Patient-Generated Subjective Global Assessment Score Research Articles

Nutritional status assessed by the Patient-Generated Subjective Global Assessment (PG-SGA) is associated with qualities of diet and life in Korean cerebral infarction patients

Objective Assessment of the nutritional status of patients with cerebral infarction (CI) is important because their nutritional status influences disease outcome. The purpose of this study was to assess the nutritional status of patients with CI using the scored Patient-Generated Subjective Global Assessment (PG-SGA) and to investigate the relation of the quality of their diet and life with their nutritional status. Methods Seventy-three patients with CI were recruited from Kyung Hee University Oriental Medical Center in Seoul, Korea, from May to July 2007. The subjects' PG-SGA, dietary quality (Dietary Diversity Score, Dietary Variety Score, and Diet Quality Index–International), and quality of life (Stroke-Specific Quality of Life, modified Barthel Index, and Beck Depression Inventory) were investigated. Results The patients were classified by PG-SGA categories as well nourished (26.0%), moderately malnourished (49.3%), or severely malnourished (24.7%). Quality of diet assessed by the Dietary Diversity Score and Dietary Variety Score was significantly lower in severely malnourished patients ( P < 0.001). The overall dietary quality expressed by the Diet Quality Index–International was significantly greater in the well-nourished group, followed by the moderately malnourished and severely malnourished groups. Quality of life assessed by the Stroke-Specific Quality of Life and modified Barthel Index was significantly lower in the malnourished group ( P < 0.05). Quality of diet ( P < 0.001) and life ( P < 0.05) in patients with CI were significantly correlated with their nutritional status. Conclusion The PG-SGA is a useful nutritional assessment tool for patients with CI with stable vital signs. When patients with CI were categorized according to their PG-SGA score, well-nourished patients demonstrated better diet quality and better quality of life.

Objective and Subjective Nutritional Assessment of Patients with Cancer in Palliative Care

This study aimed to evaluate the nutritional status of patients with cancer in palliative care and to examine the interrelationship between objective and subjective nutritional assessment measures. Patients' nutritional status in a palliative care unit of a Malaysian government hospital and a hospice facility were assessed using anthropometric measurements, weight loss at 1/6 months, and the scored patient-generated subjective global assessment (PG-SGA). Moderate-to-severe malnutrition was observed in a range from 31% to 69% using both measurements. Common nutritional impact symptoms were pain, xerostomia, and anorexia. Patient-generated subjective global assessment scores were significantly correlated with anthropometric measurements (P < .050). The PG-SGA is equally informative as objective indicators and is recommended as a quickly applied tool for nutritional status assessment of patients with cancer in palliative care.

Prevalence of malnutrition on admission to hospital – Acute and elective general surgical patients

Malnutrition is a common finding in elective general surgical patients on admission to hospital and is associated with greater postoperative morbidity, prolonged length of stay and higher cost of treatment. The situation in acute general surgical patients has not been clarified. The aim of the study was to investigate the prevalence of malnutrition in both acute and elective (scheduled admission) general surgical patients in a prospective cross-sectional study. Over an eight-week period 460 (310 acute, 150 elective) consecutive patients were recruited. The primary end point was nutritional status within 48 h of admission determined using the patient-generated subjective global assessment (PG-SGA) tool. Body mass index, upper arm circumference and triceps skin fold were measured and upper arm muscle circumference derived. Admission plasma albumin and total cholesterol, total lymphocyte count and grip strength were measured. Length of total hospital stay was recorded. In the acute setting 52% of patients were malnourished or at risk (including nearly half of those with a BMI greater than 25 kg/m2) compared to 38% of those who presented electively (P = 0.004). In the elective group, 66 (44%) patients presented with malignancy compared to 15 (5%) in the acute group (P < 0.001). Length of hospital stay increased significantly with worsening PG-SGA scores (P < 0.001 for both groups). Malnutrition risk was found to be highly prevalent in acute surgical patients despite having a much lower malignancy rate than elective surgical patients. Admission screening should be strongly advocated for both acute and elective patients.

4257 Correlation of the nutritional status as measured by the Scored Patient-generated Subjective Global Assessment (PG-SGA) and Karnofsky Performance Score (KPS) in patients with advanced lung cancer

4257 Correlation of the nutritional status as measured by the Scored Patient-generated Subjective Global Assessment (PG-SGA) and Karnofsky Performance Score (KPS) in patients with advanced lung cancer

The relationship between subjective appetite sensations, markers of inflammation and appetite in dialysis patients

Poor appetite is a marker of morbidity and mortality in haemodialysis patients, making it an important area for research. Visual analogue scales (VAS) can capture a range of subjective sensations related to appetite (such as hunger, desire to eat or fullness), but have not been commonly used to measure appetite in dialysis patients. The present study aimed to explore the association between retrospective ratings of appetite using VAS and a range of clinical variables, as well as biomarkers of appetite in haemodialysis patients. Twenty-eight haemodialysis patients [mean age 61 +/- 17 years, 50% male, median dialysis vintage 19.5 (4-101) months] rated their appetite using VAS for hunger, fullness and desire to eat and a five-point categorical scale measuring general appetite. Blood levels of the appetite peptides leptin, ghrelin and peptide YY were also measured. Hunger ratings measured by VAS were significantly (P < 0.05) correlated with a range of clinical, nutritional and inflammatory markers: age (r = -0.376), co-morbidities, (r = -0.380) Patient-Generated Subjective Global Assessment score (r = -0.451), weight (r = -0.375), fat-free mass (r = -0.435), C-reactive protein (r = -0.383) and intercellular adhesion molecule (r = -0.387). There was a consistent relationship between VAS and appetite on a five-point categorical scale for questions of hunger, and a similar trend for desire to eat, but not for fullness. Neither method for measuring subjective appetite correlated with appetite peptides. Retrospective ratings of hunger on a VAS are associated with a range of clinical variables and further studies are warranted to support their use as a method for measuring appetite in dialysis patients.

Phase II study of AVR118 in the management of cancer related anorexia/cachexia

e20631 Background: AVR118 represents a new class of cytoprotective drugs in managing symptoms associated with anorexia\/ cachexia. In a previous study in patients with advanced HIV-AIDS, an improvement in appetite, strength and alertness was noted. The precise mechanism of action is not understood, but activity may be related to AVR118's adenosine based components. Other active components include guanosine and branched chain amino acids leucine and valine. Objective: To determine the effect of AVR118 on appetite, early satiety and nutritional intake in patients with advanced cancer. Secondary endpoints include changes in performance status, lean muscle mass and quality of Life (QOL). Methods: Eligible adult patients received 4.0 ml of AVR118 subcutaneous daily injections. Patients underwent bi-monthly evaluations during the 28 day initial treatment (phase A) Evaluations included Karnofsky performance status, Edmonton Symptoms Assessment Scale (ESAS), Patient Generated Subjective Global Assessment (PG-SGA), Simmonds Functional Assessment, Dyspepsia Symptom Severity Index, Weight, Lean Body Mass, skin fold thickness and grip strength. Patients who benefited from phase A could elect to continue with therapy (phase B). Results: Currently, of 16 enrolled patients 7 have completed phase A. All 7 patients chose to continue with AVR118 treatment (phase B). Improvements in anorexia and PG-SGA scores were seen in 7/7 and 6/7 patients respectively. Weight stabilization or gain was observed in 5/7 patients. All other parameters showed no significant difference. There was AVR118 has been well tolerated and no serious side effects have been reported. Conclusions: Based on these positive results, the primary endpoints have been achieved and the study will be expanded from 14 to 30 patients. [Table: see text]

The McGill Cancer Nutrition and Rehabilitation Program

9623 Background: Cancer rehabilitation is a process that assists the individual with cancer to obtain optimal physical, social, psychological, and vocational functioning within the limits created by the disease and treatment. The McGill Cancer Nutrition and Rehabilitation (CNR) program developed as a result of the ever-increasing demand to address the individual cancer patients and their needs, as well as on achieving optimal tumour-related outcomes. Methods: To assess the effect of an interdisciplinary 8-week rehabilitation program on the functional outcomes of patients with advanced cancer. Sixty-five patients were assessed prior to and following an 8-week interdisciplinary cancer rehabilitation program consisting of medical, nursing, physiotherapy and nutritional interventions. All patients were evaluated with the Edmonton Symptom assessment Score (ESAS), Distress thermometer (DT), Patient Generated Subjective Global Assessment (PG-SGA), Simmonds Functional Assessment Tool and the 6-Minute Walk Test (6MWT). A paired t-test comparing patient’ pre and posttest scores was used. Results: Thirty three male and 32 female participants were enrolled. Their median age was 57 years (25 to 80). Their cancer diagnoses were: gastro-esophageal (20%), hepatobiliary (19%), breast (17%), hematological (12%), lung, ENT and sarcoma (9% each), colorectal (3%) and CNS lymphoma (2%) There was a significant improvement after an 8-week cancer rehabilitation program in strength (p=. 02), appetite (p&lt; 0.001), nausea (p&lt; =0.02), nervousness (p&lt; 0.001) sleepiness (p=0.01), shortness of breath (p=0.02), depression (p&lt; 0.001), DT (p&lt; 0.001), total PG-SGA score (p&lt; 0.001) and 6MWT (p=0.001). Conclusions: Preliminary findings suggest that participation in a cancer rehabilitation program ameliorates symptoms and global distress resulting in an increase in physical activities. We can conclude that participation in the Cancer Rehabilitation Program is beneficial. No significant financial relationships to disclose.

Comparison of different nutritional assessments and body-composition measurements in detecting malnutrition among gynecologic cancer patients

BackgroundFew studies have assessed global nutritional assessment tools and body-composition measurements in gynecologic cancer patients. ObjectiveWe aimed to assess the convergent validity of different nutritional tools such as the scored Patient-Generated Subjective Global Assessment (PG-SGA), serum albumin, skinfold-thickness measurements, and total-body potassium (TBK) and body density measurements to identify gynecologic cancer patients at risk of malnutrition. DesignWe assessed the nutritional status of 194 patients with suspected or proven gynecologic cancer according to the SGA and the scored PG-SGA, and skinfold-thickness (n = 145), TBK (n = 51), and body density measurements (n = 42) before primary treatment. ResultsAccording to the SGA and the scored PG-SGA global rating, 24% of gynecologic cancer patients were classified as malnourished. The prevalence of malnutrition was highest in ovarian (67%) and lowest in endometrial (6%) cancer patients. The ability of the PG-SGA score (P < 0.001) and albumin (P < 0.001), triceps skinfold-thickness (P = 0.041), and TBK (P = 0.005) measurements to predict the SGA was significantly better than chance. TBK significantly correlated with measurements associated with protein depletion, including age (P < 0.001), arm muscle area (P < 0.001), fat-free mass (P < 0.001), and the PG-SGA score (P = 0.009). Multiple regression analysis showed that, together, the PG-SGA score and arm muscle area adjusted for age accounted for 66% of total TBK variance. ConclusionsThe PG-SGA is significantly associated with subjective and objective parameters and is a widely recognized, clinically relevant method of evaluating nutritional status. It therefore seems most appropriate for identifying malnourishment in gynecologic cancer patients.

Nutritional status of advanced lung cancer patients and its effect on survival

9567 Background: Weight loss and malnutrition are common in patients with non-small cell lung cancer (NSCLC) and have a negative impact on survival. Early detection and intervention may impact positively on quality of life. The Patient Generated Subjective Global Assessment (PG-SGA) is a validated tool for screening nutritional status and triaging cancer patients with a potential score of 36 (Ottery, 2000). Methods: We measured the need for nutritional intervention in 118 newly diagnosed advanced NSCLC outpatients (stages 3B/4) using the PG-SGA score prior to any treatment. Patients were triaged into 4 Nutritional Triage (NT) groups based on Ottery’s recommendations: scores of 0–1 (NT I) required no intervention, 2–3 (NT II) required education, 4–8 (NT III) required intervention by a dietitian and 9 or greater (NT IV) were in critical need of nutritional intervention. We investigated the association between NT groups and weight loss, survival, inflammatory markers (CRP), LDH and albumin. Results: 118 recently diagnosed outpatients (M 63, F 55) aged 64 ± 11.3 years were studied. Patients were triaged into NT I - 21 (18percnt;) pts, NT II - 13 (11percnt;) pts, NT III - 34 (29percnt;) pts and NT IV - 50 (42percnt;) pts. Median PG-SGA score was 7. 76percnt; of pts had 0–5percnt; weight loss in the past month, 10percnt; had a weight loss of 5–10percnt; and 14percnt; had a weight loss >10percnt;. Low albumin, high LDH and high CRP were significantly associated with a higher PG-SGA score (p=0.016, 0.029 and 0.022 respectively). The NT group was significantly associated with survival. Overall median survival was 7.0 months. The median (95percnt; CI) survival of patients in NT groups I, II, III and IV was 12 (CI: 9–16), 10 (CI: 7–13), 8 (CI: 6–10), 4 (CI: 2–6) months respectively, p<0.0001.The amount of weight loss was also significantly associated with survival. Those with <5percnt; weight loss had a survival of 8 (CI: 5–10) mo vs. 5 (CI: 2–9) mo in those with weight loss ≥5percnt;. Conclusions: The need for nutritional intervention in advanced lung cancer patients is very high. There was a significant association between the PG-SGA NT groups and survival. Weight loss alone may not identify patients in need of nutritional intervention. However the weight loss was still discriminatory with respect to survival. The PG-SGA is a simple screening tool for triaging the nutritional needs of patients with advanced lung cancer. No significant financial relationships to disclose.

Correlation of the Karnofsky performance status (KPS) with nutritional status as measured by the Scored Patient-generated Subjective Global Assessment (PG-SGA) in patients with advanced cancer in palliative treatment

20709 Background: The incidence of malnutrition amongst patients with cancer is estimated at between 40 and 80%. Prompt detection of nutritional compromise is critical to initiate early nutritional and/or pharmacological interventions with the aim to improve the quality- of-life of cancer patients. The PG-SGA is a simple, reliable and inexpensive screening tool that uses clinical data to detect mild or moderate malnutrition before the patient becomes overly wasted. Our main objective was to characterize the nutritional status of patients with advanced cancer receiving palliative care, as measured by the PG-SGA and correlate its results with the KPS of this patient cohort. Methods: We evaluated the PG-SGA and the KPS of 74 patients with advanced stage cancer in palliative treatment. Results: Patients were aged 24–81 years (median 57 years). Forty-two patients were women (55%), and 30 of the patients (40%) were hospitalized. The most common neoplasms were: lung 39%, colorectal 18% and breast 10%. The main symptoms negatively affecting oral intake were: anorexia 70%, early satiety 62%, pain 57%, xerostomia 53%, altered smell and taste 40%, constipation 33%, dysphagia 31% and nausea 28%. According to the PG-SGA, 48% (36) were moderately or suspected of being malnourished, 30 (22%) of patients were severely malnourished and 22% (13) of patients were well-nourished. There was a significant difference in the median PG-SGA scores for each of the SGA classifications (P<0.001), with the severely malnourished patients having the highest scores. The functional capacity, as evaluated by the KPS, demonstrated that 36 (49%) scored between 50–70%, 26 (35%) between 10–40% and 12 patients (16%) between 80–100%. The median KPS was 50%. There was a statistically significant correlation between the scored PG-SGA and the KPS (r = −0.63, p<0.001). Conclusions: The ASG-PPP score and the KPS are highly correlated in patients with advanced cancer, supporting the concept that the KPS is an important and informative variable in the evaluation of the nutritional status in these patients. The nature of this correlation and its clinical implications need to be further investigated. No significant financial relationships to disclose.

Nutritional status and length of stay in patients admitted to an Acute Assessment Unit

The Redesigning Care initiative at Flinders Medical Centre aimed to improve access to timely, consistent, quality care. This led to the creation of an Acute Assessment Unit (AAU) where all patients are assessed by the Allied Health team on admission. This study aimed to: (i) determine the nutritional status of patients admitted to the AAU using the scored Patient Generated-Subjective Global Assessment (PG-SGA); and (ii) determine the association between nutritional status and length of stay (LOS). A prospective, observational study was conducted in 64 patients (mean age 79.9 +/- 11 years, 76% female). Nutritional status was assessed within 48 h of admission and LOS data were collected prospectively. According to PG-SGA global rating, 53% (n = 34) of patients were malnourished. There was a weak association between PG-SGA score and LOS (r = 0.250, P = 0.046). The malnourished patients had a longer LOS by 1 day compared to well-nourished patients, and while this did not reach statistical significance (Z = -0.988, P = 0.323), it has implications for health care costs. LOS overall was short at a median of 4.5 days (range 1-24). A significant proportion of patients admitted to the AAU is malnourished. There was a trend for these patients to have a longer LOS, indicating a critical need for nutritional management; however LOS as a whole was short. While nutrition support in hospital is useful in reinforcing dietary education, the short LOS emphasized the importance of discharge education and follow-up.

Do most newly diagnosed advanced NSCLC patients need nutritional intervention?

9108 Background: Depletion of nutritional reserves and significant weight loss are commonly noted in patients (pts) with non-small cell lung cancer (NSCLC). The Patient Generated Subjective Global Assessment (PG-SGA) is a nutritional screening tool for cancer pts, recommended by the Oncology Network of Dietitians of Canada and the American Dietetic Association. The PG-SGA categorizes total scores into 4 ranges for nutritional triage: 0–1 requires no intervention, 2–3 requires education, 4 - 8 requires intervention by a dietitian, and =9 requires urgent symptom control and nutrition intervention. (Ottery, 2000). Methods: We determined the prevalence of malnutrition in 92 newly diagnosed advanced NSCLC pts (stages 3 / 4) in an outpatient clinic who had completed a baseline PG-SGA. We also investigated the association between CRP (an inflammatory marker which correlates with poor prognosis) and the PG-SGA. PG-SGA score was based on the sum of 4 subscales: symptoms, weight history, food intake and functional status. Results: 92 pts (M 48, F 44) aged 65 ±11 years were studied. 21 (23%) pts had a PG-SGA score of 0–3, 23 (25%) 4–8, and 48 (52%) of 9 or greater. The most common symptoms accounting for a high PG-SGA score were: no appetite 37 (40%), pain 27 (29%), constipation 26 (28%), feeling full 24 (26%), dry mouth 22 (24%) and taste changes 19 (21%). 51 (55%) pts lost 0–4.9% of their body weight in the past month, 17 (19%) had a weight loss of 5–9.9% and 24 (26%) had a weight loss =10 %. In pts with a PG-SGA score of 0–3 the median CRP was 7.0 mg/L (range: 0.7–66.0), in those with a score of 4–8 the median CRP was 41.8 mg/L (0.8–266.1) and in those with a score of =9 the median CRP was 18.5 mg/L (0.3–219.0) (p=0.02). Conclusion: At time of diagnosis, 77% of advanced NSCLC pts were in need of nutritional intervention; 52% required urgent intervention. The PG-SGA is a simple screening tool which should be incorporated into patient care in outpatient oncology clinics. No significant financial relationships to disclose.

Malnutrition among gynaecological cancer patients

To assess the nutritional status of patients with gynaecological cancer. A prospective study assessing the nutritional status of gynaecological patients with suspected or proven gynaecological cancer. Queensland Centre for Gynaecological Cancer, Brisbane, Australia; a tertiary referral centre for gynaecological cancer. One hundred forty-five patients with suspected or proven gynaecological cancer aged 20-91 years. Scored patient-generated subjective global assessment (PG-SGA) and serum albumin before treatment. One hundred and sixteen (80%) patients were categorized as PG-SGA class A, 29 (20%) patients were PG-SGA B and none of the patients were PG-SGA C. Ovarian cancer patients had significantly lower serum albumin levels (P=0.003) and higher PG-SGA scores (P<0.001) than patients with other types of cancer and benign conditions. Sixty-seven per cent of patients with ovarian cancer were classified as PG-SGA B. After adjusting for patient's age, body mass index and albumin level, ovarian cancer patients were 19 times more likely to be categorized as PG-SGA class B compared to patients with benign conditions (95% confidence interval: 3.03-129.8; P=0.002). Malnutrition in gynaecological cancer patients is a significant problem, especially among those patients diagnosed with ovarian cancer.

Evidence based practice guidelines for the nutritional management of cancer cachexia

The purpose of these guidelines is to provide dietitians in Australia with a user-friendly summary of the evidence to support the nutritional management of adult patients with cancer cachexia. This best available evidence is presented and used as a basis for providing recommendations about clinical practice. The clinical questions were as follows: How should patients be identified for referral to the dietitian in order to maximise nutritional intervention opportunities? How should nutritional status be assessed? What are the goals of nutrition intervention for patients with cancer cachexia? What is the nutrition prescription to achieve these goals? Should eicosapentaenoic acid be included in the prescription? What are effective methods of implementation to ensure positive outcomes? Does nutrition intervention improve outcomes in patients with cancer cachexia? This document is a general guide to appropriate practice to be followed only subject to the dietitian's judgement in each individual case. The guidelines are designed to provide information to assist decision-making and are based on the best information available at the date of compilation. The guidelines recommend intensive nutrition therapy. This has potential resource implications that may include additional staff, change to staff roles and increased use of high/protein energy supplements if they are considered. Therefore, in applying the guidelines these potential organisational and cost barriers need to be considered. These guidelines for practice are provided with the express understanding that they do not establish or specify particular standards of care, whether legal, medical or other.

Evaluation of Nutritional and Inflammatory Status of Advanced Colorectal Cancer Patients and Its Correlation With Survival

: The purpose of this study was to evaluate novel inflammatory and nutritional prognostic factors in patients with advanced colorectal cancer (ACRC). All ACRC patients attending the clinic for palliative treatment were eligible for study. Demographics, including performance status (PS), C-reactive protein (CRP), albumin (Alb), Glasgow prognostic score (GPS), weight, weight history, body mass index (BMI), and nutritional status using the patient-generated subjective global assessment (PGSGA), were collected and correlated with survival. At a median follow-up of 29.8 mo, with a minimum follow-up of 15.7 mo, the median survival was 9.9 mo (0.8–21.8 mo). Fifteen (29%) patients were newly diagnosed (stage IV colorectal cancer), and 36 (71%) had received prior chemotherapy. Although the median BMI was 27 kg/m2 (range = 17–41 kg/m2), 28 of 50 (56%) were nutritionally at risk. In fact, 19 patients (38%) were critically in need of nutrition intervention (PGSGA score of ≥9). Thirty-three of 48 patients (69%) had an elevated CRP (>10 mg/l with a median of 21.1 mg/L), and 7 patients (15%) had both a CRP of >10 mg/l and hypoalbuminemia (< 35 g/l). A significant positive correlation was found between PGSGA score and CRP (P = 0.003; r = 0.430). Using univariate analysis, significantly worse survival was found for patients with poorer PS (P = 0.001), high GPS (P = 0.04), low Alb (P = 0.017), elevated serum alkaline phosphatase (SAP; P = 0.018), PGSGA score of > 9 (P = 0.001), and PGSGA group B/C (P = 0.02). Using the Cox proportional hazard model for multivariate survival analysis, type of treatment (hazard ratio, HR = 1.48; 95% confidence interval, CI = 1.11–1.79; P = 0.005), PS (HR = 2.37; 95% CI = 1.11–5.09; P = 0.026), GPS (HR = 2.27; 95% CI = 1.09–4.73; P = 0.028), and SAP (HR = 0.44; 95% CI = 0.18–1.07; P =0.069) remained significant predictors of survival. These preliminary data suggest that the type of treatment, PS, GPS, and SAP are important predictors of survival in ACRC.

Malnutrition determined by the patient-generated subjective global assessment is associated with poor outcomes in acute stroke patients

The extent of malnutrition in hospitalised stroke patients and its influence on outcomes including hospital complications, length of stay and discharge destination are important issues. The aim of this study was to determine the nutritional status of patients admitted to an acute stroke unit and the association between nutritional status and health outcomes. Nutritional status was determined prospectively using the scored patient generated subjective global assessment (PG-SGA) in patients (n=73) admitted to an acute stroke unit within 48 h of admission to an Australian private hospital. Outcome data were collected by retrospective audit. On admission, 19.2% of patients were malnourished and this was associated with a significantly greater PG-SGA score (15 vs. 5) and lower body weight (59.8 kg vs. 75.8 kg) compared to well-nourished patients. In terms of health outcomes, malnourished patients had longer length of stay (13 vs. 8 days), increased complications (50% vs. 14%), increased frequency of dysphagia (71% vs. 32%) and enteral feeding (93% vs. 59%). No association was found between nutritional status and serum albumin level or discharge destination. Malnutrition on admission to hospital after acute stroke is associated with poor outcomes including increased length of stay and increased prevalence of dysphagia and complications. The scored PG-SGA is a nutrition assessment tool that allows quick identification of malnourished stroke patients.

Poor nutritional status prior to peripheral blood stem cell transplantation is associated with increased length of hospital stay

The nutritional status of patients prior to peripheral blood stem cell transplantation (PBSCT) and its impact on length of hospital stay is not well described in the literature. The nutritional status of 66 consecutive patients (46 m:20 f); and the mean age 58.7+/-12.0 years was determined a maximum of 2 weeks pre-transplantation using the scored Patient-Generated-Subjective Global Assessment (PG-SGA). According to the global assessment, 73% patients were well nourished, 23% moderately malnourished and 4% severely malnourished. There was a significant difference in post transplant length of stay (mean difference+/-s.e.m. -7.0+/-2.1 days) between well-nourished and malnourished patients and a trend towards higher mortality in the malnourished group (2 vs 20%). Although 89% of patients described no problems eating, two or more nutrition impact symptoms were reported in 30% of patients. From stepwise multiple regression analysis, nutritional status as determined by PG-SGA score was significantly associated with length of stay, accounting for 12% of the variance. In conclusion, malnutrition prior to PBSCT is associated with increased length of stay. Routine nutrition assessment of patients prior to PBSCT should be undertaken.

Assessment of nutritional status in hemodialysis patients using patient-generated subjective global assessment

To evaluate the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in hemodialysis patients. A cross-sectional observational study assessing the nutritional status of hemodialysis patients. Private tertiary Australian hospital. Sixty patients, ages 63.9 +/- 16.2 years. Scored PG-SGA questionnaire, comparison of PG-SGA score > or =9 with subjective global assessment (SGA), albumin, corrected arm muscle area, and triceps skinfold. According to SGA, 80% of patients were well nourished and 20% of patients were malnourished. Patients classified as well nourished (SGA-A) attained a significantly lower median PG-SGA score compared with those rated as moderately malnourished or at risk of malnutrition (SGA-B). A PG-SGA score > or =9 had a sensitivity of 83% and a specificity of 92% at predicting SGA classification. There were significant correlations between the PG-SGA score and serum albumin, PG-SGA score, and percentage weight loss over the past 6 months. There was no association between PG-SGA score and body mass index or anthropometric measurements. The scored PG-SGA is an easy-to-use nutrition assessment tool that allows quick identification of malnutrition in hemodialysis patients.

Nutrition intervention improves outcomes in patients with cancer cachexia receiving chemotherapy?a pilot study

The aim of this study was to examine the effect of nutrition intervention on outcomes of dietary intake, body composition, nutritional status, functional capacity and quality of life in patients with cancer cachexia receiving chemotherapy. Patients received weekly counselling by a dietitian and were advised to consume a protein- and energy-dense oral nutritional supplement with eicosapentaenoic acid for 8 weeks. The medical oncologist determined the chemotherapy protocol. Eight patients enrolled and seven completed the study. There were significant improvements in total protein intake (median change 0.3 g/kg per day, range -0.1 to 0.8 g/kg per day), total energy intake (median change 36 kJ/kg per day, range -2 to 82 kJ/kg per day), total fibre intake (median change 6.3 g/day, range -3.4 to 20.1 g/day), nutritional status (patient-generated subjective global assessment score, median change 9, range -5 to 17), Karnofsky performance status (median change 10, range 0-30) and quality of life (median change 16.7, range 0-33.3). There were clinically significant improvements in weight (median change 2.3 kg; range -2.7 to 4.5 kg) and lean body mass (median change 4.4 kg, range -4.4 to 4.7 kg), although these were not statistically significant. Change in nutritional status was significantly associated with change in quality of life, change in Karnofsky performance status and change in lean body mass. Nutrition intervention together with chemotherapy improved outcomes in patients with pancreatic and non-small-cell lung cancer over 8 weeks. Supplement intake does not inhibit meal intake.

A predictive model of hospitalization and potential cost savings associated with oxandrolone in cancer patients with involuntary weight loss (IWL)

8259 Background: Patients (pts) with cancer often experience IWL. Health economics literature is limited and has focused on malnutrition, often co-existant with IWL. Oxandrolone (Oxandrin®) is an anabolic agent indicated for IWL, with demonstrated efficacy and safety in 2 clinical studies in cancer. \(\underline{\mathrm{Objectives:}}\) To (1) develop a model to predict probability of hospitalization in cancer pts based on severity of clinical status; (2) estimate costs associated with this probability of hospitalization at baseline and 2 months (M2) post-treatment with oxandrolone. Methods: Subjects in 2 studies [placebo-controlled (PC), n=65 subjects with upper aerodigestive tract cancer \(\underline{\mathrm{or}}\) open label (OL), n=131 in a variety of cancers] were assessed at baseline and M2 for weight and global clinical status, using the validated Patient-Generated Subjective Global Assessment (PG-SGA) tool. Logistic regression was used to develop a model to predict the probability of hospitalization based on PG-SGA scores. The model was derived from the PC study, and subsequently applied to the OL study with oxandrolone. Rates of hospitalization associated with different PG-SGA scores at treatment inception and at M2 were estimated. Hospitalization costs were projected from mean charges for DRG 296 (nutritional disorders, with chronic condition) from the Healthcare Cost and Utilization Project (HCUP) database. Results: PG-SGA was a significant predictor (p=0.008) of hospitalization (R2=0.25). When applied to patients who completed PG-SGA at M2 (n=83) in the open label study, the model predicted 33.6 hospitalizations for baseline PG-SGA scores, and 17.2 hospitalizations based on scores at M2. Predicted cost savings attributed to oxandrolone in terms of reduced hospitalization was $2,223 per pt. Conclusions: Using a predictive model of hospitalization based on PG-SGA score, predicted cost savings of $2,223 per patient were associated with treatment with oxandrolone. These savings, coupled with the gains in weight and QOL scores that have been associated with oxandrolone, should be considered in treatment decisions for involuntary weight loss. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Savient Pharmaceuticals, Inc. Savient Pharmaceuticals, Inc.