Top

Published in:

01-02-2021 | Nutrition | Original Paper

Quality of life, symptoms and dietary habits in oncology outpatients with malnutrition: A cross-sectional study

Authors: Mira Sonneborn-Papakostopoulos, Clara Dubois, Viktoria Mathies, Mara Heß, Nicole Erickson, Thomas Ernst, Jutta Huebner

Published in: Medical Oncology | Issue 2/2021

Abstract

Cancer-related malnutrition has a high prevalence, reduces survival and increases side effects. The aim of this study was to assess oncology outpatients and risk of malnutrition. Reported symptoms and quality of life (QoL) in patients found to be at risk of malnutrition or malnourished were compared to patients without malnutrition. Using a standardized questionnaire, the European Organization for Research and Treatment of Cancer Questionnaire for Quality of Life and the Mini Nutritional Assessment (MNA), patients in an outpatient cancer clinic undergoing chemotherapy treatment at a German University Hospital were assessed for nutrition, risk of malnutrition and quality of life. Based on the MNA, 39 (45.9%) patients were categorized as malnourished or at risk for malnutrition. Loss of appetite (n = 37.6%, p < 0.001) and altered taste sensation (n = 30,3%, p < 0.001) were the symptoms most frequently associated with reduced food intake. Patients with risk of malnutrition scored lower on the global health status (n = 48.15%, p = 0.001). Side effects of cancer treatments lead to a higher risk of malnutrition and as a consequence lower QoL. These side effects should be addressed more efficiently in cancer care.

White JV, Guenter P, Jensen G, Malone A, Schofield M, Academy Malnutrition Work G, et al. Consensus statement: academy of nutrition and dietetics and American Society for Parenteral and Enteral Nutrition: characteristics recommended for the identification and documentation of adult malnutrition (undernutrition). JPEN J Parenter Enteral Nutr. 2012;36(3):275–83. https://doi.org/10.1177/0148607112440285.CrossRefPubMed

Cederholm T, Bosaeus I, Barazzoni R, Bauer J, Van Gossum A, Klek S, et al. Diagnostic criteria for malnutrition - An ESPEN consensus statement. Clin Nutr. 2015;34(3):335–40. https://doi.org/10.1016/j.clnu.2015.03.001.CrossRefPubMed

Soderstrom L, Rosenblad A, Thors Adolfsson E, Bergkvist L. Malnutrition is associated with increased mortality in older adults regardless of the cause of death. Br J Nutr. 2017;117(4):532–40. https://doi.org/10.1017/S0007114517000435.CrossRefPubMed

Martin L, Senesse P, Gioulbasanis I, Antoun S, Bozzetti F, Deans C, et al. Diagnostic criteria for the classification of cancer-associated weight loss. J Clin Oncol. 2015;33(1):90–9. https://doi.org/10.1200/JCO.2014.56.1894.CrossRefPubMed

Bourdel-Marchasson I, Diallo A, Bellera C, Blanc-Bisson C, Durrieu J, Germain C, et al. One-year mortality in older patients with Cancer: development and external validation of an MNA-based prognostic score. PLoS One. 2016;11(2):e0148523. https://doi.org/10.1371/journal.pone.0148523.CrossRefPubMedPubMedCentral

Ozola Zalite I, Zykus R, Francisco Gonzalez M, Saygili F, Pukitis A, Gaujoux S, et al. Influence of cachexia and sarcopenia on survival in pancreatic ductal adenocarcinoma: a systematic review. Pancreatology. 2015;15(1):19–24. https://doi.org/10.1016/j.pan.2014.11.006.CrossRefPubMed

Shachar SS, Williams GR, Muss HB, Nishijima TF. Prognostic value of sarcopenia in adults with solid tumours: a meta-analysis and systematic review. Eur J Cancer. 2016;57:58–67. https://doi.org/10.1016/j.ejca.2015.12.030.CrossRefPubMed

Levolger S, van Vugt JL, de Bruin RW, JN IJ. Systematic review of sarcopenia in patients operated on for gastrointestinal and hepatopancreatobiliary malignancies. Br J Surg. 2015;102(12):1448–58. https://doi.org/10.1002/bjs.9893.CrossRefPubMed

Andreyev HJN, Norman AR, Oates J, Cunningham D. Why do patients with weight loss have a worse outcome when undergoing chemotherapy for gastrointestinal malignancies? Eur J Cancer. 1998;34(4):503–9. https://doi.org/10.1016/S0959-8049(97)10090-9.

10.

Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F, et al. ESPEN guidelines on nutrition in cancer patients. Clin Nutr. 2017;36(1):11–48. https://doi.org/10.1016/j.clnu.2016.07.015.CrossRefPubMed

11.

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;11:27. https://doi.org/10.1186/1475-2891-11-27.CrossRefPubMedPubMedCentral

12.

Norman K, Stobaus N, Zocher D, Bosy-Westphal A, Szramek A, Scheufele R, et al. Cutoff percentiles of bioelectrical phase angle predict functionality, quality of life, and mortality in patients with cancer. Am J Clin Nutr. 2010;92(3):612–9. https://doi.org/10.3945/ajcn.2010.29215.CrossRefPubMed

13.

Nourissat A, Vasson MP, Merrouche Y, Bouteloup C, Goutte M, Mille D, et al. Relationship between nutritional status and quality of life in patients with cancer. Eur J Cancer. 2008;44(9):1238–42. https://doi.org/10.1016/j.ejca.2008.04.006.CrossRefPubMed

14.

Muscaritoli M, Molfino A, Scala F, Christoforidi K, Manneh-Vangramberen I, De Lorenzo F. Nutritional and metabolic derangements in Mediterranean cancer patients and survivors: the ECPC 2016 survey. J Cachexia Sarcopenia Muscle. 2019; https://doi.org/10.1002/jcsm.12420.

15.

Maschke J, Kruk U, Kastrati K, Kleeberg J, Buchholz D, Erickson N, et al. Nutritional care of cancer patients: a survey on patients’ needs and medical care in reality. Int J Clin Oncol. 2017;22(1):200–6. https://doi.org/10.1007/s10147-016-1025-6.CrossRefPubMed

16.

Vetter ML, Herring SJ, Sood M, Shah NR, Kalet AL. What do resident physicians know about nutrition? An evaluation of attitudes, self-perceived proficiency and knowledge. J Am Coll Nutr. 2008;27(2):287–98. https://doi.org/10.1080/07315724.2008.10719702.CrossRefPubMedPubMedCentral

17.

Wirth R, Smoliner C, Spamer C, Marburger C, Schreiber FS, Willschrei HP, et al. Do doctors know how much nutrition patients need--a survey from Germany? Eur J Clin Nutr. 2014;68(7):840–3. https://doi.org/10.1038/ejcn.2014.94.CrossRefPubMed

18.

Janssen G, Pourhassan M, Lenzen-Grossimlinghaus R, Jager M, Schafer R, Spamer C, et al. The refeeding syndrome revisited: you can only diagnose what you know. Eur J Clin Nutr. 2019; https://doi.org/10.1038/s41430-019-0441-x.

19.

Poulia KA, Klek S, Doundoulakis I, Bouras E, Karayiannis D, Baschali A, et al. The two most popular malnutrition screening tools in the light of the new ESPEN consensus definition of the diagnostic criteria for malnutrition. Clin Nutr. 2017;36(4):1130–5. https://doi.org/10.1016/j.clnu.2016.07.014.CrossRefPubMed

20.

Isenring E, Cross G, Daniels L, Kellett E, Koczwara B. Validity of the malnutrition screening tool as an effective predictor of nutritional risk in oncology outpatients receiving chemotherapy. Support Care Cancer. 2006;14(11):1152–6. https://doi.org/10.1007/s00520-006-0070-5.CrossRefPubMed

21.

Castillo-Martinez L, Castro-Eguiluz D, Copca-Mendoza ET, Perez-Camargo DA, Reyes-Torres CA, Avila EA, et al. Nutritional assessment tools for the identification of malnutrition and nutritional risk associated with cancer treatment. Rev Invest Clin. 2018;70(3):121–5. https://doi.org/10.24875/RIC.18002524.CrossRefPubMed

22.

Ye XJ, Ji YB, Ma BW, Huang DD, Chen WZ, Pan ZY, et al. Comparison of three common nutritional screening tools with the new European Society for Clinical Nutrition and Metabolism (ESPEN) criteria for malnutrition among patients with geriatric gastrointestinal cancer: a prospective study in China. BMJ Open. 2018;8(4):e019750. https://doi.org/10.1136/bmjopen-2017-019750.CrossRefPubMedPubMedCentral

23.

Du H, Liu B, Xie Y, Liu J, Wei Y, Hu H, et al. Comparison of different methods for nutrition assessment in patients with tumors. Oncol Lett. 2017;14(1):165–70. https://doi.org/10.3892/ol.2017.6154.CrossRefPubMedPubMedCentral

24.

Read JA, Crockett N, Volker DH, MacLennan P, Choy ST, Beale P, et al. Nutritional assessment in cancer: comparing the mini-nutritional assessment (MNA) with the scored patient-generated subjective global assessment (PGSGA). Nutr Cancer. 2005;53(1):51–6. https://doi.org/10.1207/s15327914nc5301_6.CrossRefPubMed

25.

Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85(5):365–76. https://doi.org/10.1093/jnci/85.5.365.CrossRefPubMed

26.

Calderon C, Carmona-Bayonas A, Beato C, Ghanem I, Hernandez R, Majem M, et al. Risk of malnutrition and emotional distress as factors affecting health-related quality of life in patients with resected cancer. Clin Transl Oncol. 2019;21(5):687–91. https://doi.org/10.1007/s12094-018-1954-9.CrossRefPubMed

27.

Alvaro Sanz E, Garrido Siles M, Rey Fernandez L, Villatoro Roldan R, Rueda Dominguez A, Abiles J. Nutritional risk and malnutrition rates at diagnosis of cancer in patients treated in outpatient settings: early intervention protocol. Nutrition. 2019;57:148–53. https://doi.org/10.1016/j.nut.2018.05.021.CrossRefPubMed

28.

Muscaritoli M, Lucia S, Farcomeni A, Lorusso V, Saracino V, Barone C, et al. Prevalence of malnutrition in patients at first medical oncology visit: the PreMiO study. Oncotarget. 2017;8(45):79884–96. https://doi.org/10.18632/oncotarget.20168.CrossRefPubMedPubMedCentral

29.

Araujo dos Santos C, de Oliveira Barbosa Rosa C, Queiroz Ribeiro A, Lanes Ribeiro Rde C. Patient-generated subjective global assessment and classic anthropometry: comparison between the methods in detection of malnutrition among elderly with cancer. Nutr Hosp. 2015;31(1):384–92. https://doi.org/10.3305/nh.2015.31.1.7543.CrossRefPubMed

30.

Zhang X, Sun M, McKoy JM, Bhulani NNA, Valero V, Barcenas CH, et al. Malnutrition in older patients with cancer: appraisal of the mini nutritional assessment, weight loss, and body mass index. J Geriatr Oncol. 2018;9(1):81–3. https://doi.org/10.1016/j.jgo.2017.07.012.CrossRefPubMed

31.

Leandro-Merhi VA, Aquino JLB. Relationship between nutritional status and the clinical outcomes of patients with and without neoplasms according to multiple correspondence analysis. Arq Gastroenterol. 2017;54(2):148–55. https://doi.org/10.1590/S0004-2803.201700000-05.CrossRefPubMed

32.

Gyan E, Raynard B, Durand JP. Lacau saint Guily J, Gouy S, Movschin ML et al. malnutrition in patients with Cancer: comparison of perceptions by patients, relatives, and physicians-results of the NutriCancer2012 study. JPEN J Parenter Enteral Nutr. 2018;42(1):255–60. https://doi.org/10.1177/0148607116688881.CrossRefPubMed

33.

Lacau St Guily J, Bouvard E, Raynard B, Goldwasser F, Maget B, Prevost A, et al. NutriCancer: a French observational multicentre cross-sectional study of malnutrition in elderly patients with cancer. J Geriatr Oncol. 2018;9(1):74–80. https://doi.org/10.1016/j.jgo.2017.08.003.CrossRefPubMed

34.

Uster A, Ruefenacht U, Ruehlin M, Pless M, Siano M, Haefner M, et al. Influence of a nutritional intervention on dietary intake and quality of life in cancer patients: a randomized controlled trial. Nutrition. 2013;29(11–12):1342–9. https://doi.org/10.1016/j.nut.2013.05.004.CrossRefPubMed

35.

Bozzetti F, Mariani L, Lo Vullo S, Amerio ML, Biffi R, Caccialanza R, et al. The nutritional risk in oncology: a study of 1,453 cancer outpatients. Support Care Cancer. 2012;20(8):1919–28. https://doi.org/10.1007/s00520-012-1387-x.CrossRefPubMedPubMedCentral

36.

Tong H, Isenring E, Yates P. The prevalence of nutrition impact symptoms and their relationship to quality of life and clinical outcomes in medical oncology patients. Support Care Cancer. 2009;17(1):83–90. https://doi.org/10.1007/s00520-008-0472-7.CrossRefPubMed

37.

Renken RJ, Gietema JA, Slart R, MGJ M, Lefrandt JD, et al. Changes in taste and smell function, dietary intake, food preference, and body composition in testicular cancer patients treated with cisplatin-based chemotherapy. Clin Nutr. 2017;36(6):1642–8. https://doi.org/10.1016/j.clnu.2016.10.013.CrossRefPubMed

38.

Khalid U, McGough C, Hackett C, Blake P, Harrington KJ, Khoo VS, et al. A modified inflammatory bowel disease questionnaire and the Vaizey incontinence questionnaire are more sensitive measures of acute gastrointestinal toxicity during pelvic radiotherapy than RTOG grading. Int J Radiat Oncol Biol Phys. 2006;64(5):1432–41. https://doi.org/10.1016/j.ijrobp.2005.10.007.CrossRefPubMed

39.

Gangadharan A, Choi SE, Hassan A, Ayoub NM, Durante G, Balwani S, et al. Protein calorie malnutrition, nutritional intervention and personalized cancer care. Oncotarget. 2017;8(14):24009–30. https://doi.org/10.18632/oncotarget.15103.CrossRefPubMedPubMedCentral

40.

Harder SL, Groenvold M, Herrstedt J, Johnsen AT. Nausea in advanced cancer: relationships between intensity, burden, and the need for help. Support Care Cancer. 2019;27(1):265–73. https://doi.org/10.1007/s00520-018-4326-7.CrossRefPubMed

41.

Najafi S, Haghighat S, Raji Lahiji M, RazmPoosh E, Chamari M, Abdollahi R, et al. Randomized study of the effect of dietary counseling during adjuvant chemotherapy on chemotherapy induced nausea and vomiting, and quality of life in patients with breast Cancer. Nutr Cancer. 2018:1–10. https://doi.org/10.1080/01635581.2018.1527375.

42.

Climent M, Munarriz M, Blazeby JM, Dorcaratto D, Ramon JM, Carrera MJ, et al. Weight loss and quality of life in patients surviving 2 years after gastric cancer resection. Eur J Surg Oncol. 2017;43(7):1337–43. https://doi.org/10.1016/j.ejso.2017.01.239.CrossRefPubMed

43.

Thomas MN, Kufeldt J, Kisser U, Hornung HM, Hoffmann J, Andraschko M, et al. Effects of malnutrition on complication rates, length of hospital stay, and revenue in elective surgical patients in the G-DRG-system. Nutrition. 2016;32(2):249–54. https://doi.org/10.1016/j.nut.2015.08.021.CrossRefPubMed

44.

Kang MC, Kim JH, Ryu SW, Moon JY, Park JH, Park JK, et al. Prevalence of malnutrition in hospitalized patients: a multicenter Cross-sectional study. J Korean Med Sci. 2018;33(2):e10. https://doi.org/10.3346/jkms.2018.33.e10.CrossRefPubMed

45.

Correia MI, Waitzberg DL. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr. 2003;22(3):235–9.CrossRef

46.

Nishiyama VKG, Albertini SM, Moraes C, Godoy MF, Netinho JG. Malnutrition and clinical outcomes in surgical patients with colorectal disease. Arq Gastroenterol. 2018;55(4):397–402. https://doi.org/10.1590/S0004-2803.201800000-85.CrossRefPubMed

47.

Ovesen L, Hannibal J, Mortensen EL. The interrelationship of weight loss, dietary intake, and quality of life in ambulatory patients with cancer of the lung, breast, and ovary. Nutr Cancer. 1993;19(2):159–67. https://doi.org/10.1080/01635589309514246.CrossRefPubMed

48.

Ghelfi F, Tieri M, Gori S, Nicolis F, Petrella MC, Filiberti A, et al. Do cancer patients change their diet in the e-health information era? A review of the literature and a survey as a proposal for the Italian population. Food Res Int. 2018;104:59–68. https://doi.org/10.1016/j.foodres.2017.10.021.CrossRefPubMed

49.

Grace EM, Shaw C, Lalji A, Mohammed K, Andreyev HJN, Whelan K. Nutritional status, the development and persistence of malnutrition and dietary intake in oesophago-gastric cancer: a longitudinal cohort study. J Hum Nutr Diet. 2018;31(6):785–92. https://doi.org/10.1111/jhn.12588.CrossRefPubMed

50.

Ravasco P, Monteiro-Grillo I, Camilo M. Individualized nutrition intervention is of major benefit to colorectal cancer patients: long-term follow-up of a randomized controlled trial of nutritional therapy. Am J Clin Nutr. 2012;96(6):1346–53. https://doi.org/10.3945/ajcn.111.018838.CrossRefPubMed

51.

Poulsen GM, Pedersen LL, Osterlind K, Baeksgaard L, Andersen JR. Randomized trial of the effects of individual nutritional counseling in cancer patients. Clin Nutr. 2014;33(5):749–53. https://doi.org/10.1016/j.clnu.2013.10.019.CrossRefPubMed

52.

Baldwin C, Spiro A, Ahern R, Emery PW. Oral nutritional interventions in malnourished patients with cancer: a systematic review and meta-analysis. J Natl Cancer Inst. 2012;104(5):371–85. https://doi.org/10.1093/jnci/djr556.CrossRefPubMed

53.

Cereda E, Cappello S, Colombo S, Klersy C, Imarisio I, Turri A, et al. Nutritional counseling with or without systematic use of oral nutritional supplements in head and neck cancer patients undergoing radiotherapy. Radiother Oncol. 2018;126(1):81–8. https://doi.org/10.1016/j.radonc.2017.10.015.CrossRefPubMed

54.

Kufeldt J, Viehrig M, Schweikert D, Fritsche A, Bamberg M, Adolph M. Treatment of malnutrition decreases complication rates and shortens the length of hospital stays in a radiation oncology department. Strahlenther Onkol. 2018;194(11):1049–59. https://doi.org/10.1007/s00066-018-1360-9.CrossRefPubMed

55.

Tanaka N, Takeda K, Kawasaki Y, Yamane K, Teruya Y, Kodani M, et al. Early intensive nutrition intervention with dietary counseling and Oral nutrition supplement prevents weight loss in patients with advanced lung Cancer receiving chemotherapy: a clinical prospective study. Yonago Acta Med. 2018;61(4):204–12.CrossRef

56.

Hiesmayr M, Schindler K, Pernicka E, Schuh C, Schoeniger-Hekele A, Bauer P, et al. Decreased food intake is a risk factor for mortality in hospitalised patients: the NutritionDay survey 2006. Clin Nutr. 2009;28(5):484–91. https://doi.org/10.1016/j.clnu.2009.05.013.CrossRefPubMed

Title: Quality of life, symptoms and dietary habits in oncology outpatients with malnutrition: A cross-sectional study
Authors: Mira Sonneborn-Papakostopoulos
Clara Dubois
Viktoria Mathies
Mara Heß
Nicole Erickson
Thomas Ernst
Jutta Huebner
Publication date: 01-02-2021
Publisher: Springer US
Keywords: Nutrition
Malnutrition
Published in: Medical Oncology / Issue 2/2021
Print ISSN: 1357-0560
Electronic ISSN: 1559-131X
DOI: https://doi.org/10.1007/s12032-021-01460-7

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Quality of life, symptoms and dietary habits in oncology outpatients with malnutrition: A cross-sectional study

Abstract

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 2/2021

Is there any place for novel agents in treating biliary tract cancer?

Prevalence of mutations in BRCA and MMR genes in patients affected with hereditary endometrial cancer

Correction to: Primary evaluation of an air‑cooling device to reduce oral mucositis: a pilot study in healthy volunteers

Pyrvinium pamoate inhibits cell proliferation through ROS-mediated AKT-dependent signaling pathway in colorectal cancer

Real-world patterns of adjuvant chemotherapy treatment for patients with resected pancreatic adenocarcinoma

The role of palliative radiotherapy in the management of elderly and frail patients with advanced bladder cancer: A survey by the AIRO uro-group

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page