Abstract
BackgroundIn cancer, malnutrition is common and negatively impacts tolerance and outcomes of anti-tumor therapies. The aim of this study was to evaluate the prevalence of malnutrition risk and compare the clinicodemographic features between those with high malnutrition screening tool (MST) scores (i.e., ≥ 2 of 5 = high risk for malnutrition, H-MST) to low scores (L-MST).MethodsA cohort of 3585 patients (May 2017 through December 2018), who completed the MST at least once at the time of diagnosis of any stage solid tumor, were analyzed. Logistic regression tested for associations between clinicodemographic factors, symptom scores, and H-MST prevalence.ResultsThe median age was 64 years (25–75 IQR, 55–72), with 62% females and 81% White. Most common tumor primary sites were breast (28%), gastrointestinal (GI) (21%), and thoracic (13%). Most had non-metastatic disease (80%). H-MST was found in 28%—most commonly in upper (58%) and lower GI (42%), and thoracic (42%) tumors. L-MST was most common in breast (90%). Multivariable regression confirmed that Black race (OR 1.9, 95% CI 1.5–2.4, p = < 0.001), cancer primary site (OR 1.6–5.7, p = < 0.001), stage IV disease (OR 1.8, 95% CI 1.4–2.2, p = < 0.001), low BMI (OR 4.2, 95% CI 2.5–6.9 p = < 0.001), and higher symptom scores were all independently associated with H-MST.ConclusionsTwenty-eight percent of solid tumor oncology patients at diagnosis were at high risk of malnutrition. Patients with breast cancer rarely had malnutrition risk at diagnosis. Significant variation was found in malnutrition risk by cancer site, stage, race, and presence of depression, distress, fatigue, and trouble eating/swallowing.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00520-021-06612-z.
Highlights
[16] Multiple validated malnutrition screening tools of varying structure are available and incorporate patient, clinician, and objective data. [17, 18] Developed in 1999, the malnutrition screening tool (MST) is a short tool validated in oncology outpatients (Table 1). [3, 19, 20] An observational, cross-sectional study of 50 chemotherapy patients determined relative MST validity compared to the PatientGenerated Subjective Global Assessment (PG-SGA)
The MST completed closest to date of cancer diagnosis was analyzed; median time from diagnosis to MST was 20 days (25–75 IQR, 11–33 days)
There was significant variation with the greatest risk of malnutrition in those with lower GI, upper GI, and thoracic cancers, advanced stage disease, Black race, and higher symptom scores. These striking results are consistent with oncology cohort studies, those that included early-stage disease and breast cancer. [29,30,31] Despite nearly one-third being at high risk of malnutrition, our observed rate is lower than other studies which suggests variation in prevalence is driven by the specific oncology population
Summary
Multiple factors contribute to malnutrition including tumor-related symptoms (e.g., anorexia, early satiety, fatigue), treatment-related complications (e.g., dysgeusia, mucositis, nausea), and psychological distress. [1] The prevalence of cancer-related malnutrition ranges from 30 to 80% in ambulatory and hospitalized patients. [2,3,4,5,6,7] Malnutrition has profound negative effects on performance status (PS), psychological well-being, and overall quality of life (QoL). [8,9,10] Importantly, malnutrition is a predictor of cancer survival independent of cancer site, PS, or stage. [11] Despite this, routine screening for malnutrition in oncology is the exception with underutilization of potentially helpful nutritional support services. [12,13,14,15]Guidelines from the European Society for Clinical Nutrition and Metabolism (ESPEN) support universal nutritional screening as it might allow early nutritional interventions. [16] Multiple validated malnutrition screening tools of varying structure are available and incorporate patient, clinician, and objective data. [17, 18] Developed in 1999, the malnutrition screening tool (MST) is a short tool validated in oncology outpatients (Table 1). [3, 19, 20] An observational, cross-sectional study of 50 chemotherapy patients determined relative MST validity compared to the PatientGenerated Subjective Global Assessment (PG-SGA). How much weight (kg) have you lost? Logistic regression tested for associations between clinicodemographic factors, symptom scores, and H-MST prevalence. Multivariable regression confirmed that Black race (OR 1.9, 95% CI 1.5–2.4, p = < 0.001), cancer primary site (OR 1.6–5.7, p = < 0.001), stage IV disease (OR 1.8, 95% CI 1.4–2.2, p = < 0.001), low BMI (OR 4.2, 95% CI 2.5–6.9 p = < 0.001), and higher symptom scores were all independently associated with H-MST. Conclusions Twenty-eight percent of solid tumor oncology patients at diagnosis were at high risk of malnutrition. Patients with breast cancer rarely had malnutrition risk at diagnosis. Significant variation was found in malnutrition risk by cancer site, stage, race, and presence of depression, distress, fatigue, and trouble eating/swallowing
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