Asian Journal of Nursing Education and Research

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Nutritional Status and Functional Assessment of Anorexia, Cachexia Including Quality of Life (QoL) in Patients with Gastrointestinal Malignancies Undergoing Chemotherapy


Affiliations
1 Assistant Professor, College of Nursing, CMC, Vellore, Tamil Nadu, India
2 Professor, College of Nursing, CMC, Vellore, Tamil Nadu, India
3 Charge Nurse, Hemato-Oncology Ward, CMC, Vellore, Tamil Nadu, India
4 Chemotherapy Nurse Coordinator, Department of Medical Oncology, CMC, Vellore, Tamil Nadu, India
     

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Malnutrition is an overlooked domain of concern among patients with GI malignancies especially, while undergoing chemotherapy. Poor nutrition deleteriously impacts treatment outcomes, performance status and eventually the QoL. A quantitative descriptive research approach was used to assess the nutritional status and the functional assessment of anorexia/cachexia including QoL among patients with GI malignancies undergoing chemotherapy. A total of 111 adult patients were enrolled using consecutive sampling technique. Data were collected using PGSGA and FAACT questionnaires. The findings revealed that based on PGSGA, 50.5% were moderately and 23.4% were severely malnourished. 73.90% had a PGSGA point score of ≥ 9. Based on SCRINIO classification, 20.7% were symptomatically cachexic and 58.6% were symptomatic precachexic. Hemoglobin was < 11.9g/dL in 63% of patients. 45% had a performance status (ECOG) score of 1. The overall mean FAACT score was moderate (108.6822.82). Statistically significant, strong negative correlation existed between nutritional status and FAACT (r=-0.710, p-0.000). Statistically significant difference was found in the mean nutritional status based on ECOG score (p-0.000), SCRINIO classification (p-0.000), hemoglobin level (p-0.001), BMI (p-0.020), family income (p-0.035) and the duration of last chemotherapy received (p-0.035). Also, statistically significant difference was seen in the mean FAACT score based on ECOG score (p-0.000), SCRINIO classification (p-0.000), family income (p-0.001), hemoglobin level (p-0.004) and BMI status (p-0.030). The study reveals that majority of GI cancer patients undergoing chemotherapy are moderately to severely malnourished and have a moderate functional status and QoL. The study emphasizes the critical need for ongoing preemptive nutritional assessment/interventions, improved symptom management and individualized dietary counseling to cancer patients.

Keywords

GI Malignancies, Chemotherapy, Nutritional Status, Functional Assessment of Anorexia and Cachexia, Quality of Life.
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  • Marshall KM, Loeliger J, Nolte L, Kelaart A, Kiss NK. Prevalence of malnutrition and impact on clinical outcomes in cancer services: A comparison of two time points. Clin Nutr. 2019 Apr;38(2):644–51.

  • Mascaretti F, Evangelista J. Nutritional Assessment in Gastrointestinal Tumors: News from the 2020 ASCO and ESMO World GI Meetings.

  • Gastrointestinal Disorders. 2020 Sep;2(3):310–7.

  • Jamshidi S, Hejazi N, Zimorovat AR. Nutritional Status in Patients with Gastrointestinal Cancer in Comparison To Other Cancers In Shiraz, Southern Iran: a Case-Control Study. World J Plast Surg. 2018 May;7(2):186–92.

  • Arends J, Baracos V, Bertz H, Bozzetti F, Calder PC, Deutz NEP, et al. ESPEN expert group recommendations for action against cancer-related malnutrition. Clin Nutr. 2017 Oct;36(5):1187–96.

  • Zietarska M, Krawczyk-Lipiec J, Kraj L, Zaucha R, Malgorzewicz S. Nutritional status assessment in colorectal cancer patients qualified to systemic treatment. Contemp Oncol (Pozn). 2017;21(2):157–61.

  • Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982 Dec;5(6):649–55.

  • Bozzetti F, Mariani L. Defining and classifying cancer cachexia: a proposal by the SCRINIO Working Group. JPEN J Parenter Enteral Nutr. 2009 Aug;33(4):361–7.

  • Yoo SH, Oh EG, Youn MJ. The Reliability and Validity of Patient-Generated Subjective Global Assessment (PG-SGA) in Stroke Patients. Journal of Korean Academy of Adult Nursing. 2016 Jun 16;21(6):559–69.

  • Ribaudo JM, Cella D, Hahn EA, Lloyd SR, Tchekmedyian NS, Von Roenn J, et al. Re-validation and shortening of the Functional Assessment of Anorexia/Cachexia Therapy (FAACT) questionnaire. Qual Life Res. 2000;9(10):1137–46.

  • Sharma D, Kannan R, Tapkire R, Nath S. Evaluation of Nutritional Status of Cancer Patients during Treatment by Patient-Generated Subjective Global Assessment: a Hospital-Based Study. Asian Pac J Cancer Prev. 2015;16(18):8173–6.

  • Alsaleh K, Almomen FA, Altaweel A, Barasain O, Alqublan A, Binsalamah A, et al. Malnutrition in cancer patients receiving chemotherapy in a single oncology center. Journal of Nature and Science of Medicine. 2021 Apr 1;4(2):170.

  • Nitichai N, Angkatavanich J, Somlaw N, Voravud N, Lertbutsayanukul C. Validation of the Scored Patient-Generated Subjective Global Assessment (PG-SGA) in Thai Setting and Association with Nutritional Parameters in Cancer Patients. Asian Pac J Cancer Prev. 2019 Apr 29;20(4):1249–55.

  • Barret M, Malka D, Aparicio T, Dalban C, Locher C, Sabate J-M, et al. Nutritional status affects treatment tolerability and survival in metastatic colorectal cancer patients: results of an AGEO prospective multicenter study. Oncology. 2011;81(5–6):395–402.

  • Zhao W, Shi HP. The Prevalence of Malnutrition in Patients Suffering from Different Cancers by Three Classification Methods (P05-041-19). Curr Dev Nutr. 2019 Jun 13;3(Suppl 1):nzz030.P05-041-19.

  • da Rocha IMG, Marcadenti A, de Medeiros GOC, Bezerra RA, Rego JF de M, Gonzalez MC, et al. Is cachexia associated with chemotherapy toxicities in gastrointestinal cancer patients? A prospective study. J Cachexia Sarcopenia Muscle. 2019 Apr;10(2):445–54.

  • Zhou T, Yang K, Thapa S, Fu Q, Jiang Y, Yu S. Validation of the Chinese version of functional assessment of anorexia-cachexia therapy (FAACT) scale for measuring quality of life in cancer patients with cachexia. Support Care Cancer. 2017 Apr;25(4):1183–9.

  • Prathima S, Murthy M, Maka VV, Paibhavi PR, Reddy H, Vungarala S. Assessment of nutritional status and quality of life among cancer patients undergoing chemotherapy. Annals of Oncology. 2019 Nov 1;30:ix149–50.

  • Zaid ZA, Jackson K, Phd L, Kandiah M. Relationship between quality of life and nutritional status in colorectal cancer patients undergoing chemotherapy. Malaysian Journal of Nutrition. 2017 Jan 1;23:375–84.

  • Lis CG, Gupta D, Lammersfeld CA, Markman M, Vashi PG. Role of nutritional status in predicting quality of life outcomes in cancer--a systematic review of the epidemiological literature. Nutr J. 2012 Apr 24;11:27.

  • Santos IM, Mendes L, Carolino E, Santos CA. Nutritional Status, Functional Status, and Quality of Life - What is the Impact and Relationship on Cancer Patients? Nutr Cancer. 2020 Oct 29;1–14.

  • Maeda H, Sato M, Kobayashi M, Takiguchi N, Yoshikawa T, Yoshino S, et al. Validity of the Japanese version of functional assessment of cancer therapy-gastric (FACT-Ga) and its sensitivity to ascites volume change: a retrospective analysis of Japanese clinical trial participants. Support Care Cancer. 2016 Nov;24(11):4515–21.1. Marshall KM, Loeliger J, Nolte L, Kelaart A, Kiss NK. Prevalence of malnutrition and impact on clinical outcomes in cancer services: A comparison of two time points. Clin Nutr. 2019 Apr;38(2):644–51.

  • Mascaretti F, Evangelista J. Nutritional Assessment in Gastrointestinal Tumors: News from the 2020 ASCO and ESMO World GI Meetings.

  • Gastrointestinal Disorders. 2020 Sep;2(3):310–7.

  • Jamshidi S, Hejazi N, Zimorovat AR. Nutritional Status in Patients with Gastrointestinal Cancer in Comparison To Other Cancers In Shiraz, Southern Iran: a Case-Control Study. World J Plast Surg. 2018 May;7(2):186–92.

  • Arends J, Baracos V, Bertz H, Bozzetti F, Calder PC, Deutz NEP, et al. ESPEN expert group recommendations for action against cancer-related malnutrition. Clin Nutr. 2017 Oct;36(5):1187–96.

  • Zietarska M, Krawczyk-Lipiec J, Kraj L, Zaucha R, Malgorzewicz S. Nutritional status assessment in colorectal cancer patients qualified to systemic treatment. Contemp Oncol (Pozn). 2017;21(2):157–61.

  • Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982 Dec;5(6):649–55.

  • Bozzetti F, Mariani L. Defining and classifying cancer cachexia: a proposal by the SCRINIO Working Group. JPEN J Parenter Enteral Nutr. 2009 Aug;33(4):361–7.

  • Yoo SH, Oh EG, Youn MJ. The Reliability and Validity of Patient-Generated Subjective Global Assessment (PG-SGA) in Stroke Patients. Journal of Korean Academy of Adult Nursing. 2016 Jun 16;21(6):559–69.

  • Ribaudo JM, Cella D, Hahn EA, Lloyd SR, Tchekmedyian NS, Von Roenn J, et al. Re-validation and shortening of the Functional Assessment of Anorexia/Cachexia Therapy (FAACT) questionnaire. Qual Life Res. 2000;9(10):1137–46.

  • Sharma D, Kannan R, Tapkire R, Nath S. Evaluation of Nutritional Status of Cancer Patients during Treatment by Patient-Generated Subjective Global Assessment: a Hospital-Based Study. Asian Pac J Cancer Prev. 2015;16(18):8173–6.

  • Alsaleh K, Almomen FA, Altaweel A, Barasain O, Alqublan A, Binsalamah A, et al. Malnutrition in cancer patients receiving chemotherapy in a single oncology center. Journal of Nature and Science of Medicine. 2021 Apr 1;4(2):170.

  • Nitichai N, Angkatavanich J, Somlaw N, Voravud N, Lertbutsayanukul C. Validation of the Scored Patient-Generated Subjective Global Assessment (PG-SGA) in Thai Setting and Association with Nutritional Parameters in Cancer Patients. Asian Pac J Cancer Prev. 2019 Apr 29;20(4):1249–55.

  • Barret M, Malka D, Aparicio T, Dalban C, Locher C, Sabate J-M, et al. Nutritional status affects treatment tolerability and survival in metastatic colorectal cancer patients: results of an AGEO prospective multicenter study. Oncology. 2011;81(5–6):395–402.

  • Zhao W, Shi HP. The Prevalence of Malnutrition in Patients Suffering from Different Cancers by Three Classification Methods (P05-041-19). Curr Dev Nutr. 2019 Jun 13;3(Suppl 1):nzz030.P05-041-19.

  • da Rocha IMG, Marcadenti A, de Medeiros GOC, Bezerra RA, Rego JF de M, Gonzalez MC, et al. Is cachexia associated with chemotherapy toxicities in gastrointestinal cancer patients? A prospective study. J Cachexia Sarcopenia Muscle. 2019 Apr;10(2):445–54.

  • Zhou T, Yang K, Thapa S, Fu Q, Jiang Y, Yu S. Validation of the Chinese version of functional assessment of anorexia-cachexia therapy (FAACT) scale for measuring quality of life in cancer patients with cachexia. Support Care Cancer. 2017 Apr;25(4):1183–9.

  • Prathima S, Murthy M, Maka VV, Paibhavi PR, Reddy H, Vungarala S. Assessment of nutritional status and quality of life among cancer patients undergoing chemotherapy. Annals of Oncology. 2019 Nov 1;30:ix149–50.

  • Zaid ZA, Jackson K, Phd L, Kandiah M. Relationship between quality of life and nutritional status in colorectal cancer patients undergoing chemotherapy. Malaysian Journal of Nutrition. 2017 Jan 1;23:375–84.

  • Lis CG, Gupta D, Lammersfeld CA, Markman M, Vashi PG. Role of nutritional status in predicting quality of life outcomes in cancer--a systematic review of the epidemiological literature. Nutr J. 2012 Apr 24;11:27.

  • Santos IM, Mendes L, Carolino E, Santos CA. Nutritional Status, Functional Status, and Quality of Life - What is the Impact and Relationship on Cancer Patients? Nutr Cancer. 2020 Oct 29;1–14.

  • Maeda H, Sato M, Kobayashi M, Takiguchi N, Yoshikawa T, Yoshino S, et al. Validity of the Japanese version of functional assessment of cancer therapy-gastric (FACT-Ga) and its sensitivity to ascites volume change: a retrospective analysis of Japanese clinical trial participants. Support Care Cancer. 2016 Nov;24(11):4515–21.


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  • Nutritional Status and Functional Assessment of Anorexia, Cachexia Including Quality of Life (QoL) in Patients with Gastrointestinal Malignancies Undergoing Chemotherapy

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Authors

Abijah Princy B.
Assistant Professor, College of Nursing, CMC, Vellore, Tamil Nadu, India
Amalorpavamari Lucas
Professor, College of Nursing, CMC, Vellore, Tamil Nadu, India
Merlin Nancy Deepa V.
Charge Nurse, Hemato-Oncology Ward, CMC, Vellore, Tamil Nadu, India
Vanitha S.
Chemotherapy Nurse Coordinator, Department of Medical Oncology, CMC, Vellore, Tamil Nadu, India
Shiny Angel S.
Chemotherapy Nurse Coordinator, Department of Medical Oncology, CMC, Vellore, Tamil Nadu, India

Abstract


Malnutrition is an overlooked domain of concern among patients with GI malignancies especially, while undergoing chemotherapy. Poor nutrition deleteriously impacts treatment outcomes, performance status and eventually the QoL. A quantitative descriptive research approach was used to assess the nutritional status and the functional assessment of anorexia/cachexia including QoL among patients with GI malignancies undergoing chemotherapy. A total of 111 adult patients were enrolled using consecutive sampling technique. Data were collected using PGSGA and FAACT questionnaires. The findings revealed that based on PGSGA, 50.5% were moderately and 23.4% were severely malnourished. 73.90% had a PGSGA point score of ≥ 9. Based on SCRINIO classification, 20.7% were symptomatically cachexic and 58.6% were symptomatic precachexic. Hemoglobin was < 11.9g/dL in 63% of patients. 45% had a performance status (ECOG) score of 1. The overall mean FAACT score was moderate (108.6822.82). Statistically significant, strong negative correlation existed between nutritional status and FAACT (r=-0.710, p-0.000). Statistically significant difference was found in the mean nutritional status based on ECOG score (p-0.000), SCRINIO classification (p-0.000), hemoglobin level (p-0.001), BMI (p-0.020), family income (p-0.035) and the duration of last chemotherapy received (p-0.035). Also, statistically significant difference was seen in the mean FAACT score based on ECOG score (p-0.000), SCRINIO classification (p-0.000), family income (p-0.001), hemoglobin level (p-0.004) and BMI status (p-0.030). The study reveals that majority of GI cancer patients undergoing chemotherapy are moderately to severely malnourished and have a moderate functional status and QoL. The study emphasizes the critical need for ongoing preemptive nutritional assessment/interventions, improved symptom management and individualized dietary counseling to cancer patients.

Keywords


GI Malignancies, Chemotherapy, Nutritional Status, Functional Assessment of Anorexia and Cachexia, Quality of Life.

References