Table 5 Nutritional status and quality of life in heterogeneous cancer population

Norman K, 2010, Germany [30]

NA

Prospective cross-sectional

189

Gastrointestinal: 103; Head and Neck: 30; Urinary Tract: 8; Gynecologic: 21; Others: 13

SGA

EORTC-QLQ-C30

SGA-A: Well nourished (n = 109)

SGA-B: Moderately malnourished & SGA-C: Severely malnourished (n = 80)

Most QoL functional scales were significantly reduced in malnutrition and the majority of symptom scales were higher in the malnourished patients. Malnutrition emerged as an independent determinant for functional status (estimated effect size 19.4%, p < 0.001) next to age and gender, which were the strongest predictors.

Malnutrition is a disease independent risk factor for reduced muscle strength and functional status in cancer patients.

Norman K, 2010, Germany [10]

December 2006 to June 2007

Prospective consecutive case series

399 with solid or hematologic tumor disease

Gastrointestinal: n = 149; Head and neck or lung: n = 71; Urogenital: n = 23; Gynecologic: n = 35; Neuroendocrine, adrenal, thyroid: n = 30; Others: n = 20; Hematologic disease: n = 71

1. SGA

2. Phase angle determined by BIA

EORTC-QLQ-C30

1. SGA –

SGA-A: Well nourished (n = 167)

SGA-B: Moderately malnourished (n = 132) & SGA-C: Severely malnourished (n = 100).

2. BIA –

Below fifth

percentile (n = 191) & above fifth percentile (n = 208) of the phase angle

Univariate:

All function scales of the EORTC quality-of-life questionnaire apart from emotional function were significantly impaired in patients with a phase angle below the fifth reference percentile, and among the symptom scale, fatigue, nausea and vomiting, pain, dyspnea, appetite loss, and constipation were increased.

Multivariate:

The standardized phase angle was an independent predictor of muscle function as were sex, age, and SGA in a GLM regression model and an independent predictor for EORTC global function score next to SGA, BMI, handgrip strength, and age.

The standardized phase angle is an independent predictor for impaired functional and nutritional status than are malnutrition and disease severity in cancer.

Shahmoradi N, 2009, Malaysia [5]

November 2008 to April 2009

Prospective

61

Colon: n = 8;

Rectum: n = 8;

Breast: n = 11;

Lung: n = 7;

Stomach: n = 4;

Prostate: n = 3; Kidney: n = 3;

Nasopharynx: n = 3; Leukemia: n = 3; Liver: n = 2

Brain: n = 2;

Cevix uteri: n = 1; Ovary: n = 1;

Pancreas: n = 1;

Other: n = 4

PG-SGA

HQLI

Well-nourished, Severely

malnourished & Moderately malnourished

Univariate:

The PG-SGA score was significantly correlated to total quality of life score (p = 0.000). PG-SGA score alone was able to explain 38% of the total variation in total quality of life score.

Multivariate:

PG-SGA score showed significant correlation with psychophysiological well-being (p = 0.000), functional well-being (p = 0.000) and social/spiritual well-being (p = 0.040). PG-SGA score is able to explain 36.9%, 41.8% and 7% of the total variation in psychophysiological, functional and social/spiritual wellbeing, respectively.

Advanced cancer patients with poor nutritional status have a diminished quality of life. There is a need for a comprehensive nutritional intervention for improving nutritional status and quality of life in terminally ill cancer patients under hospice care.

Tong H, 2009, Australia [3]

Data collection concluded in 2000, primary data analysis by 2001

Prospective observational longitudinal study

219 solid and hematological

Head neck: n = 7;Gastrointestinal: n = 47; Breast: n = 63; lung: n = 15; urinary: n = 31; Soft tissue–skin–brain–CNS: n = 7; Primary unknown: n = 3; Hematological: n = 46

PG-SGA

Global QoL was measured using Life Satisfaction Scale

Both PG-SGA & QoL are used as continuous variables

A small to medium negative correlation was found between PG-SGA scores and life satisfaction scores across all time points.

1. At baseline (n = 218):

r = −0.224, p = 0.001

2. At 6 months (n = 196):

r = −0.350, p < 0.001

3. At 12 months (n = 157):

r = −0.288, p < 0.001).

Nutrition impact symptoms were commonly experienced, even 12 months following commencement of chemotherapy, and were associated with poorer QoL and performance status.

Nourissat A, 2008, France [31]

Over 2 weeks

Transversal observational study

883 evolving cancer s

Males (n = 434)

Lung: n = 105;

Colorectal: n = 84; Prostate: n = 67

Females (n = 449)

Breast: n = 194;

Colorectal: n = 79;Ovary: n = 33

Weight loss

EORTC-QLQ C30

Weight loss < 10% (n = 622) & Weight loss ≥ 10% (n = 261)

(a) Mean Global QoL score = 62.8 & 48.8 respectively for weight loss < 10% & ≥ 10%, p < 0.001.

(b) Physical, functional, emotional, cognitive and social functions were significantly higher in weight loss < 10% group. Symptom scores were also lower for fatigue, nausea, vomiting, pain, dyspnea, loss of appetite, constipation and diarrhea.

To improve QoL in patients with cancer, a nutritional intervention should be implemented as soon as cancer is diagnosed. The nutritional therapy should form part of the integral oncological support.

Trabal J, 2006, Spain [6]

April 2004 to September 2004

Descriptive cross-sectional study, consecutive case series

50 non-terminal cancer

Lung: n = 20; Breast: n = 7;

Gynecologic: n = 6; Esophagus: n = 4; Others: n = 13

1. BMI

2. Percentage of usual

weight

3. Ideal weight percentage,

4. Percentage weight loss

5. TSF

6. Mid-upper arm circumference

7. Serum albumin

8. Prealbumin

9. Total proteins

EORTC QLQ-C30

Protein intake < 0.9 g/kg/d & ≥ 0.9 g/kg/d

1. Patients with hypo albuminemia reported more problems with diarrhea (p = 0.05).

2. Protein intake below 0.9 g/kg was associated to a poorer perception on physical functioning (p = 0.01), and fatigue was close to significance (p = 0.058).

3. No significant differences were found regarding caloric intake though, being fatigue (p = 0.06) the closest relation.

4. No other nutritional parameters, like percentage of weight loss, were statistically related to changes in QoL.

Nutrition is only one of the factors that influence QoL in cancer patients, but nutritional evaluation of cancer patients needs to be improved and individualized nutritional counseling should be done, so as to offer better treatment of symptoms and to improve patients’ QoL.

Ravasco P, 2004, Portugal [32]

July 2000 to September 2002

Prospective, cross-sectional, consecutive case series

271

Head and neck

Base of tongue: n = 11; Salivary gland: n = 6; Tonsil: n = 4; Nasopharynx: n = 11; Oropharynx: n = 22; Larynx: n = 33; Oesophagus: n = 14; Stomach: n = 26; Colorectum: n = 144

Percentage

weight loss over the previous

6 months

EORTC-QLQ C30

≥ 10% weight loss & < 10% weight loss over the previous 6 months

Malnutrition was associated with poorer function scales and with some symptoms: global QoL (P = 0.05),

physical (P = 0.01), role (P = 0.02), cognitive (P = 0.02), emotional (P = 0.01) and social (P = 0.01); anorexia (P = 0.001), increased fatigue (P = 0.03), dyspnea, insomnia and diarrhea (P = 0.04).

Although cancer stage was the major determinant of patients’ QoL globally, there were some diagnoses for which the impact of nutritional deterioration combined with deficiencies in nutritional intake may be more important than the stage of the disease process.

Isenring E, 2003, Australia [2]

Over a 1 year period

Prospective longitudinal

60 ambulatory patients receiving radiation therapy

to the head, neck, rectal or abdominal area

PG-SGA

EORTC-QLQ C30

well-nourished (n = 39)

malnourished (n = 21)

PG-SGA scores and QoL used as continuous variables

(A) At baseline –

Correlation between PG-SGA score and global QoL

r = − 0.66, P < 0.001

(B) After 4 weeks of radiotherapy –

Correlation between PG-SGA score and global QoL

r = − 0.61, P < 0.001

(C) Correlation between the change in PG-SGA score and change in global QoL

r = − 0.55, P < 0.001

26% of the variation of change in QoL was explained by change in PG-SGA score (P = 0.001). A change in PGSGA score of 9 resulted in a change of 17 in the QoL score.

The scored PG-SGA is a nutrition assessment tool that identifies malnutrition in ambulatory oncology patients receiving radiotherapy and can be used to predict the magnitude of change in QoL.

Ravasco P, 2003, Portugal [7]

July 2000 to

February 2001

Prospective longitudinal study,

Consecutive case series

125

HR: High Risk

Oesophagus: n = 6;Stomach: n = 5; Colorectal: n = 46; Base of the tongue: n = 3;

Salivary gland: n = 1; Tonsil: n = 2

Nasopharynx: n = 3; Oropharynx: n = 3; Larynx: n = 11

LR: Low Risk

Prostate: n = 21;

Breast: n = 7;

Lung : n = 5;

Brain: n = 4;

Gallbladder: n = 6; Uterus: n = 2

SGA

1. EUROQOL

2. EORTC-QLQ-C30

QoL used as a continuous variable

Normal, moderate and severe malnutrition groups

(A) EUROQOL –

1. At baseline:

In HR patients, baseline malnutrition was associated with lower self reported health status (SRHS) (P = 0.002).

2. At the end of Radiotherapy:

Improved nutritional status was associated with higher SRHS (P = 0.03).

(B) EORTC-QLQ-C30 –

(a) At baseline:

In HR patients, malnutrition associated with worse function scales: global QoL (P = 0.05), physical (P = 0.01), role (P = 0.02), cognitive (P = 0.02), emotional (P = 0.01) and social (P = 0.01) as well as symptoms: poor appetite (P = 0.001) or increased fatigue (P = 0.03)

(b) At the end of Radiotherapy:

All associations with function scales were also present at the end of treatment: global QoL (P = 0.01), physical (P = 0.02), role (P = 0.02), cognitive (P = 0.03), emotional (P = 0.01) and social (P = 0.04). In LR patients, nutritional parameters were not significantly associated with QoL dimensions.

Malnutrition as assessed by SGA was associated with a worse QoL in high risk patients.

Ovesen L, 1993, Denmark [33]

In 1989

Prospective

104 biopsy-proven breast cancer, ovarian cancer, or small cell lung cancer.

Breast: n = 19;

Ovarian: n = 47;

Small cell lung: n = 38

Unintentional weight loss*

*defined as weight loss within recent 3 months

1. GHQ

2. QL

Weight-losing group (− weight loss): weight loss of ≥ 5% of habitual body weight (n = 56) &

Weight-stable group (+ weight loss): weight loss of < 5% of habitual body weight (n = 48)

General health, as assessed by the GHQ score, was rated significantly worse by patients with weight loss than by weight-stable patients. Similarly, the scores on the social

functioning and the outlook/happiness subscales indicated significantly lower quality of life for the patients with weight loss, and this result was confirmed by a significant group difference on the modified QL.

Many ambulatory cancer patients do not eat enough to maintain weight and that even a moderate weight loss is associated with psychological distress and lower quality of life.