Aims
Malnutrition is an important supportive care need for people with cancer. The aims of this study were to determine the prevalence of malnutrition using the Patient-Generated Subjective Global Assessment (PG-SGA) for in-patients and ambulatory patients receiving chemotherapy and/or radiotherapy, identify the proportion of malnourished patients receiving dietetic intervention and the association between malnutrition and clinical outcomes at 30 days.
Methods
Sixteen Victorian Health Services, representing 75% of annual cancer treatments participated in this state-wide cross-sectional point prevalence study of 1693 adult cancer patients during March 2012.
Results
Overall 31% of cancer patients were identified as malnourished. Malnutrition prevalence was higher in patients with tumours of the upper gastro-intestinal tract (62%), head & neck (40%) and lung (37%) but commonly identified across all tumour streams. Malnutrition prevalence was found to be 57% of in-patients (n=336) and 25% of ambulatory patients undergoing chemotherapy and/or radiotherapy (n=1357). Patients with metastatic disease had a higher prevalence of malnutrition than those without (39% vs 27%, p<0.0001). Of those patients identified as malnourished only 56% were receiving dietetic intervention. Patients with malnutrition had a significantly higher 30-day mortality (6% vs 1%, p<0.001) and unplanned hospital admission/re-admission rate (38% vs 12%, p<0.001). The mean length of stay was 20.3 ± 17.6 days for malnourished in-patients and 15.7 ± 11.8 days for well-nourished patients (p<0.001).
Conclusions
Malnutrition prevalence in cancer patients is dependent on tumour type, treatment modality and is associated with increased length of stay, mortality and unplanned hospital admissions. Identification and treatment of malnutrition with validated screening and assessment tools is essential to ensure patients receive appropriate and timely dietetic intervention. This study is the largest of its kind in Australia and provides valuable insight and direction for the implementation of evidence-based nutrition interventions to address the widespread issue of malnutrition in cancer patients.
Funding provided by Victorian Government Department of Health through special project grants to each participating site.