Prevalence of Malnutrition among Cancer Patients in a Nigerian Institution
Keywords:Nutrition, Status, oncology, MUST, SGA, nutritional assessment.
Background: Cancer is a major health problem. Successful management includes adequate supportive care. Nutritional problems are common among cancer patients and these are not routinely addressed by oncologists during oncology care leading to suboptimal outcome even in developed countries. In Nigeria and other low and medium income countries, the situation is worse as nutritional screening and assessment of cancer patients are not routinely carried out.
Objectives: To determine the proportion of cancer patients at risk of malnutrition and compare convergence of risk assessment using SGA and MUST tools.
Methods: This was a prospective study carried out among cancer patients who presented for cancer care in the Department of Radiation Oncology, University College Hospital Ibadan, Nigeria. Nutritional assessment tools which included Malnutrition Universal Scoring Tool (MUST) and Subjective Global Assessment (SGA) were used to assess the nutritional status of the participants.
Results: A total of 89 patients aged between 18 and 85 years participated in the study. The number of males were 13 (15%) while females were 76(85%). In our study 54 (60.8%) of our patients were at risk of malnutrition using the malnutrition universal scoring tool (MUST) scale while 53(60%) were malnourished using the subjective global assessment (SGA) scale. The reliability for the classifications using the MUST and SGA scales was positive (moderate) [Kappa = 0.584 (p<0.0005), 95% CI (0.410, 0.758)].
Conclusion: There is a high proportion of clinical malnutrition among cancer patients in the study population. According to this study, there was similarity between the classifications of nutritional risk, using the MUST and SGA tools.
Vergara N, Montoya JE, Luna HG, Amparo JR, Cristal-Luna G. Quality of life and nutritional status among cancer patients on chemotherapy. Oman Med J 2013; 28(4): 270-4. https://doi.org/10.5001/omj.2013.75
Bozzetti F. Nutritional support of the oncology patient. Crit Rev Oncol Hematol 2013; 87(2): 172-200. https://doi.org/10.1016/j.critrevonc.2013.03.006
Von Meyenfeldt M. Cancer-associated malnutrition: an introduction. Eur J Oncol Nurs 2005; 9(Suppl 2): S35-8.
Davies M. Nutritional screening and assessment in cancer-associated malnutrition. Eur J Oncol Nurs 2005; 9(Suppl 2): S64-73.
Gudny Geirsdottir O, Thorsdottir I. Nutritional status of cancer patients in chemotherapy; dietary intake, nitrogen balance and screening. Food Nutr Res 2008; 52: 1856. https://doi.org/10.3402/fnr.v52i0.1856
Capra S, Ferguson M, Ried K. Cancer: impact of nutrition intervention outcome--nutrition issues for patients. Nutrition 2001; 17(9): 769-72. https://doi.org/10.1016/S0899-9007(01)00632-3
Fessler TA. Malnutrition: A Serious Concern for Hospitalized Patients. Today’s Dietit 2008; 10(7): 44.
ASPEN. The ASPEN Nutrition Support Core Curriculum: A Case-Based Approach — The Adult Patient. American Society of Parenteral and Enteral Nutrition, editor. Silver Spring, Md 2007.
Van Cutsem E, Arends J. The causes and consequences of cancer-associated malnutrition. Eur J Oncol Nurs 2005; 9(Suppl 2): S51-63. https://doi.org/10.1016/j.ejon.2005.09.007
Caro, Marín MM, Laviano A, Pichard C. Nutritional intervention and quality of life in adult oncology patients. Clin Nutr 2007; 26(3): 289-301. https://doi.org/10.1016/j.clnu.2007.01.005
Isenring E. Nutrition Intervention Improves Nutritional Status and Quality of Life Outcomes in Patients Undergoing Radiotherapy. In: Kataria T, editor. Frontiers in Radiation Oncology. Zagreb: InTech 2013; pp. 205-16. https://doi.org/10.5772/55988
Kondrup J, Allison SP, Elia M, Vellas B, Plauth M. ESPEN guidelines for nutrition screening 2002. Clin Nutr 2003; 22(4): 415-21. https://doi.org/10.1016/S0261-5614(03)00098-0
Borges NP, Silva BDA, Cohen C, Filho PEP, Medeiros FJ, Indicadores E, et al. Comparison of the nutritional diagnosis, obtained through different methods and indicators, in patients with cancer. Nutr Hosp 2009; 24(1): 51-5.
Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelson RA, et al. What is subjective global assessment of nutritional status? JPEN J Parenter Enteral Nutr 1987; 11(1): 8-13. https://doi.org/10.1177/014860718701100108
Gupta D, Lis CG, Vashi PG, Lammersfeld CA. Impact of improved nutritional status on survival in ovarian cancer. Support Care Cancer 2010; 18(3): 373-81. https://doi.org/10.1007/s00520-009-0670-y
Raguso CA, Maisonneuve N, Pichard C. [Subjective Global Assessment (SGA): evaluation and followup of nutritional state]. Rev me?dicale la Suisse Rom 2004; 124(10): 607-10.
Abe Vicente M, Barão K, Silva TD, Forones NM. What are the most effective methods for assessment of nutritional status in outpatients with gastric and colorectal cancer? Nutr Hosp 2013; 28(3): 585-91.
Folasire OF, Folasire AM, Sanusi RA. Measures of Nutritional Status and Quality of Life in Adult People Living with HIV/AIDS at a Tertiary Hospital in Nigeria. Food Nutr Sci 2015; 06(04): 412-20. https://doi.org/10.4236/fns.2015.64042
Tarnus E, Bourdon E. Anthropometric evaluations of body composition of undergraduate students at the University of La Reunion. Adv Physiol Educ 2006; 30(4): 248-53. https://doi.org/10.1152/advan.00069.2005
Stratton RJ, Hackston A, Longmore D, Dixon R, Price S, Stroud M, et al. Malnutrition in hospital outpatients and inpatients: prevalence, concurrent validity and ease of use of the “malnutrition universal screening tool” (’MUST') for adults. Br J Nutr 2004; 92(5): 799-808. https://doi.org/10.1079/BJN20041258
McMahon K, Decker G, Ottery FD. Integrating proactive nutritional assessment in clinical practices to prevent complications and cost. Semin Oncol 1998; 25(2 Suppl 6): 20-7.
Spiro A, Baldwin C, Patterson A, Thomas J, Andreyev HJN. The views and practice of oncologists towards nutritional support in patients receiving chemotherapy. Br J Cancer 2006; 95(4): 431-4. https://doi.org/10.1038/sj.bjc.6603280
Wu B-W, Yin T, Cao W-X, Gu Z-D, Wang X-J, Yan M, et al. Clinical application of subjective global assessment in Chinese patients with gastrointestinal cancer. World J Gastroenterol 2009; 15(28): 3542-9. https://doi.org/10.3748/wjg.15.3542
Righini C-A, Timi N, Junet P, Bertolo A, Reyt E, Atallah I. Assessment of nutritional status at the time of diagnosis in patients treated for head and neck cancer. Eur Ann Otorhinolaryngol Head Neck Dis 2013; 130(1): 8-14. https://doi.org/10.1016/j.anorl.2012.10.001
Grobbelaar EJ, Owen S, Torrance AD, Wilson JA. Nutritional challenges in head and neck cancer. Clin Otolaryngol Allied Sci 2004; 29(4): 307-13. https://doi.org/10.1111/j.1365-2273.2004.00850.x
Haghjoo S. Malnutrition associated with head and neck cancers. Rev Clin Med 2015; 2(2): 76-9.
Santarpia L, Contaldo F, Pasanisi F. Nutritional screening and early treatment of malnutrition in cancer patients. J Cachexia Sarcopenia Muscle 2011; 2(1): 27-35. https://doi.org/10.1007/s13539-011-0022-x