Abstract
BackgroundPatients with cancer have an increased risk of malnutrition which is associated with poor outcome. The Mini Nutritional Assessment (MNA®) is often used in older patients with cancer but its relation to outcome is not known.MethodsFour databases were systematically searched for studies relating MNA-results with any reported outcome. Two reviewers screened titles/abstracts and full-texts, extracted data and rated the risk of bias (RoB) independently.ResultsWe included 56 studies which varied widely in patient and study characteristics. In multivariable analyses, (risk of) malnutrition assessed by MNA significantly predicts a higher chance for mortality/poor overall survival (22/27 studies), shorter progression-free survival/time to progression (3/5 studies), treatment maintenance (5/8 studies) and (health-related) quality of life (2/2 studies), but not treatment toxicity/complications (1/7 studies) or functional status/decline in (1/3 studies). For other outcomes – length of hospital stay (2 studies), falls, fatigue and unplanned (hospital) admissions (1 study each) – no adjusted results were reported. RoB was rated as moderate to high.ConclusionsMNA®-result predicts mortality/survival, cancer progression, treatment maintenance and (health-related) quality of life and did not predict adverse treatment outcomes and functional status/ decline in patients with cancer. For other outcomes results are less clear. The moderate to high RoB calls for studies with better control of potential confounders.
Highlights
Patients with cancer have an increased risk of malnutrition which is associated with poor outcome
In this systematic review, we investigated the prognostic significance of baseline nutritional status according to Mini Nutritional Assessment (MNA) regarding health and treatment outcomes in patients with cancer
In 56 studies included in our review, we found that, based on a moderate to high risk of bias, poor nutritional status is associated with a significantly higher risk for mortality / poor overall survival (22/27 studies), longer progression-free survival / time to progression (3/5 studies), worse treatment maintenance (5/8 studies) and quality of life (2/2 studies) in multivariable analyses
Summary
Patients with cancer have an increased risk of malnutrition which is associated with poor outcome. The Mini Nutritional Assessment (MNA®) is often used in older patients with cancer but its relation to outcome is not known. Cancer is the second leading cause of death of noncommunicable diseases worldwide [1]. Prevalence and incidence of cancer in people aged 70. Due to the effects of both, the disease and its usually intensive treatment, patients with cancer have an increased risk of malnutrition. Various cancer-related mechanisms, such as systemic inflammation [3] and hypoxic stress [4] affect the patients’ nutritional status. Patients might already present lower dietary intake before anticancer treatment [5] and in addition, side effects of anticancer therapy, e. Patients might already present lower dietary intake before anticancer treatment [5] and in addition, side effects of anticancer therapy, e. g. loss of appetite, dry mouth or nausea that are associated with a lower energy intake [6].
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