Subjective Global Assessment—An independent predictor of survival in breast cancer

Abstract

17541 Background: The Subjective Global Assessment (SGA) which is an easy-to-use, inexpensive, and non-invasive validated clinical instrument to assess nutritional status, combines data from subjective and objective aspects of medical history and physical examination. Since malnutrition can be a frequent manifestation in breast cancer, we investigated the prognostic role of SGA in patients with breast cancer treated in an integrative cancer treatment setting. Methods: We evaluated 305 histologically confirmed case series of breast cancer patients treated at Cancer Treatment Centers of America. Using SGA, patients were classified as well nourished (SGA A), moderately malnourished (SGA B) or severely malnourished (SGA C). Kaplan Meier method was used to calculate survival. Cox proportional hazard models were constructed to evaluate the prognostic effect of SGA independent of stage at diagnosis and prior treatment history. Results: Of 305 patients, 91 were newly diagnosed at our hospital while 214 had received prior treatment elsewhere. 69 had stage I disease at diagnosis, 131 had stage II, 51 had stage III and 41 had stage IV. The median age at diagnosis was 49 years (range 25 - 74 years). 216 patients were well-nourished (SGA A) while 89 were malnourished (SGA B or C). Well nourished patients had a median survival of 49.9 months (95% CI: 29.9 to 69.9), while malnourished patients had a median survival of 15.7 months (95% CI: 8.7 to 22.6); the difference being statistically significant (p < 0.001). Multivariate Cox modeling, after adjusting for stage at diagnosis and prior treatment history found that malnourished status was associated with a relative risk (RR) of 2.7 (95% CI: 1.8 to 4.0, p < 0.001). Stage at diagnosis was associated with a RR of 1.9 (95% CI: 1.3 to 3.0; p = 0.002) and prior treatment history was associated with a RR of 8.8 (95% CI: 4.6 to 16.9; p = 0.002). Conclusions: In this cohort, we found that low SGA scores (well-nourished status) versus high SGA scores (moderate to severe malnourished status) identified patients with better survival outcomes. At our center, we continue to investigate the role of nutritional intervention in improving prognosis in patients with breast cancer. No significant financial relationships to disclose.