Elsevier

Clinical Nutrition

Volume 38, Issue 2, April 2019, Pages 644-651
Clinical Nutrition

Original article
Prevalence of malnutrition and impact on clinical outcomes in cancer services: A comparison of two time points

https://doi.org/10.1016/j.clnu.2018.04.007Get rights and content

Summary

Background

The prevention and management of malnutrition is increasingly recognised as a significant element of cancer care. By identifying and comparing cancer malnutrition in two large cross-sectional cancer populations, this study aims to provide a greater understanding of clinical characteristics and trajectories relating to cancer malnutrition.

Methods

A multi-centre point prevalence study was conducted in Victoria, Australia at two time points (March 2012, May 2014). Adults with cancer receiving ambulatory chemotherapy, radiotherapy and multi-day inpatients were included. The presence of malnutrition was determined using Patient Generated-Subjective Global Assessment (PG-SGA). Demographic, clinical information and 30-day outcomes were collected.

Results

The study included 1677 patients in 2012 (17 sites) and 1913 patients in 2014 (27 sites). Older age, ≥5% weight loss, hospital admission and metastatic disease were factors significantly associated with malnutrition. Patients with upper gastrointestinal, head and neck and lung cancers were more likely to be malnourished. Malnutrition was associated with infection and poor outcomes at 30-days. Malnutrition prevalence reduced from 31% in 2012 to 26% in 2014 (p = 0.002). This reflects a reduction in patients with malnutrition receiving ambulatory chemotherapy, those with upper gastrointestinal or colorectal cancers and those residing in regional areas.

Conclusion

The study has provided a comprehensive description of cancer malnutrition prevalence representative of all treatment settings, tumour types and stages of disease. This provides valuable insight into cancer malnutrition enabling oncology services to identify opportunities to embed identification and prevention strategies into models of care, resulting in improved patient outcomes and reduced health care costs.

Introduction

In 2012, the global incidence of cancer reached 14.1 million new cases, while 32.6 million people were living with a cancer diagnosis [1]. Cancer treatment is often associated with significant acute toxicities that negatively impact on the ability to achieve an adequate nutritional intake with a subsequent increased risk of malnutrition. Malnutrition due to starvation, disease or ageing has been defined as “a state resulting from lack of uptake or intake of nutrition leading to altered body composition (decreased fat free mass) and body cell mass leading to diminished physical and mental function and impaired clinical outcome from disease [2]. International evidence based guidelines highlight the severe negative impact on patient outcomes, including reduced survival, increased health care costs and recognise malnutrition as a significant supportive care need [3], [4], [5]. Understanding the magnitude of the problem and in which groups the greatest need exists is a vital step toward the recognition and management of cancer malnutrition.

Cancer patients have one of the highest prevalence of malnutrition [6]. Cross-sectional and point prevalence studies using a variety of malnutrition assessment techniques, across various oncology populations have been undertaken in a number of countries [7], [8], [9], [10]. These studies have largely focused on particular patient populations including patients with advanced cancer or those in the inpatient or ambulatory setting.

The Patient Generated-Subjective Global Assessment (PG-SGA) is a standardised tool for assessing nutritional status [11] and has been validated as having the ability to detect patients with malnutrition in oncology settings [12], [13]. It has also widely used in other studies of malnutrition in cancer populations [10], [14], [15], [16].

There is currently a lack of data regarding malnutrition prevalence in patients undergoing active cancer treatment across all treatment settings, tumour types and disease stage. This study aimed to identify and compare the prevalence of cancer malnutrition at two time points for both inpatients admitted for cancer related care and ambulatory patients receiving chemotherapy and/or radiotherapy.

Section snippets

Study design and setting

This prospective multi-centre point prevalence study was conducted in public and private health services across the state of Victoria, Australia at two time points, March 2012 and May 2014. Seventeen sites participated in 2012, which represented greater than 70% of the cancer treatments delivered in the state, and included the highest volume cancer services in metropolitan and regional Victoria. In 2014 the study was conducted in a total of 27 sites, all original sites and 10 additional sites.

Results

A total of 1677 participants were included in 2012 and 1913 in 2014. The flow of participants is described in Fig. 1.

Participant characteristics were similar across both study groups, with details described in Table 1.

Discussion

This unique study conducted at two-time points, reports for the first time the prevalence and factors associated with cancer malnutrition from a population which is representative of all treatment settings, tumour types and stages of disease. Overall malnutrition prevalence was 31% in 2012 and 26% in 2014. This overall prevalence is lower than results reported in previous cross sectional populations, including the 2014 study of 1903 patients attending French hospitals [22], the 2005 Spanish

Conclusion

The study has provided a comprehensive description of malnutrition prevalence in cancer patients receiving active treatment across all treatment settings, tumour types and disease stage. Social, demographic and clinical characteristics have been identified that increase the likelihood of malnutrition. The findings of this study provide valuable clinical insight into cancer malnutrition that can inform the design and delivery of clinical oncology services to prevent the poor patient outcomes and

Funding sources

A grant was provided to each participating health services by the Victorian Government (Australia) to support their participation at each time point.

Conflict of interest

All authors declare no conflict of interest.

Authors contributions

Conception and design: Linda Nolte, Kathryn Marshall, Jenelle Loeliger.

Financial support: Linda Nolte.

Data analysis and interpretation: Kathryn Marshall, Jenelle Loeliger, Nicole Kiss, and Amber Kelaart.

Manuscript writing: All authors.

Final approval of manuscript: All authors.

Acknowledgements

As the authors, we thank the managers and coordinating dietitians from participating Nutrition departments including Albury Wodonga Health: Jane Ford; Alfred Health: Ibolya Nyulasi, Melina De Corte, Susannah King; Austin Health: Leonie Pearce, Brooke Chapman, Kate Kaegi; Ballarat Health Services: Meredith Atkinson, Rebecca Nunes; Barwon Health: Roy Hoevenaars, Carolyn Hall; Bendigo Health: Lee Mason, Virginia Fox, Narelle McPhee, Lauren Ballantyne; Cabrini Health: Elizabeth Kent, Sally Zeunert,

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    Present Address: Clinical Nutrition, Royal Melbourne Hospital, Grattan St, Melbourne, Victoria, 3000, Australia.

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