 8.3, 95% CI 5.8-12, p < 0.001), and cancer site: lung (OR 4.6, 95% CI 3.2-6.6, p < 0.001), upper digestive cancer (OR 3.7, 95% CI 2.7-5.2, p < 0.001), and head and neck cancer (OR 3.7, 95% CI 2.7-5.2, p < 0.001). The score for Worksheet 4 on the PG-SGA had a higher association with malnutrition (OR 7.3, 95% CI 6.6-8.2, p < 0.001). CONCLUSIONS: Malnutrition is highly prevalent in cancer patients in Brazil, and is associated with nutritional impact symptoms, cancer site and age ≥65 years.

Associação entre Avaliação Subjetiva Global Produzida pelo Próprio Paciente e musculatura esquelética determinada pela tomografia computadorizada em pacientes com câncer do colo do útero / [Association between Subjective Global Assessment Produced by the Patient and Skeletal Muscle Determined by Computed Tomography in Patients with Cervical Cancer]

Introdução: A miopenia é um problema significativo em pacientes oncológicos e a utilização de instrumentos fidedignos para sua identificação faz-se necessária. Objetivo: Avaliar a associação entre a Avaliação Subjetiva Global Produzida Pelo Próprio Paciente (ASG-PPP) com a musculatura esquelética avaliada pela tomografia computadorizada (TC) em pacientes com câncer do colo do útero. Métodos: Trata-se de um estudo observacional, transversal, com mulheres com câncer do colo do útero, maiores de 18 anos e que iniciaram o tratamento entre janeiro de 2015 e setembro de 2018. Foram incluídas as que apresentaram a ASG-PPP e imagens de TC, com intervalo máximo entre eles de 45 dias. O índice de musculatura esquelética (IME) foi utilizado para classificação da miopenia e um nível de significância de 5% foi adotado. Resultados: Pela ASG-PPP, a desnutrição esteve em 56% das pacientes e 23% foram classificadas com miopenia pela TC. Os parâmetros da ASG-PPP apresentaram associação significativa com o IME e os pontos de corte para o escore total da ASG-PPP ≥ 10, depleção muscular ≥ 2.0 e pontuação do exame físico ≥ 2.0, foram os que melhor descriminaram a miopenia. Conclusão: A ASG-PPP mostrou ser um método útil e viável que apresenta boa associação e correlação com o IME.

Introduction: Myopenia is a significant problem in oncology patients and the use of reliable instruments for its identification in clinical practice is necessary. Objective: To evaluate the association between the Scored Patient-Generated Subjective Global Assessment (PG-SGA) and skeletal muscle measured by computed tomography (CT) in patients with cervical cancer. Methods: This is an observational, cross-sectional study which enrolled women with cervical cancer, over 20 years, who started treatment between January 2015 and September 2018. The ones who presented PG-SGA and imaging of CT with a maximum interval of 45 days between them were included. The skeletal muscle index (SMI) was used to classify myopenia and a significance level of 5% was adopted. Results: According to the PG-SGA, malnutrition was found in 56% patients and 23% were classified with myopenia by CT. The PG-SGA parameters were significantly associated with the SMI. The cut-off points that best discriminated myopenia were the PG-SGA total score ≥ 10, muscle depletion ≥ 2.0 and physical examination score ≥ 2.0. Conclusion: The PG-SGA showed to be a useful and viable method that shows good association and correlation with the SMI.

Performance of Patient-Generated Subjective Global Assessment (PG-SGA) in Patients With Advanced Cancer in Palliative Care.

BACKGROUND: The purpose of this study was to evaluate the prognostic significance of the Patient-Generated Subjective Global Assessment (PG-SGA) in patients receiving palliative care for advanced cancer. METHODS: The PG-SGA was used to assess nutrition status of 120 patients admitted to the Palliative Care Unit at the National Cancer Institute in Brazil. RESULTS: According to the PG-SGA, 94.2% (n = 113) of the patients were evaluated as malnourished. The PG-SGA evaluated that xerostomia was the only symptom associated with a short survival (odds ratio [OR], 2.54; 95% confidence interval [CI], 1.2-5.38; P = .014). Survival was found to be significantly higher in well-nourished (PG-SGA A) than malnourished (PG-SGA B [ P = .021] or C [ P = .013]) patients. Total PG-SGA score (hazard ratio [HR], 1.06; 95% CI, 1.001-1.09; P = .045) and Karnofsky Performance Status of 20%-30% (HR, 15.4; 95% CI, 1.63-92.9; P = .001) and 40%-50% (HR, 10.0; 95% CI, 1.22-64.9; P = .031) were found to be independent prognostic survival factors. CONCLUSION: The scored PG-SGA is an independent prognostic factor of survival and thus can be a useful tool for nutrition evaluation in palliative care.

Association Between Nutrition Status and Survival in Elderly Patients With Colorectal Cancer.

BACKGROUND: Aging patients with cancer have a higher risk of mortality and treatment-associated morbidity than younger patients. Nutrition status may play an important role in cancer mortality. We aimed to evaluate the survival time of elderly patients with colorectal cancer and its association with body mass index (BMI), the patient-generated subjective global assessment (PG-SGA), and phase angle (PA). MATERIALS AND METHODS: BMI, PG-SGA, and PA were determined for all patients (n = 250) at first assessment. RESULTS: Seventy-one (28.4%) patients were in active oncologic treatment (group 1) and 179 (71.6%) were in remission (group 2). At the time of the analysis, 73 (29.2%) patients had died and 177 (70.8%) were censored. The mean (standard deviation) age was 70.9 (7.49) years; 17.2% were undernourished, 56% normal weight, and 26.8% were overweight. According to the PG-SGA, 35.2% of patients needed some nutrition intervention and 4.4% needed it urgently. The mean PA was 4.94 ± 1°. PG-SGA, tumor stage, and PA differed significantly ( P < .001) between the groups; BMI did not ( P = .459). Severe malnutrition (PG-SGA C), compared with PG-SGA A, was associated with a relative hazard of death of 12.04 (95% confidence interval [CI], 3.43-42.19, P < .001). PA >5° was associated with better prognosis: a relative hazard of 0.456 (95% CI, 0.263-0.792; P < .005). CONCLUSION: Among elderly patients with colorectal cancer, PA and PG-SGA were prognosis factors. PA >5° was associated with best survival and PG-SGA C with worst survival.

Desnutrición a partir de la valoración global subjetiva generada por el paciente (VGS-GP) en pacientes con cáncer de cabeza y cuello / Malnutrition based on the scored-patient-generated subjective global assessment (EGS-GP) in head and neck cancer patients at the national cancer institute

La desnutrición es una complicación frecuente en pacientes con cáncer de cabeza y cuello (CyC). La Valoración Global Subjetiva Generada por el Paciente (VGS-GP)es una herramienta validada para valorar el estado nutricional. El objetivo del estudio fuedeterminar la frecuencia de desnutrición según VGS-GP en pacientes con cáncer de cabeza y cuello en el Instituto Nacional del Cáncer (INC) “Prof. Dr. Manuel Riveros” en el periodo 2014-2015.Estudioobservacional descriptivo de corte transversal en el que se estudiaron 81 pacientes mayores de 18 años, de ambos sexos condiagnóstico de cáncer de cabeza y cuello en el periodo 2014 - 2015. El estado nutricional de los pacientes fue valorado mediante la herramienta VGS-GP. La VGS-GP mostró una desnutrición moderada/severa del 64,2% (32,1% categorías B y 32,1%categorías C). El 98% de los pacientes presentó complicaciones secundarias, siendo la disfagia el síntoma más frecuente. Las "categorías B y C" se observaron con mayor frecuencia en pacientes del sexo masculino, de edades avanzadas, en estadiosIII/IV de la neoplasia, así como en pacientes sometidos a cirugía y quimioterapia ycon cáncer en faringe, cavidad oral y esófago proximal. Según la VGS-GPmás de la mitad de los pacientes con cáncer de cabeza y cuello presentaron desnutrición moderada o severa ("categorías B y C").

Malnutrition is a common complication in head and neck cancer patients. Scored Patient-Generated Subjective Global Assessment (EGS-GP) is a validated tool fornutritional evaluation in patients with cancer. To determine the frequency of malnutritionac cording to Scored-Patient-Generated Subjective Global Assessment (EGS-GP) inpatients with head and neck cancer at the National Cancer Institute “Prof. Dr. Manuel Riveros” from 2014-2015. It’s an observational descriptive cross-sectional study with primary data. A total of 81 patients of both sexes, over 18 years old with head and neck cancer were studied using the Patient-Generated Subjective Global Assessment during the evaluation period between 2014-2015. Scored-PG-SGA showed moderately/severe lymalnutrition with 64.2% ("class B and C" with 32.1% for each one). A high percentage of the patients display secondary symptoms (98%) and the dysphagia is the most common symptom observed. "Class B and C" were showed with more frequency in male patients, an advanced age, stages III/IV of the neoplasia, as in patients treated with surgery and chemotherapy and in patients with cancer in pharynx, oral cavity and proximal esophagus. According to Scored-Patient-Generated Subjective Global Assessment (EGSGP)more than half of head and neck cancer patients had moderate or severe malnutrition.