Researchers test tool for screening cancer patients for malnutrition

Considering the many things a cancer patient has to think about, it's easy to understand why maintaining proper nutrition may not be top of mind.

This can be true, too, at busy outpatient settings where it's often difficult to find the time and resources to test cancer patients for malnutrition.

However, researchers at St. Michael's Hospital have found a shorter version of a commonly used nutrition-assessment tool does the job effectively and can potentially improve outcomes for cancer patients.

"The full-length test for malnutrition is too cumbersome for a busy clinic," said Pauline Darling, the senior author of the study, and a dietitian and researcher at the hospital. "We need a tool that is quick, easy to apply and accurate. Otherwise, testing for patients' nutrition falls through the cracks."

The scored Patient-Generated Subjective Global Assessment tool (PG-SGA) is the recommended test used to identify malnutrition in cancer patients. Patients answer questions about their weight, dietary intake, symptoms that may affect intake and their activity level and then a trained personnel performs a physical assessment. The PG-SGA is often not used in an outpatient setting because of the time and resources it takes to complete.

Darling and colleagues looked at whether an abridged version of this tool – which forgoes the physical examination and has fewer questions – could be just as effective but easier to complete.

The short version, called the abPG-SGA, is used by some institutions but until now there has been no data on how well it captures malnourished patients.

The study, which appeared online in Nutrition and Cancer today, looked at 90 patients receiving chemotherapy from the outpatient oncology clinic at St. Michael's Hospital between January and June 2008. The results found the abPG-SGA was the best tool in terms of identifying patients who needed further nutrition assessment by a registered dietitian. It was also the best tool for minimizing the number of patients referred to a dietitian but who turn out not to need their services.

In looking at the effectiveness of the tool, researchers found 36 per cent of the patients they looked at were malnourished.

"This is a large number of people and it speaks to the importance of using a reliable approach to correctly identify the patients that are top priority from a nutrition standpoint," said Darling, also a scientist at the hospital's Li Ka Shing Knowledge Institute. "Having malnutrition is associated with a higher risk of mortality and the chemotherapy is less effective in patients who are malnourished."

Malnutrition is commonly seen in cancer patients because the cancer itself may cause increased metabolic demands, often caused by tumors, reduces appetite and side effects from the cancer treatment can reduce food intake.

Darling said it's important to catch the patients before their nutritional status worsens because after a certain point, severe malnutrition is difficult to reverse.

"We need a tool in place that's easy, quick and effective because otherwise it's difficult to identify which patients need the most help," Darling said. "People often equate malnutrition with a low BMI, but usually the patients' weight is at or above normal range and is no indication of whether they're malnourished. We are more interested in knowing about weight loss sustained over a short period of time and whether the patient is eating enough nourishing food."