Original articlePrevalence of malnutrition and impact on clinical outcomes in cancer services: A comparison of two time points
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,
References (40)
- et al.
Diagnostic criteria for malnutrition e an ESPEN consensus statement
Clin Nutr
(2015) - et al.
Nutritional status and dietary intake of acute care patients: results from the Nutrition Care Day Survey 2010
Clin Nutr 2010
(2012) - et al.
An epidemiological evaluation of the prevalence of malnutrition in Spanish patients with locally advanced or metastatic cancer
Clin Nutr
(2005) - et al.
Nutritional deterioration in cancer: the role of disease and diet
Clin Oncol
(2003) - et al.
Development of a valid and reliable malnutrition screening tool for adult acute hospital patients
Nutrition
(1999) - et al.
BMI and all-cause mortality in older adults: a meta-analysis
AJCN (Am J Clin Nutr)
(2014) - et al.
The German hospital malnutrition study
Clin Nutr
(2006) - et al.
Geriatric syndromes increased the nutritional risk in elderly cancer patients independently from tumour site and metastatic status (The ELCAPA-05 cohort study)
Clin Nutr
(2014) - et al.
Social risk factors for hospital malnutrition
Nutrition
(2005) - et al.
Body-mass index and risk of 22 specific cancers: a population-based cohort study of 5·24 million UK adults
Lancet
(2014)
Estimated incidence, mortality and prevalence worldwide in 2012 fact sheet
Oncology evidence-based nutrition practice guideline
Updated evidence-based practice guidelines for the nutritional management of patients receiving radiation therapy and/or chemotherapy
Nutr Diet
Board of Directors of the American Society for Parentral and Enteral Nutrition: A.S.P.E.N Clinical Guidelines: nutrition support therapy during adult anticancer treatment and in hematopoietic cell transplantation
J Parenter Enteral Nutr
Screening the nutritional status in oncology: a preliminary report on 1,000 outpatients
Support Care Canc
Prevalence of malnutrition and current use of nutrition support in patients with cancer
J Parenter Enteral Nutr
An evaluation of the prevalence of malnutrition in cancer patients attending the outpatient oncology clinic
Asia Pac J Clin Oncol
Patient generated subjective global assessment
Comparison of a malnutrition screening tool with subjective global assessment in hospitalised patients with cancer- sensitivity and specificity
Asia Pac J Clin Nutr
Use of the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in patients with cancer
Eur J Clin Nutr
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- 1
Present Address: Clinical Nutrition, Royal Melbourne Hospital, Grattan St, Melbourne, Victoria, 3000, Australia.
- 2
Present Address: ACP Program Manager, Austin Health, PO Box 5555 Heidelberg Victoria, 3084, Australia.
- 3
Present Address: Cancer Council Victoria, 615 St Kilda Rd, Melbourne, Victoria, 3004, Australia.
- 4
Present Address: Senior Lecturer, Deakin University, Geelong, Australia, Institute for Physical Activity and Nutrition (IPAN).