Nutritional assessment and risk factors associated to malnutrition in patients with esophageal cancer
Introduction
Esophageal cancer is the sixth most common malignant tumor and the fourth most common cause of cancer death in China.1 It is estimated that about 375,000 Chinese will die from Esophageal cancer in 2015, accounting for 13.3% of all cancer deaths.2
Influenced by the disease itself and the treatment of cancer, the nutritional problems of patients with malignant tumors are more serious. Malnutrition has been shown to have negative effect on cancer patients, such as reducing the tolerance and efficacy of their treatment,3 increasing the risk for clinical and surgical complications,4 and lengthening hospital stay with a concomitant increase in health care costs.5 It is estimated that 10%-20% of cancer patients die from malnutrition, not cancer itself.6 Esophageal cancer, as a kind of upper gastrointestinal cancer, directly affects the intake of food and has a higher risk of malnutrition. Most of the patients diagnosed with esophageal cancer are advanced, about 40%-60% of the patients were malnourished at the time of admission.7 Progressive dysphagia8 and significant weight loss9 are the typical symptomatic presentation of advanced esophageal cancer patients and concurrent radiotherapy and chemotherapy is an effective way of esophageal cancer treatment.10 The characteristics of esophageal cancer make patients with esophageal cancer are more likely to suffer from malnutrition.
The importance of nutritional status of cancer patients is widely recognized, and various methods to assess nutritional status of patients are emerging. The Patient Generated Subjective Global Assessment (PG-SGA) is a specific nutritional assessment and screening tool for cancer patients, it is significantly associated with subjective and objective parameters and widely recognized method of assessing nutritional status.11 NRS-2002 is a nutritional risk screening method recommended by the European Society of Parenteral Nutrition (ESPEN) for hospitalized patients12 and the Karnofsky performance status (KPS) available to monitor the variation in vitality and dependence levels can also reflect the nutritional status of cancer patients to a certain extent.13 Besides, anthropometry and laboratory examinations can provide objective measurements to reflect the nutritional status of cancer patients.
Studies confirmed that understanding the nutritional status of patients and implementing nutritional intervention can improve the quality of life and reduce the risk of malnutrition. However, no single method or indicator can accurately assess the overall nutritional status of patients. Up to now, study on comprehensive assessment of nutritional status of patients with esophageal cancer has not yet been found. In the current study, we attempt to evaluate the nutritional status of patients with esophageal cancer from multiple perspectives. The PG-SGA, NRS-2002, and KPS scores of 1482 esophageal cancer patients were estimated and classic anthropometric and laboratory indicators that can reflect the nutritional status of patients were collected. In addition, unconditional logistic regression analysis was carried out to identify the factors that might affect nutritional risk of esophageal cancer patients.
Section snippets
Subjects
In the cross-sectional study, a total of 1482 esophageal cancer patients in 72 hospitals in China came from a Program on Nutrition Status and its Clinical Outcome of Common Cancers supported by Chinese Society for Oncological Nutrition & Supportive Care in 2013. All participants followed strict inclusion and exclusion criteria: (1) age ≥18 years; (2) pathology diagnosed with esophageal cancer; (3) conscious, and no communication disorders; (4) informed consent; (5) deem the patients as 1 case
The Characteristics of Esophageal Cancer Patients
A total of 1482 esophageal cancer patients were included in the study, of which 273(18.42%) were females and 1209 (81.58%) were males with a mean age of 62.68 ± 10.91 years. There were 35.09% (519) esophageal cancer patients with moderately malnourished status (scores 4-8), 46.93% (694) with severely malnourished status (score≥9), 11.49% (170) with suspicious malnourished status (scores 2-3), and only 6.49% (96) with well-nourished status (scores 0-1). We observed 613(41.39%) patients received
Discussion
The PG-SGA was recommended as a nutritional screening tool specifically for oncology patients.18 It could detect subtle changes in nutritional risk in a short time and most of PG-SGA can be done by patients alone.19 It was widely recognized that PG-SGA was a quick, valid, and reliable nutrition risk screening tool. In a previous article, we evaluated the nutritional risk of 16 common malignant tumors in 23904 cancer patients by PG-SGA methods and the results showed malnutrition risk is highest
References (35)
- et al.
Why do patients with weight loss have a worse outcome when undergoing chemotherapy for gastrointestinal malignancies?
Eur J Cancer
(1998) - et al.
Postoperative complications in gastrointestinal cancer patients: the joint role of the nutritional status and the nutritional support
Clin Nutr
(2007) - et al.
ESPEN expert group recommendations for action against cancer-related malnutrition
Clin Nutr
(2017) - et al.
Interdialytic weight gain, systolic blood pressure, serum albumin, and C-reactive protein levels change in chronic dialysis patients prior to death
Kidney Int
(2013) - et al.
Diagnostic criteria for malnutrition – an ESPEN consensus statement
Clin Nutr
(2015) - et al.
Global gender disparities in obesity: a review
Adv Nutr (Bethesda, MD)
(2012) - et al.
Do total parenteral nutrition and bowel rest reduce the risk for perforation in patients with gastrointestinal tract lymphoma receiving chemotherapy?
Nutrition (Burbank, Los Angeles County, Calif)
(2019) - et al.
Cancer incidence and mortality in China, 2014
Chin J Cancer Res
(2018) - et al.
Cancer statistics in China, 2015
CA
(2016) - et al.
The prevalence of nutrition impact symptoms and their relationship to quality of life and clinical outcomes in medical oncology patients
Support Care Cancer
(2009)
Surgery in esophageal and gastric cancer patients: what is the role for nutrition support in your daily practice?
Ann Surg Oncol
Diagnosis, and management of esophageal adenocarcinoma
Gastroenterology
Feeding challenges in patients with esophageal and gastroesophageal cancers
Gastrointest Tumors
Radiotherapy for esophageal carcinoma: dose, response and survival
Cancer Manage Res
Use of the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in patients with cancer
Eur J Clin Nutr
NRS2002 assesses nutritional status of leukemia patients undergoing hematopoietic stem cell transplantation
Chin J Cancer Res = Chung-kuo yen cheng yen chiu
Impact of the Karnofsky performance status on survival and its dynamics during the terminal year of peritoneal dialysis patients
Peritoneal Dial Int
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This work was financially supported by Chinese Society for Oncological Nutrition & Supportive Care; The National Key Research and Development Program (2017YFC1309200); Support program for scientific and technological innovation talents of Henan Universities (19HASTIT005); Medical Science and Technology Key Projects of Henan Province and Zhengzhou (192102310088, SBGJ2018089, 19A32000820);The National Natural Science Foundation of China (U1604168).
Conflicts of Interest: The authors declare that they have no competing interests.
- 1
Hanping Shi, Chunhua Song, and Tao Li contributed equally to this work.