Malnutrition In Cancer Patients Research Articles

Use of an Abridged Scored Patient-Generated Subjective Global Assessment (abPG-SGA) as a Nutritional Screening Tool for Cancer Patients in an Outpatient Setting

The scored Patient-Generated Subjective Global Assessment tool (PG-SGA), regarded as the most appropriate means of identifying malnutrition in cancer patients, is often challenging to implement in a busy outpatient setting. We assessed the validity of an abridged version of the PG-SGA (abPG-SGA), which forgoes the physical examination, and compared its usefulness in discerning malnutrition to the full PG-SGA and Malnutrition Screening Tool (MST). The nutritional status of 90 oncology outpatients receiving chemotherapy was assessed according to SGA global rating, PG-SGA, and MST. Receiver operating characteristic (ROC) curves were generated to estimate the sensitivity and specificity of various cut-off scores for malnutrition. Thirty-six percent of patients were malnourished (SGA). The abPG-SGA yielded 94% sensitivity and 78% specificity and area under the curve (AUC) = 0.956, which was slightly lower than PG-SGA (97% sensitivity, 86% specificity, AUC = 0.967) and higher than MST (81% sensitivity, 72% specificity, AUC = 0.823). Patient reported symptoms included loss of appetite (30%), altered taste (31%), fatigue (30%), and decreased ability to perform activities of daily living (53%). In conclusion, the abPG-SGA is a practical, informative and valid tool for detecting malnutrition in the outpatient oncology setting.

Gastrointestinal symptoms and weight loss in cancer patients receiving chemotherapy

Cancer patients receiving chemotherapy have a high risk of malnutrition secondary to the disease and treatment, and 40-80 % of cancer patients suffer from different degrees of malnutrition, depending on tumour subtype, location, staging and treatment strategy. Malnutrition in cancer patients affects the patient's overall condition, and it increases the number of complications, the adverse effects of chemotherapy and reduces the quality of life. The aim of the present study was to evaluate weight-loss prevalence depending on the tumour site and the gastrointestinal (GI) symptoms of oncology patients receiving chemotherapy. We included 191 cancer patients receiving chemotherapy. Files of all patients were reviewed to identify symptoms that might potentially influence weight loss. The nutritional status of all patients was also determined. The cancer sites in the patients were as follows: breast (31·9 %); non-colorectal GI (18·3 %); colorectal (10·4 %); lung (5·8 %); haematological (13·1 %); others (20·5 %). Of these patients, 58 % experienced some degree of weight loss, and its prevalence was higher among the non-colorectal GI and lung cancer patients. Common symptoms included nausea (59·6 %), anorexia (46 %) and constipation (31·9 %). A higher proportion of patients with ≥ 5 % weight loss experienced anorexia, nausea and vomiting (OR 9·5, 2·15 and 6·1, respectively). In conclusion, these results indicate that GI symptoms can influence weight loss in cancer patients, and they should be included in early nutritional evaluations.

New Strategies for Metabolic Support in Cancer

The management of cancer patients is frequently complicated by the occurrence of cachexia, a complex syndrome characterized by marked depletion of body weight, associated with profound alterations of both nutritional status and metabolic homeostasis. Progressive wasting of skeletal muscle mass and adipose tissue is a typical feature of cancer cachexia. This syndrome has a large impact on morbidity and mortality, and significantly affects patients’ quality of life. On this line, understanding the pathogenic mechanisms of cachexia is of crucial importance to define targeted therapeutic strategies. Many studies have addressed the relevance of nutritional interventions in cancer hosts. In particular, it has been shown that malnutrition in cancer patients can be delayed when nutritional supplementation is adopted early in the course of the disease. The preservation of a good nutritional status, in particular when it is achieved concurrently with specific antineoplastic treatment, will prevent or at least delay the onset of overt cachexia, allowing the use of more aggressive therapeutic regimens. This extended and updated version of our previously published article titled “ Nutritional support in cancer” will review the most recent and relevant literature, focusing on those options that have shown more promising for the clinical practice.

The relevance of body composition in cancer patients: what is the evidence?

In the past few years, there has been a growing interest on body composition changes of cancer patients. Muscle mass and fat mass are pointed out as the most important compartments from a physiological point of view, as their changes are the ones with the most impact on disease. The excess of fat mass is related with increased risk of incidence and recurrence of some types of cancer, and some studies identify it as a major contributing factor for increased morbidity and mortality in cancer patients. Weight loss in cancer is frequent and is associated with symptoms, circulating pro-cachectic substances produced by the tumour, and/or hypermetabolism states, not compensated with adequate intake. Muscle mass depletion is the most worrying, and has been associated with decreased functional capacity, increased toxicity of anti-neoplastic treatments, longer length of stay and higher risk of nosocomial infections. In end stage disease, some patients may develop cancer cachexia, an irreversible condition highly associated with mortality. Of note that, lean body mass depletion may occur with excess fat mass (sarcopenic obesity), a condition that combines the health risks of obesity and those of sarcopenia. The high prevalence of malnutrition in cancer patients justifies its relevance. Many patients point it as a cause for the reduction of physical, cognitive, emotional and social functions, as well as anorexia, fatigue, dyspnoea, insomnia, gastrointestinal symptoms and worse Quality of Life. Additionally, body composition may be affected by nutrition, lifestyles and physical activity; therefore, any approach to the patient should include all these dimensions, with special emphasis on individualised nutritional intervention. Therefore, nutritional therapy should be adjuvant to any treatment, as it is essential in all stages of the disease: for its development, during the treatment(s) and in the follow-up period. The aim of nutritional intervention is to promote changes in body composition, by maintaining or increasing lean body mass and keeping fat mass in healthy levels, which may have a positive impact on Quality of Life, response to treatment(s), prognosis and reduced health care costs.

Methodology of Clinical Nutrition Guidelines for Adult Cancer Patients

Malnutrition delays recovery from cancer treatment and can lead to additional serious complications. Clinical guidelines for the management of malnutrition in cancer patients are essential tools for optimizing nutritional care; therefore, their methodological quality is of great importance. This review assesses the methodological quality of international clinical guidelines for the management of malnutrition in adult cancer patients. Guidelines were identified through searches in multiple electronic databases; afterward, they were systematically reviewed with the AGREE instrument, which is one method of evaluating the methodological quality of guidelines. The methodological quality of the guidelines reviewed varied greatly. The highest scores were observed in the domains "scope and purpose" and "clarity and presentation," while the lowest scores were awarded in the domains "editorial independence," "stakeholder involvement," and "applicability." Furthermore, there was consensus on the indication for parenteral nutrition and nutrition screening. However, there was a lack of consensus on how nutritional therapy should be provided. No improvement was observed in methodological quality of the more recent guidelines compared to the older ones. The methodological quality of clinical guidelines on malnutrition for cancer patients and the way they are reported need to be improved. To achieve this, developers should utilize available guideline assessment tools, such as the AGREE instrument, when writing or updating guidelines on this topic.

Nutritional screening and early treatment of malnutrition in cancer patients

Background Malnutrition is a frequent complication in patients with cancer and can negatively affect the outcome of treatments. On the other hand, side effects of anticancer therapies can also lead to inadequate nutrient intake and subsequent malnutrition. The nutritional screening aims to identify patients at risk of malnutrition for prompt treatment and/or careful follow-up. Methods and results This manuscript highlights the need of an interdisciplinary approach (oncologist, nutritionist, dietitian, psychologist, etc.) to empower patients who are experiencing loss of physiological and biological function, fatigue, malnutrition, psychological distress, etc., as a result of cancer disease or its treatment, and maintain an acceptable quality of life. Conclusions It is necessary to make all healthcare professionals aware of the opportunity to identify cancer patients at risk of malnutrition early in order to plan the best possible intervention and follow-up during cancer treatment and progression.

Nutritional screening and early treatment of malnutrition in cancer patients

BackgroundMalnutrition is a frequent complication in patients with cancer and can negatively affect the outcome of treatments. On the other hand, side effects of anticancer therapies can also lead to inadequate nutrient intake and subsequent malnutrition. The nutritional screening aims to identify patients at risk of malnutrition for prompt treatment and/or careful follow-up.Methods and resultsThis manuscript highlights the need of an interdisciplinary approach (oncologist, nutritionist, dietitian, psychologist, etc.) to empower patients who are experiencing loss of physiological and biological function, fatigue, malnutrition, psychological distress, etc., as a result of cancer disease or its treatment, and maintain an acceptable quality of life.ConclusionsIt is necessary to make all healthcare professionals aware of the opportunity to identify cancer patients at risk of malnutrition early in order to plan the best possible intervention and follow-up during cancer treatment and progression.

Status gizi awal berdasarkan Patient Generated Subjective Global Assessment (PG-SGA) berhubungan dnegan asupan zat gizi dan perubahan berat badan pada penderita kanker rawat inap di RSUP Dr. Mohammad Hosein Palembang

Background: Weight loss is commonly detected among cancer patients in their early stages. This presumably happens due to low calory intake and increasing energy requirements which finally lead to malnutrition in cancer patients. Early detection to identify nutrition problems of cancer patients is through screening so as to maximize nutrient intake through nutrition therapy and diet modification and to improve nutrition status as well as quality of life of cancer patients.Objective: The study aimed to identify the relationship between nutrition status based on PS-SGA and nutrient intake and weight loss of cancer patients hospitalized at Dr. M. Hoesin Hospital of Palembang.Methods: The study was observational with prospective cohort study design. In this study the group that had fulfilled inclusion criteria were screened during their early hospitalization (within 24 hours) using patient-generated subjective global assessment score to identify their nutrition problem. Next, the group was divided into 2 smaller groups consisting of one group with malnutrition and another group without malnutrition. Analysis of nutrient intake obtained from foods provided by the hospital and outside the hospital was made to the two groups within 2 weeks of hospitalization using visual comstock and food record. Anthropometric measurement was made to find weight loss the subject of the study.Results: The results of the study showed that there was significant relationship between nutrition status and intake of energy and protein with p=0.000. The result of logistic regression test to nutrition status based on weight changes indicated that there was significant relationship between risk of nutrition and weight changes; patients with risk of nutrition had 7.016 times greater probability for weight loss than those without risk of nutrition (95% C5 2.896-16.997).Conclusion: There was significant relationship between nutrition status and nutrient intake among cancer patients and there was greater probability for weight loss.

Dénutrition en cancérologie: quand demander un avis spécialisé?

Nutritional management of the cancer patient cannot be ignored, given the well-established links between malnutrition and mortality, postoperative complications, toxicity of radiation and chemotherapy, and quality of life. The expertise of a medical specialist in nutrition is often required given the diversity of the clinical presentation of malnutrition in cancer patients and in certain areas lacking evidence in the literature. In at least some situations, such as for malnourished patients requiring surgery, preoperative nutrition (normally enteral nutrition if possible), is indicated and is also the subject of international recommendations/clinical practice guidelines. The role of the specialist in nutrition is to disseminate such information. There are some situations where the literature offers useful approaches, even if there are no guidelines/recommendations. For example, in disease for which there are not curative therapies but the patient is not yet in a terminal stage, it is legitimate to propose parenteral nutrition in the case of partial bowel obstruction, without waiting for advice from a nutrition specialist. By contrast, his advice is of interest in the ethical discussion which sometimes surrounds decisions to initiate artificial nutrition in patients in the terminal phase. Nutritional recommendations are difficult to formulate for patients with solid tumors on chemotherapy, because there are few data in the literature. The expertise of the specialist in nutrition in this case is most effectively deployed when active treatment of the disease is planned (earlier rather than later in the disease trajectory, in patients responding to treatment for whom further treatment is planned, participants in phase I studies). For cancers of the head and neck preoperative enteral nutrition is recommended for malnourished patients. The literature also provides some practical solutions, even in the absence of well-defined recommendations in some instances. Enteral nutrition is also indicated, without consulting a specialist in nutrition, during radiotherapy when intake falls, to prevent the development of malnutrition. Given the high frequency and important consequences of malnutrition in patients receiving combined radiation and chemotherapy, it is appropriate to initiate enteral nutrition at the 3rd week of treatment. The role of the specialist in nutrition is to interpret the literature and to develop procedures for specific cases.

An exploratory case study of cancer nurses’ understanding and use of nutritional screening in patients diagnosed with cancer

Background: Cancer is often associated with malnutrition and therefore nutritional support should be considered a major component of treatment and used in adjunct with anti‐neoplastic therapies (Read et al., 2006). Successful nutritional support depends on thorough nutritional assessment (Mercadante, 1996). The literature suggests that systematic screening through the use of a tool enables practitioners to provide relevant nutritional support but this does not occur in practice due to a lack of formal education and gaps in knowledge (Savage & Scott, 2005). This gap in the evidence appears to relate to the nurses’ own perceptions of the importance of nutritional assessment and its’ application in practice. The aim of this study was to explore nurses’ understanding and use of nutritional assessment in patients diagnosed with cancer.Methods: Case study methodology was used to understand the culture of the ward. Sampling was defined by the methodology as the case was chosen to facilitate exploration of the phenomenon. Non‐random sampling was employed as it allowed for the richest possible source of information (O’Leary, 2004). A letter of invitation and information sheet was sent to all eligible nurses. Data from two nursing staff focus groups (n = 7, n = 11), a survey of patient documentation (n = 27) and field observations were used to elicit influences of nursing practice on nutritional risk screening. A tentative focus group question guide was used to ensure that the process had as few interruptions as possible and a moderator facilitated this. The focus groups were audio tape‐recorded and were transcribed verbatim. The data was analyzed using triangulation, looking for phrases and themes that related to the propositions. A mind map was used to explore connections between the themes and propositions along with my own perceptions ensuring transparency of analysis. The case was reported using a reflexive narrative enabling the causal links between the data and propositions to be explored. Study propositions were: did nurses play a critical role in identifying patients at nutritional risk? What were the nurses’ understanding and use of nutritional assessment? Was the nurse's commitment to nutrition inconsistent with their actions and documentation?Results: Nurses’ felt they played a critical role in nutritional risk assessment; ‘it's everyone's responsibility but mainly the nurses and makes a difference in the success of treatment”, this was not reflected in the survey. Their understanding of nutritional risk assessment was apparent ‘you need to get their weight history and what they can eat’but they blamed lack of time and increasing pressures of medicalised tasks, for example drug administration to justify the assessment being observational and ad hoc. The survey of patients’ documentation supported this, 81% of patients had incomplete documentation of their nutritional risk.Discussion: Pressures of workload and conflicting primary tasks influence nurses’ behaviour around nutritional support. The survey of documentation showed that NICE (2006) guidelines have had little impact in practice. Nurses’ are involved in multiple tasks and due to pressures on time and resources have become reactive and not proactive; nutritional assessment is a proactive activity.Conclusions: Lack of recognition the impact ward and organizational culture had on individual behaviour may have been the pivotal factor that led to the inconsistency in understanding and use of nutritional risk assessment. The relationship between nurses’ attitude to nutritional assessment, knowledge of nutrition and practice was complex. The priority of nutrition needs to increase in both the organisation and ward culture in order for nutritional support to be successfully implemented.References Mercadante, S. (1996) Nutrition in cancer patients. Support. Care Cancer 4, 10–20.National Institute for Clinical Excellence. (2006) Nutrition support in adults: oral nutrition support, enteral tube feeding and parenteral nutrition. London: Department of Health.O’Leary Z. (2004) The Essential Guide to doing Research. London: Sage.Read, J.A. et al. (2006) An evaluation of the prevalence of malnutrition in cancer patients’ attending the oncology outpatient oncology clinic. Asia‐Pacific J. Clin.Oncol.2, 80–86.Savage, J. & Scott, C. (2005) Patients’ nutritional care in hospital: an ethnographic study of nurses’ role and patients’ experience. London: RCN.

Ice cream, a new alternative to oral nutritional supplements

Background: Cancer patients have been identified as being at risk of nutritional problems due to the treatments of cytotoxic chemotherapy and local radiotherapy which can cause side effects such as general loss of appetite, sore, dry mouth, mucositis and oral thrush (Bella Talwar, 2007). Traditionally, oral nutritional supplement drinks are prescribed to provide nutritional support. Ice cream presents a new popular approach to treat malnutrition and has been proved successful in at least one previous unpublished trial. Ice cream is a cool, soft nutritious food which is very palatable and easy to swallow. Therefore, soft whip ice cream (Malibu Ice cream) machines were installed on the oncology wards. The aims of this study were to assess overall patient satisfaction of the ice cream compared with the standard hospital ice cream, how easy patients thought the new ice cream is to eat and the preference of ice cream over taking oral nutritional supplements.Methods: A total of 123 patients on two oncology wards admitted from in 2007 over a 4 week period were asked to complete an internally developed patient satisfaction survey on the intervention, the new ice cream. Patients were asked to rate the new ice cream on taste, texture and preference over the standard ice cream. The new ice cream was given at meal times and available in between meals. The nutritional content of the ice cream (Malibu), 1269.7 kJ (300 kcal), 6 g protein per 6.6 oz portion [679 kJ (162 kcal), 4.1 g protein per 100 g] compares favourably with oral nutritional supplement drinks. The ice cream was given at meal times and available between meals on demand.Results: There was a 41% (n = 59) response rate from the patient satisfaction survey. Of the responses received 74% rated the new ice cream as either excellent or good for taste. The majority (79%) of patients who responded thought that the ice cream was easy to eat. When asked about preference of the new ice cream compared to the standard hospital ice cream 77% of patients would prefer to eat the Malibu ice cream. Most (88%) patients would rather eat the ice cream than conventional nutritional supplements.Discussion: The patients’ response to the introduction of this variety of ice cream was very positive. The ice cream showed potential benefits due to the compliance in this patient group.Conclusion: The use of ice cream illustrates a positive way forward for the dietetic treatment of malnutrition in cancer patients and further work is planned for the future. The use of branded ice creams provides an acceptable alternative to oral nutritional supplements in cancer patients with chemotherapy and radiotherapy associated mouth problems.Reference Talwar, B. (2007) Tackling nutritional problems related to cancer and its treatment. Complete Nutr. 7, 61–63.

Nutritional status of cancer patients in chemotherapy; dietary intake, nitrogen balance and screening

Objective: To evaluate a short screening sheet (SSM) for malnutrition and to investigate the nutritional status of patients receiving chemotherapy for cancer of the lungs, colon or breast at an outpatient clinic.Design: Full nutritional assessment was conducted to define malnutrition and validate the SSM. Additionally, weight change from earlier healthy weight was evaluated, and calculations for intake of energy-giving nutrients (three-day-weighed food records) and protein balance were performed. After the evaluation study, the SSM was tested in clinical routine and data collected about patients’ need for nutritional counseling.Subjects: Patients at the outpatient clinic of the Department of Oncology at Landspitali-University Hospital (n=30 with lung-, colon- or breast cancer in the study population, n=93 with all cancer type in clinical routine screening).Results: Malnutrition was defined by full nutritional assessment in 20% of the participating patients and SSM had high sensitivity and specificity. Declining nutritional status of the patients was seen as a negative nitrogen balance and unintentional weight loss from healthy weight, but not as total energy intake, recent weight loss or underweight. The test of SSM in clinical routine showed that 40% were malnourished. According to the patients, 80% needed nutritional counseling but only 17% had such counseling.Conclusion: Screening (SSM) for malnutrition in cancer patients is a valid simple approach to define cancer patients for nutritional care. More patients regard themselves in need for nutritional counseling than the number of patients really achieving any.

Nutritional Support in Cancer

The management of cancer patients is frequently complicated by the occurrence of cachexia, a complex syndrome characterized by marked depletion of body weight, associated with profound alterations of both nutritional status and metabolic homeostasis. Progressive wasting of skeletal muscle mass and adipose tissue is a typical feature of cancer cachexia. This syndrome has a large impact on morbidity and mortality, and significantly affects patients quality of life. On this line, understanding the pathogenic mechanisms of cachexia is of crucial importance to define targeted therapeutic strategies. Many studies have addressed the relevance of nutritional interventions in cancer hosts. In particular, it has been shown that malnutrition in cancer patients can be delayed when nutritional supplementation is adopted early in the course of the disease. The preservation of a good nutritional status, in particular when it is achieved concurrently with specific antineoplastic treatment, will prevent or at least delay the onset of overt cachexia, allowing the use of more aggressive therapeutic regimens. This paper will review the relevant literature, focusing on those options that have shown more promising for the clinical practice. Keywords: cancer-related anorexia, Malignant tumors, metabolism, HDL-cholesterol levels, Lipid-Mobilizing Factor

An evaluation of the prevalence of malnutrition in cancer patients attending the outpatient oncology clinic

AbstractBackground: The aim of the study was to assess the nutritional status of cancer patients attending the medical oncology outpatient setting for the first time.Methods: One‐hundred and forty‐one patients (87 males, 54 females) were assessed by a dietitian, using the nutrition assessment tool, the Patient‐Generated Subjective Global Assessment (PG‐SGA). Tumor types included colorectal, head and neck, lung, pancreatic, gastric or esophageal cancer. No patient had previously received chemotherapy.Results: Forty‐eight (34%) patients were well nourished (PG‐SGA rating A), 79 (56%) patients were at risk of malnutrition (B), and 14 (10%) patients were malnourished (C). The median PG‐SGA score was 7. There were no significant differences in nutritional status between those > 65 years and those ≤ 65 years. The highest PG‐SGA scores (indicating a greater nutritional risk) were found in patients with gastric, pancreatic and oesophageal cancers. There were significant differences found between certain cancer groups using the PG‐SGA, however, these were not detected using other more commonly used criteria, such as the body mass index (BMI).Conclusion: This study confirms that the majority of new patients with cancer presenting to a medical oncologist are at risk of malnutrition or malnourished. It calls for better screening, and adequate nutrition intervention in patients who are about to be considered for systemic treatment.

High prevalence of malnutrition among patients with solid non-hematological tumors as found by using skinfold and circumference measurements

Malnutrition in cancer patients has many causes. Nutritional status is usually assessed from weight/height indices. These present limitations for the nutritional assessment of cancer patients: their weights include tumor mass, and lean mass changes are not reflected in weight/height indices. The objective was to evaluate differences between two anthropometric methods and compare deficits, in non-hematological tumor patients and hematological disease patients. Cross-sectional study at Instituto de Oncologia Pediátrica, Universidade Federal de São Paulo. Children and adolescents were evaluated between March 1998 and January 2000. Traditional anthropometric measurements were obtained in the first month of treatment (induction therapy), by weight-for-height (W/H) using z-scores index for children and body mass index (BMI) for adolescents. Body composition evaluations consisted of specific anthropometric measurements: triceps skinfold thickness (TSFT), mid-upper arm circumference (MUAC) and arm muscle circumference (AMC). Data were analyzed to compare nutritional assessment methods for diagnosing malnutrition prevalence. The chi-squared test was used for comparative analyses between tumor patients and hematological disease patients. Analysis was done on 127 patients with complete data. Higher percentages of deficits were found among tumor patients, by W/H z-scores or BMI and by MUAC and AMC. Higher percentages of deficits were shown by TSFT (40.2%) and MUAC (35.4%) than by W/H z-scores or BMI (18.9%). Non-hematological tumor patients presented higher malnutrition prevalence than did hematological disease patients. Body composition measurements by TSFT and MUAC detected more patients with malnutrition than did W/H or BMI.

Catabolic outcome from non-gastrointestinal malignancy-related malabsorption leading to malnutrition and weight loss

Malnutrition of cancer patients is a significant cause of mortality and morbidity. The contributory factors in cancers anatomically involving the gastrointestinal tract are self-evident. However, how non-gastrointestinal malignancies affect gastrointestinal structure and function is not clear. The aim of this paper is to review the relationship between non-gastrointestinal malignancies and malabsorption, which leads to malnutrition, weight loss and increased mortality. In non-gastrointestinal cancer patients, intestinal morphological atrophy occurs, whereas in the jejunum absorption is impaired. Cytokines including IL-1 and TNF-alpha primarily induce delayed gastric emptying and also act directly on intestinal mucosa to induce malabsorption. These cytokines also directly act on several gastrointestinal hormones including cholecystokinin, neuropeptides including corticotropin-releasing factor, and via the vagus to decrease gastrointestinal motility. The combination of small intestine atrophy and delayed gastrointestinal motility are some of the reasons for malabsorption in cancer patients with non-gastrointestinal malignancies that contribute to the catabolic process.

An epidemiological evaluation of the prevalence of malnutrition in Spanish patients with locally advanced or metastatic cancer

Malnutrition is frequent in cancer. The objective of this study was to determine the prevalence, in Spain, of malnutrition in cancer patients with advanced disease and to assess the therapeutic focus. A total of 781 patients were evaluated to determine individual nutritional status using the Scored Patient Generated-Subjective Global Assessment (Scored PG-SGA) questionnaire. Almost 60% of the patients included were receiving cancer treatment. Patients with the highest weight loss were those with tumours of oesophagus (57%), stomach (50%) and larynx (47%). Serious eating problems were encountered by 68% of the patients; the principal problem being anorexia (42.2%). The median number of symptoms impeding food intake was 2. According to the Scored PG-SGA, 52% of the patients were moderately or severely malnourished and 97.6% required some form of nutritional intervention/recommendation. (a) the majority of patients in the study needed nutritional intervention; (b) more than 50% had moderate or severe malnutrition; (c) the Scored PG-SGA is a useful and simple tool for evaluating nutritional status and contains additional information on nutritional recommendations; (d) nutritional evaluation of the cancer patients needs to be improved so as to offer better treatment of symptoms and to improve the patient's quality of life.

Early nutritional support and quality of life (QoL): Primary end point in cancer patients during chemo- and/or radiotherapy

8190 Background: progressive weight loss in cancer patients is a complex, multifactorial syndrome occuring through a variety of mechanisms related to the tumor, the host response and cancer treatment. clinical features of malnutrition include anorexia, depletion of lean body mass, muscle weakness, fatigue and impaired immunological function. weight loss significantly correlates with increased chemotherapy-induced toxicity, decreased response to treatment, performance status (PS), survival and QoL. The aim of this study is to evaluate the relationship between QoL and malnutrition in cancer patients who underwent chemo and/or radiotherapy, and the efficacy of an early nutritional support. Methods: between October 2003 and October 2004, 176 cancer patients were enrolled. All patients were evaluated for nutritional status, ECOG PS and QoL (measured with QLQ-C30 v. 3.0) at the biginning of their oncological treatment. Nutritional support consisted in 1,5/2 gr protein and 30 non proteic Kcal/Kg per day, enriched with at least 2 gr of EPA and DHA per os. Patients requiring tube feeding or parenteral nutrition and having major surgical intervention that can influence dietary intake were excluded. Results: Weight loss >10% (range 17 +- 6 SD) was onserved in 51/176 (28,9%) of patients; in 29 patients (59%) before starting treatment, in 8 (15,6%) during treatment, and in 14 (27,4) after treatment. Weight loss was observed more frequently in stomach cancer (88%), pancreatic (66%), head and neck (50%) and colon-rectum (22%). 46/51 patients were evaluable. After 4 weeks of nutritional support, all of the 37/51 (81%) patients who respected the prescribed regimen showed a weight gain of 2,9 +- 1Kg. Weight gain positively correlate with PS (PS0 before treatment: none. PS0 after treatment: 13 (35%) patients) and QoL. Conclusions: Our data suggests that, in cancer patients underling oncological treatment, careful monitoring of nutritional status reduce the incidence of fatigue, ameliorate QoL, allows to complete the full anticancer treatment and improves the outcome. No significant financial relationships to disclose.

Nutritional support of the cancer patient.

Malnutrition, a common problem in cancer patients, adversely affects survival and quality of life. It results from several factors that alter nutritional intake and cause massive metabolic disturbances. Anticancer therapies may compound the malnutrition. Optimal nutrition improves therapeutic modalities and the clinical course and outcome. Oral nutrition should be used whenever possible; in patients unable to ingest adequate amounts orally, enteral and parenteral feedings are safe and effective.

Perioperative nutrition in cancer patients.

Cancer patients have the highest incidence of protein-calorie malnutrition seen in hospitalized patients, with significant malnutrition occurring in more than 30% of cancer patients undergoing major upper gastrointestinal procedures. Clinically significant malnutrition occurs as a result of diminished nutrient intake, increased nutrient losses, and tumor-induced derangements in host metabolism. In the absence of adequate exogenous nutrients, the body utilizes endogenous substrates to satisfy the ongoing requirements of both host and tumor for energy and protein. In those patients with malignant obstruction of the gastrointestinal tract, the tumor itself may induce diminished nutrient intake. Present day treatment modalities including gastrointestinal resection, chemotherapy, and radiotherapy compound these metabolic derangements, further increasing the risk of postoperative morbidity and death. The presence of malnutrition in cancer patients has prognostic importance. In a review of more than 3000 cancer patients, DeWys and colleagues identified significantly improved survival in those patients without weight loss compared with those had lost 6% of their body weight (Am J Med 69:491-497, 1980). Other investigators have noted increased postoperative morbidity and mortality associated with malnutrition. Early hypotheses suggested that reversal of weight loss would improve survival. The development and refinements of enteral and parenteral nutrition have provided the opportunity for studying the relationship between nutritional supplementation and postoperative prognosis. Nutrition support is therefore often instituted to improve nutritional status and thereby reduce the risks of postoperative complications. This article addresses the beneficial role of preoperative nutrition therapy in cancer patients.