Advertisement

Supportive Care in Cancer

, Volume 17, Issue 3, pp 279–284 | Cite as

Screening the nutritional status in oncology: a preliminary report on 1,000 outpatients

  • Federico Bozzetti
  • on behalf of the SCRINIO Working Group
Original Article

Abstract

Objective

This study presents the preliminary data of a prospective multi-centre investigation on the screening of the nutritional status of cancer outpatients with the purpose to define: (1) prevalence and rate of weight loss and nutritional risk in this patient population, and (2) to assess the association among some patient-dependent, tumour-dependent and therapy-dependent variables with the nutritional status and the nutritional risk.

Materials and methods

Seventeen centres were involved to collect demographic data (age and sex), oncologic data (site of primary tumour, stage, Eastern Cooperative Oncology Group Performance State, oncologic therapy) and presence and severity of systemic and digestive/nutritional symptoms (fatigue, anorexia, nausea/vomiting, early satiety, dysgeusia/dysosmia, dysphagia/odynophagia, diarrhoea/constipation). Furthermore, the percentage of the weight loss on the usual body weight and the body mass index were computed. The nutritional risk was assessed according to the Nutrition Risk Screening 2002 questionnaire which scores the risk from 0 to 7.

Main results

On the first 1,000 screened patients, a significant weight loss (≥10%) and a nutritional risk score ≥3 were observed in 39.7% and 33.8% of patients, respectively. Weight loss was higher in upper gastrointestinal tumours, in advanced stages of disease and in patients with a poor performance status. Similarly, the nutritional risk was higher in esophageal and pancreatic cancer and in those with a worse performance status. There was a good correlation between the severity of anorexia and the rate of the weight loss The majority of patients with no weight loss or a weight loss <10% were not anorectic; on the contrary, the majority of those with more severe weight loss had some degree of anorexia.

Conclusions

Weight loss and nutritional risk are frequent in an unselected series of cancer outpatients. Site of primary tumour, stage and performance state appear to be associated, at a preliminary analysis, with significant weight loss and nutritional risk. Anorexia and weight loss are closely related, and this supports the concept that nutritional depletion can play a major role in the onset of malnutrition-cachexia.

Keywords

Screening the nutritional status Nutritional status of cancer patients Malnutrition of cancer patients Cancer cachexia-anorexia 

Notes

Acknowledgements

We thank Novartis (now HealthCare Nestle) Medical Nutrition for the help in collecting data from different centres.

References

  1. 1.
    Ambrus JL, Ambrus CM, Mink IB (1975) Causes of death in cancer patients. J Med 6:61–64PubMedGoogle Scholar
  2. 2.
    Andreyev HJ, Norman AR, Oates J, Cunningham D (1998) Why do patients with weight loss have a worse outcome when undergoing chemotherapy for gastrointestinal malignancies? Eur J Cancer 34:2132–2133 doi: 10.1016/S0959-8049(97)10090-9 CrossRefGoogle Scholar
  3. 3.
    Bosaeus I, Daneryd P, Lundholm K (2002) Dietary intake, resting energy expenditure, weight loss and survival in cancer patients. J Nutr 132(11):3465S–3466SPubMedGoogle Scholar
  4. 4.
    Bosaeus IG, Ellegard L, Malmros V et al (2007) Body composition, gender, and survival in advanced cancer. Clin Nutr Suppl 2:111Google Scholar
  5. 5.
    Bozzetti F (2007) Total parenteral nutrition in cancer patients. Curr Opin Support Palliat Care 4:281–286CrossRefGoogle Scholar
  6. 6.
    Bozzetti F, Migliavacca S, Scotti A et al (1982) Impact of cancer, type, site, stage and treatment on the nutritional status of patients. Ann Surg 196:170–179PubMedGoogle Scholar
  7. 7.
    Correia MI, Waitzberg DL (2003) The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr 22:235–239 doi: 10.1016/S0261-5614(02)00215-7 PubMedCrossRefGoogle Scholar
  8. 8.
    Dewys WD, Begg C, Lavin PT et al (1980) Prognostic effect of weight loss prior chemotherapy in cancer patients.Estearn Cooperative Oncology Group. Am J Med 69:491–497 doi: 10.1016/S0149-2918(05)80001-3 PubMedCrossRefGoogle Scholar
  9. 9.
    Drzikova B, Wiedenmann B, Sturm A, Pape U (2007) Malnutrition screening of hospitalised gastroenterological patients with SGA and NRS in comparison with objective nutritional status parameters and clinical outcome. Clin Nutr Suppl 2:51Google Scholar
  10. 10.
    Edington J, Winter PD, Cole SJ et al (1999) Outcomes of undernutrition in the community with cancer or cardiovascular disease. Proc Nutr Soc 58:655–661 doi: 10.1079/PNS19990007 PubMedCrossRefGoogle Scholar
  11. 11.
    Fein R, Kelsen DP, Geller N et al (1985) Adenocarcinoma of the esophagus and gastroesophageal junction. Prognostic factors and results of therapy. Cancer 15:2512–2518 doi: 10.1002/1097-0142(19851115)56:10<2512::AID-CNCR2820561032>3.0.CO;2-9 CrossRefGoogle Scholar
  12. 12.
    Gupta D, Lammersfeld CA, Burrows JL et al (2004) Bioelectric impedance phase angle in clinical practice: implications for prognosis in advanced colorectal cancer. Am J Clin Nutr 80:1634–1638PubMedGoogle Scholar
  13. 13.
    Hosseini S, Amirkalali B, Nayebi N et al (2006) Nutrition status during hospitalization, Teheran, Iran. Nutr Clin Pract 21:518–521 doi: 10.1177/0115426506021005518 PubMedCrossRefGoogle Scholar
  14. 14.
    Inagaki J, Rodriguez V, Bodey GP (1974) Causes of death in cancer patients. Cancer 33:568–573 doi: 10.1002/1097-0142(197402)33:2<568::AID-CNCR2820330236>3.0.CO;2-2 PubMedCrossRefGoogle Scholar
  15. 15.
    Izawa S, Enoki H, Hirakawa Y et al (2007) Lack of body weight measurement is associated with mortality and hospitalization in community-dwelling frail elderly. Clin Nutr Suppl 2:35Google Scholar
  16. 16.
    Kadar L, Albertson M, Areberg J et al (2000) The prognostic value of body protein in patients with lung cancer. Ann N Y Acad Sci 904:584–591PubMedCrossRefGoogle Scholar
  17. 17.
    Klastersky J, Daneau D, Verhest A (1972) Causes of death in patients with cancer. Eur J Cancer 8:149–154 doi: 10.1016/0014-2964(72)90036-9 PubMedGoogle Scholar
  18. 18.
    Kondrup J, Rasmussen HH, Hamberg O, Stanga Z, ad hoc ESPEN Working Group (2003) Nutrition risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr 22:321–326PubMedCrossRefGoogle Scholar
  19. 19.
    Kondrup J, Allison SP, Elia M et al (2003) ESPEN guidelines for nutrition screening 2002. Clin Nutr 22:415–421 doi: 10.1016/S0261-5614(03)00098-0 PubMedCrossRefGoogle Scholar
  20. 20.
    Kudsk KA, Tolley EA, Chance DeWitt R et al (2003) Preoperative albumin and surgical site identity surgical risk for major postoperative complications. JPEN 27:1–9Google Scholar
  21. 21.
    Lennard-Jones JE, Arrowsmith H, Davison C et al (1995) Screening by nurses and junior doctors to detect malnutrition when patients are first assessed in hospital. Clin Nutr 14:336–340 doi: 10.1016/S0261-5614(95)80050-6 PubMedCrossRefGoogle Scholar
  22. 22.
    Mitry E, Douillard JY, Van Cutsem E et al (2004) Predictive factors of survival in patients with advanced colorectal cancer: an individual data analysis of 602 patients included in irinotecan phase III trials. Ann Oncol 15:1013–1017 doi: 10.1093/annonc/mdh267 PubMedCrossRefGoogle Scholar
  23. 23.
    Pedersen H, Hansen HS, Cederqvist C, Lober J (1982) The prognostic significance of weight loss and its integration in stage-grouping of oesophageal cancer. Acta Chir Scand 148:363–366PubMedGoogle Scholar
  24. 24.
    Persson C, Glimelius B (2002) The relevance of weight loss for survival and quality of life in patients with advanced gastrointestinal cancer treated with palliative chemotherapy. Anticancer Res 22:3661–3668PubMedGoogle Scholar
  25. 25.
    Pirlich M, Schutz T, Norman K et al (2006) The German hospital malnutrition study. Clin Nutr 25:563–572 doi: 10.1016/j.clnu.2006.03.005 PubMedCrossRefGoogle Scholar
  26. 26.
    Ravasco P, Monteiro Grillo I, Camilo M (2007) The long-term follow-up of a prospective randomised clinical trial of nutritional therapy in head and neck cancer patients submitted to radiotherapy. Clin Nutr Suppl 2:123Google Scholar
  27. 27.
    Ravera E, Bozzetti F, Ammatuna M, Radaelli G (1987) Impact of hospitalization on the nutritional status of cancer patients. Tumori 73:375–380PubMedGoogle Scholar
  28. 28.
    Ross PJ, Ashley S, Norton A, Priest K et al (2004) Do patients with weight loss have a worse outcome when undergoing chemotherapy for lung cancers? Br J Cancer 90:1905–1911 doi: 10.1038/sj.bjc.6601781 PubMedCrossRefGoogle Scholar
  29. 29.
    Stanley K (1980) Prognostic factors for survival in patients with inoperable lung cancer. J Natl Cancer Inst 65:25–32PubMedGoogle Scholar
  30. 30.
    Swenerton KD, Legha SS, Smith T et al (1979) Prognostic factors in metastatic breast cancer treated with combination chemotherapy. Cancer Res 39:1552–1562PubMedGoogle Scholar
  31. 31.
    Toso S, Piccoli A, Gusella M et al (2000) Altered tissue electric properties in lung cancer patients as detected by bioelectric impedance vector analysis. Nutritioion 16:120–124Google Scholar
  32. 32.
    Tubiana M, Attié E, Flamant R et al (1971) Prognostic factors in 454 cases of Hodgkin’s disease. Cancer Res 31:1801–1810PubMedGoogle Scholar
  33. 33.
    Van Bokorst-de van der Schueren MAE, van Leeuwen PAM, Kuik DJ et al (1999) The impact of nutritional status on the prognosis of patients with advanced head and neck cancer. Cancer 86:519–527 doi: 10.1002/(SICI)1097-0142(19990801)86:3<519::AID-CNCR22>3.0.CO;2-S CrossRefGoogle Scholar
  34. 34.
    Warren S (1932) The immediate cause of death in cancer. Am J Med Sci 184:610–615 DOI  10.1097/00000441-193211000-00002 CrossRefGoogle Scholar
  35. 35.
    Weinsier RL, Hunker EM, Krumdieck CL, Butterworth CE (1979) Hospital malnutrition: A prospective evaluation of general medical patients during the course of hospitalization. Am J Clin Nutr 32:418–426PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Federico Bozzetti
    • 1
    • 2
  • on behalf of the SCRINIO Working Group
  1. 1.Department of SurgeryHospital of PratoPratoItaly
  2. 2.Residenza Le Querce-Milano DueSegrateItaly

Personalised recommendations