Patient-Generated Subjective Global Assessment in relation to site, stage of the illness, reason for hospital admission, and mortality in patients with gynecological tumors

The relationship between loneliness, psychological resilience, quality of life and taste change in cancer patients receiving chemotherapy

PURPOSE

This study aimed to determine the correlation between taste change, nutritional intake and quality of life in cancer patients receiving chemotherapy. A total of 610 (F = 314, M = 296) volunteers aged 19 and 65 who received outpatient chemotherapy treatment participated in the study.

METHODS

Individuals' general information was obtained, anthropometric measurements were carried out, malnutrition status (Patient-Generated Subjective Global Assessment PG-SGA), loneliness (Cancer Loneliness Scale), psychological resilience (Psychological Resilience Scale), quality of life (Quality of Life Scale (EORT QLQ-C30) and taste changes were scrutinized [Chemotherapy-Induced Taste Alteration Scale (CiTAS)].

RESULTS

There was a negative correlation between the Cancer Loneliness Scale and PG-SGA and General Health Status (r = -0.494, p = 0.000; r = -0.406, p = 0.000) and a positive correlation with Symptom Scales (r = 0.484, p = 0.000; r = 0.506, p = 0.000) (p < 0.05). There was a positive correlation between the Psychological Resilience Scale and General Health Status (r = 0.393, P = 0.000), Functional Scales (r = 0.349, P = 0.000), and a negative correlation between Symptom Scales (r = -0.302, p = 0.000) (p < 0.05). 70.9% of men and 70.7% of women had severe malnutrition. General Taste Changes, General Health and Symptom Scale values were significant predictors of severe malnutrition status (p < 0.05).

CONCLUSION

The symptoms that develop during the treatment process cause many psychological problems. Before starting treatment, patients should be evaluated comprehensively, depression anxiety levels and quality of life levels should be determined, and precautions should be taken accordingly.

Nutritional status assessed by Patient-Generated Subjective Global Assessment is associated with toxicity to chemoradiotherapy in women with cervical cancer: a prospective study

BACKGROUND

Patient-generated subjective global assessment (PG-SGA), a validated tool for nutritional assessment, has been associated with worse clinical outcomes in patients with cancer. However, studies assessing its relationship in chemoradiotherapy outcomes are scarce. The study aimed to determine the prevalence of malnutrition according to PG-SGA and its association with the incidence of toxicity to chemoradiotherapy treatment in women with cervical cancer.

METHODS

In a single-centre prospective observational study, we enrolled 391 women with locally advanced cervical cancer. Patients were assessed on the day of their first chemotherapy infusion, when nutritional status was evaluated by the PG-SGA form and anthropometric measurements. Sociodemographic and clinical data were also collected. Toxicity to chemoradiotherapy was assessed weekly and toxicity-induced modification of treatment (TIMT) was defined as any serious adverse event that resulted in treatment delay, interruption, or dose reduction. Multivariate mixed-effects Poisson and Logistic regression models were performed to identify the factors contributing to the outcome number of adverse events ≥ grade 3 and TIMT, respectively.

RESULTS

Malnutrition was found in 47.6% of the population. Roughly 1/3 had TIMT and 54.2% experienced at least one symptom ≥grade 3. In the adjusted models, PG-SGA B and C, as well as the score ≥9 were independent predictors of the number of toxicity events ≥grade 3 and higher incidence of TIMT.

CONCLUSIONS

PG-SGA may represent an important assessment tool to predict toxicity outcomes in women with cervical cancer, besides being considered a simple, fast, and low-cost tool, which allows early nutritional care.

A comparison of three preoperative nutritional assessment methods for predicting ovarian cancer patient prognosis: which is better?

BACKGROUND

The study aimed to compare the predictive values of three widely used nutritional assessment methods, body mass index (BMI), Nutritional Risk Screening 2002 (NRS 2002), and the prognostic nutritional index (PNI), for different clinical prognostic indicators of ovarian cancer patients.

METHODS

Patients diagnosed with ovarian cancer treated in our hospital between January 2017 and March 2019 were retrospectively included. The three nutritional assessment methods were assessed, and multivariable analysis was conducted to explore predictive factors for clinical prognoses. Receiver operating characteristic (ROC) curves and the area under the ROC curve (AUROC) were generated to evaluate the discriminative abilities of the three nutritional assessment tools.

RESULTS

A total of 442 patients were recruited. Multivariable analysis revealed that the PNI value predicted 1-year death and 1-year recurrence and that both the NRS 2002 score and the PNI value predicted 30-day readmission (P < 0.05). For PNI, AUROCs were 0.834 for predicting 1-year death and 0.719 for 1-year recurrence prediction; for NRS, the AUROC was 0.820 2002 for predicting 30-day readmission. The optimal cutoff values that maximized the prognostic prediction ability were PNI values of 47.75 g/L and 50.40 g/L for 1-year death and 1-year recurrence, respectively, and an NRS 2002 score of 3 points for 30-day readmission following discharge.

CONCLUSION

For ovarian cancer patients, the PNI is better at predicting 1-year death and 30-day readmission after discharge, and the NRS 2002 is superior for predicting 1-year recurrence.

Nutrition risk screening and implications for patients with gynaecological cancers undergoing pelvic radiotherapy and/or other treatment modalities: A retrospective observational study

AIM

There is scarcity of research for the nutritional management of pelvic radiotherapy in gynaecological malignancies and delivery of specialised nutrition care is limited due to the current knowledge gap in guidelines. This study aimed to better understand the nutritional risk, weight changes and pattern of nutrition impact symptoms occurring at various treatment timepoints in this population, to inform an effective model of care.

METHODS

This retrospective, observational study included women with gynaecological cancers receiving pelvic radiotherapy at a tertiary hospital from January 2017 to December 2018 (n = 104). Information was collected on: first day of radiotherapy; weekly during treatment; acute-phase post-treatment (0-6 weeks); and intermediate-phase post-treatment (6 weeks to 6 months). This study reported on incidence of clinically significant weight change (±5%), documented nutrition impact symptoms and the current nutrition care model (nutrition screening, referral, assessment and interventions).

RESULTS

Clinically significant weight loss was experienced by 38% (n = 40/104) of patients prior to commencing treatment and 19% (n = 14/73) during treatment. Diarrhoea (n = 40/79), fatigue (n = 54/79), nausea (n = 38/79) and pain (n = 31/79) were frequently reported during treatment, and fatigue (n = 33/92) and pain (n = 25/92) continued acutely post-treatment. Despite high rates of weight loss and prevalence of nutrition impact symptoms, only 38% (n = 40/104) of patients were referred to a dietitian.

CONCLUSIONS

A considerable proportion of patients with gynaecological cancers are at nutrition risk before and during treatment due to clinically significant weight loss and prevalence of nutrition impact symptoms experienced. This highlights the importance of nutrition-risk screening and access to specialised dietetic care as part of their model of care.

Nutritional status and primary tumour site in incurable cancer

OBJECTIVES

We aimed (1) to assess the nutritional status (NS) using different methods, according to the primary tumour site and (2) to evaluate the performance of these methods in patients with incurable cancer from a reference centre in Brazil.

METHODS

Cross-sectional analysis of data from patients admitted to the palliative care unit of a reference cancer centre in Brazil, between July 2016 and March 2020. The primary tumour site was the independent variable and the NS using different methods were the dependent variables. Logistic regressions were performed.

RESULTS

A total of 2,144 patients were included in the study. The most common primary tumour site was the upper gastrointestinal (GI) tract (18.0%), followed by gynaecological (17.6%) and head and neck (HN) (13.5%). Our results showed that patients with tumours of the upper GI tract followed by HN presented significantly higher risk of worse NS. In contrast, breast tumours, bone and connective tissues and melanoma presented inverse association. The gynaecological cancer was variably associated with nutritional impairment, according to the assessment method.

CONCLUSIONS

Patients with incurable cancer present high prevalence of NS impairment, depending on the tumour site, shown to be elevated in patients with tumour in the upper GI tract.

Validation of the scored Patient-Generated Subjective Global Assessment Short Form as a prognostic tool for patients with incurable cancer

BACKGROUND

The Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF) is a standardized tool for assessing nutrition risk in patients with cancer. The aim of this study was to propose and validate a cutoff point for the PG-SGA SF related to the prognosis of patients with incurable cancer in exclusive palliative care.

METHODS

This is a prospective cohort study of patients with incurable cancer at the National Cancer Institute in Brazil. A total sample (n = 2,144) was randomly divided into groups: (1) training (n = 1,072), to determine the most accurate PG-SGA SF cutoff, and (2) validation (n = 1,072), to test the predictive accuracy of this cutoff point. The receiver operating characteristic curve was plotted to determine the best cutoff point of the PG-SGA SF related to death. Concordance statistics (C statistic) were used to test the predictive accuracy of the models. Kaplan-Meier curve and the Cox hazard model were used to verify a prognostic value of the cutoff point.

RESULTS

PG-SGA SF score ≥15 was found to be the best cutoff based on 90-day mortality with good accuracy discrimination (C statistic ≥ 0.74). Patients whose PG-SGA SF score was ≥15 had a shorter survival of 32 (interquartile range [IQR], 12-75) vs 83 days (IQR, 31-90) (p-value < .001) and higher risk of death (hazard ratio: 2.20; 95% CI, 1.64-2.95).

CONCLUSIONS

The proposed PG-SGA SF cutoff score is valid and, alongside its usefulness in nutrition triage, could provide prognostic value for patients with incurable cancer.

Malnutrition and the Survival of Cervical Cancer Patients: A Prospective Cohort Study Using the PG-SGA Tool

BACKGROUND

Cervical cancer is the second most common cancer among women in developing countries. Malnutrition is associated with poor prognosis and early detection of malnutrition and timely nutritional interventions can improve the outcome for cervical cancer patients. The study was aimed to assess the association between the nutritional status and survival of cervical cancer patients.

METHODS

A prospective cohort study design was used. Overall 175 cervical cancer patients were followed over one year period with (median 8.5 mo, range (3.6-12).

RESULTS

The prevalence of malnutrition determined by means of the PG-SGA was 17.7% at admission and 47.1% at the end of follow-up. According to the SGA, one in three (29.7%) patients required nutritional intervention at the end of follow-up. Patients who were malnourished (PG-SGA-B and C) had an increased risk of mortality (Hazard Ratio [HR]: 3.12, 95% CI: 1.23 - 7.86) as compared to those who were well nourished (PG-SGA-A). Patients from rural areas had an increased risk of mortality (HR: 6.99, 95% CI: 2.07 - 23.58) compared to patients from urban areas.

CONCLUSION

In the context of developing country setting and COVID19 outbreak, malnutrition significantly decreases cervical cancer survival. A thorough nutrition assessment using scored PG-SGA is needed.

Clinical malnutrition predictive model among gynecologic cancer patients prior to elective operation: A cross-sectional study

BACKGROUND

Malnutrition is common among cancer patients regardless of stage of cancer. Given the strong association between malnutrition with prolonged hospitalization, delayed recovery and even higher post-operative complications among gynaecologic cancer (GC) patients, it is important to understand its predictive factors. The current study aimed to determine malnutrition predictors among GC patients before elective operation.

METHOD

A cross-sectional study was conducted among surgical GC patients who were admitted for elective surgery. Data on socio-demographic characteristics, clinical status (diagnosis, the staging of cancer, comorbidities and family history on cancer), anthropometric measures [ Body Mass Index (BMI), weight changes, the percentage of weight loss past one month, muscle mass, fat mass, fat-free mass and mid-upper arm circumference (MUAC)], biochemical profiles [C-reactive protein, albumin and C-reactive protein (CRP) to albumin ratio (CAR)], handgrip strength, total daily energy and protein intake, and malnutrition status [scored Patient Generated-Subjective Global Assessment (PG-SGA)] were assessed during admission.

RESULTS

Study recruited 124 participants and 57.2% (n = 71) were malnourished. Mean for age, weight changes past one month, handgrip strength, total daily energy and protein intake, PG-SGA score and CAR of participants were 49.9 ± 12.5 years, -4.9 ± 7.2%, 15.6 ± 6.2 kg, 25±7 kcal/kg/day, 1.0 ± 0.3 g/kg/day, 6.5 ± 5.4 and 0.7 ± 1.9, respectively. Multiple linear regression test revealed that the percentage of weight loss past one month, haemoglobin, CRP and handgrip strength were the significant predictors of malnutrition.

CONCLUSION

Malnutrition is common among GC patient even before elective operation. The early malnutrition screening following with proper nutritional intervention is crucial to optimize nutritional status among GC patients before elective operation.

The patient-generated subjective global assessment is a promising screening tool for cancer cachexia

Background

Cancer cachexia is a complex metabolic syndrome characterised by a loss of muscle with or without loss of fat mass, and is associated with high morbidity and mortality. Despite its clinical importance, there is a lack of simple tools to screen patients for cancer cachexia. The aim of this study was to evaluate and validate the patient-generated subjective global assessment (PG-SGA) as a screening tool for cancer cachexia.

Methods

This is a secondary analysis of a multicentre, cross-sectional, observational study. Cancer cachexia was diagnosed when there was weight loss ≥5% during the past 12 months and at least three of the five following conditions were present: decreased muscle strength, fatigue, anorexia, low Fat-Free Mass Index (FFMI) and abnormal laboratory findings. A quadratic discriminant analysis was conducted for the ability of PG-SGA to predict cachexia.

Results

A total of 4231 patients with cancer were included in this analysis, and 351 patients (8.3%) were diagnosed as having cachexia. The highest incidence of cachexia was found among patients with pancreatic cancer (32.5%), oesophageal cancer (21.5%) and gastric cancer (17.9%). Compared with patients without cachexia, patients with cachexia had a lower body mass index, FFMI, hand grip strength, total protein, prealbumin, albumin, haemoglobin and Karnofsky performance status (p<0.05), while they had a higher C reactive protein level and PG-SGA Score (4.71±3.71 vs 10.87±4.84, p<0.05). The best cut-off value for PG-SGA was 6.5, with 79.8% of sensitivity and 72.3% specificity for cachexia, and the area under the receiver operating characteristic curve was 0.846 (95% CI 0.826 to 0.866, p<0.001).

Conclusions

PG-SGA is a highly specific tool that can be used to screen patients for cancer cachexia.

Patient interpretation of the Patient-Generated Subjective Global Assessment (PG-SGA) Short Form

BACKGROUND

The Patient-Generated Subjective Global Assessment (PG-SGA) is a patient-reported instrument for assessment of nutrition status in patients with cancer. Despite thorough validation of PG-SGA, little has been reported about the way patients perceive, interpret, and respond to PG-SGA. The aim of this study was to investigate how patients interpret the patient-generated part of the PG-SGA, called PG-SGA Short Form.

METHODS

Purposive sampling was used to identify participants that had experienced weight loss and/or reduced dietary intake and/or had a low body mass index. Data were collected from 23 patients by combining observations of patients filling in the PG-SGA Short Form, think-aloud technique and structured interviews, and analyzed qualitatively using systematic text condensation.

RESULTS

Most of the participants managed to complete the PG-SGA Short Form without problems. However, participant-related and questionnaire-related sources of misinterpretation were identified, possibly causing misinterpretations or wrong/missing answers. Participants either read too fast and skipped words, or they struggled to find response options that were suitable for covering their entire situation perfectly. The word "normal" was perceived ambiguous, and the word "only" limited the participants' possibility to accurately describe their food intake. Long recall periods in the questions and two-pieced response options made it difficult for patients to select only one option.

CONCLUSION

The results of this study provide a unique patient perspective of using the PG-SGA Short Form and valuable input for future use and revisions of the form. The identified sources of misunderstanding could be used to develop a standardized instruction manual for patients and health care personnel using the PG-SGA Short Form.

Prevalence and relationship of malnutrition and distress in patients with Cancer using questionnaires

Background

Negative feelings, such as anxiety and depression, are common in patients with cancer. Our aim was to investigate the prevalence of malnutrition and distress in cancer patients and to examine the relationship between them.

Materials and methods

We did a cross-sectional study in West China hospital, China, using adapted questionnaires derived from Patient-Generated Subjective Global Assessment (PG-SGA), Nutritional Risk Screening 2002 (NRS2002) and Distress Thermometer (DT). We also focused on the factors associated with distress.

Results

We found that psychological distress in cancer patients was common, with 39.5% patients suffering from distress. The mean score of PG-SGA was 3.37 (0–6), and 39.1% patients had malnutrition when using 4 as a cut-off value. Meanwhile, the mean score of NRS2002 was 1.91 (0–11), and 25.8% patients presented with malnutrition when using 3 as the cut-off value. Higher scores of nutritional risks confirmed by PG-SGA (r = 0.148, p < 0.001) and NRS2002 (r = 0.142, p < 0.001) were significantly correlated with higher levels of psychological stress.

Conclusion

Malnutrition was correlated with psychological stress in cancer patients. Early intervention in the mental problems and nutrition was meaningful, which could improve the psychological statuses of cancer patients.

Electronic supplementary material

The online version of this article (10.1186/s12885-018-5176-x) contains supplementary material, which is available to authorized users.

Comparison of the prognostic value of different skeletal muscle radiodensity parameters in endometrial cancer

BACKGROUND/OBJECTIVES

Recent data have shown that dividing skeletal muscle (SM) into sub-ranges of radiodensity can improve the prediction of short-term outcomes in the oncology setting. We aim to investigate whether the skeletal muscle mass, when divided into sub-ranges of low or high-radiodensity, improves the prediction of short-term survival in endometrial cancer (EC) patients when compared to average muscle attenuation and to the overall skeletal muscle radiodensity.

SUBJECTS/METHODS

EC patients who had computed tomography (CT) images available within 30 days before treatment were enrolled in this retrospective cohort (n = 232). CT images at the third lumbar vertebra (L3) were used to assess overall skeletal muscle index (SMI). Then we divided SMI into sub-ranges of radiation attenuation: low-radiodensity skeletal muscle index (LRSMI) and high-radiodensity skeletal muscle index (HRSMI). The average muscle radiation attenuation was also assessed. Low SMI was defined when SMI was <38.9 cm²/m². One-year survival was evaluated by Kaplan-Meier method and Cox Regression.

RESULTS

Sarcopenia was found in 25.8% of the patients. Roughly 80% of the patients in the highest quartile of LRSMI were obese. All the skeletal muscle parameters were significantly associated with shorter 1-year survival, LRSMI presented a trend for significance in the adjusted model. When the SM parameters were additionally adjusted for low SMI, only HRSMI and LRSMI remained in the model as early-mortality predictors.

CONCLUSIONS

Classifying the skeletal muscle into sub-ranges of radiodensity have an additional value than using the average muscle attenuation of the overall skeletal muscle area and should be exploited in further studies.

Influence of chemoradiotherapy on nutritional status, functional capacity, quality of life and toxicity of treatment for patients with cervical cancer

AIM

Assess the influence of chemoradiotherapy on the nutritional status, functional capacity and quality of life (QoL), associating these indicators at baseline with toxicity and interruption of oncologic treatment in women with cervical cancer.

METHODS

Prospective cohort study performed on 49 women diagnosed with cervical cancer, who underwent treatment between August 2015 and January 2016. For data collection, two appointments were conducted by the lead researcher: the first occurred the day before the first chemotherapy session (T0) and the other at the end of chemotherapy session (T1). Nutritional status was measured by anthropometry (weight, height, mid-upper arm circumference and triceps skinfold thickness) and computed tomography (skeletal muscle index-SMI), functional capacity by handgrip strength (HGS) and Karnofsky Performance Status (KPS), and application of QoL questionnaire (EORTC QLQ-C30).

RESULTS

The average age was 45 ± 13.8 years and 81.6% of the women were diagnosed in stages II and III. There was significant reduction in HGS, KPS and QoL between T0 and T1, in addition to a significant QoL reduction according to worsening nutritional status. The interruption of chemotherapy was significantly associated with the variables of nutritional status assessed at baseline. Women who interrupted treatment due to acute toxicity also had a significant lower median SMI than those who concluded the treatment and 83% of these patients presented cachexia.

CONCLUSIONS

Chemoradiotherapy treatment in patients with cervical cancer had changed negative nutritional parameters, function capacity and QoL, and poor nutritional status at baseline was associated with chemotherapy interruption.

Relationship of nutritional status and inflammation with survival in patients with advanced cancer in palliative care

OBJECTIVE

This study aimed to evaluate the prognostic value of nutritional and inflammatory status in patients with advanced cancer receiving palliative care.

METHODS

The systemic inflammatory response was assessed using the modified Glasgow Prognostic Score (mGPS), and nutritional status was evaluated according to the Patient-Generated Subjective Global Assessment (PG-SGA) in 172 patients evaluated on their first visit in the Palliative Care Unit at the National Cancer Institute in Brazil. The receiver operating characteristic (ROC) curve was used to define the best cutoff point for the death-related PG-SGA score in 90 d. Kaplan-Meier curves were conducted for survival analyses, and logistic regression analyses were performed using the Cox proportional hazards model.

RESULTS

According to the PG-SGA, 83.6% of the patients (n = 143) were malnourished (B + C) and 34.8% (n = 53) had mGPS ≥1. The best cutoff of the PG-SGA score for death was ≥19 points (area under the curve, 0.69; P = 0.041). Patients with scores ≥19, mGPS ≥1, albumin <3.5 g/dL, and C-reactive protein ≥10 mg/L had a significantly lower overall survival. According to the multivariate analysis, albumin <3.5 g/dL (hazard ratio [HR], 2.04; 95% confidence interval [CI], 1.16-3.58), mGPS ≥1 (HR, 1.46; 95% CI, 1.09-2.22), and PG-SGA score ≥19 (HR, 1.66; 95% CI, 1.08-2.55) were independent prognostic factors for overall survival.

CONCLUSION

The severity of the systemic inflammation and the poor nutritional status predict survival and were considered independent prognostic factors. Thus they can be useful tools for nutritional evaluation in palliative care.

Nutritional status of cancer outpatients using scored patient generated subjective global assessment in two cancer treatment centers, Nairobi, Kenya

Background

Malnutrition is a universal problem in cancer patients renowned as an important factor for increased morbidity, decreased quality of life and high mortality. Early diagnosis of malnutrition risk through nutrition screening followed by comprehensive and timely interventions reduces mortality associated with malnutrition. The Scored Patient-Generated Subjective Global Assessment (PGSGA) method has been proved efficient in identifying cancer patients with nutrition challenges and guiding appropriate interventions. However this tool has not been adopted in management of cancer patients in Kenya. The aim of the study was to assess and describe nutrition status of cancer outpatients receiving treatment at Kenyatta National Hospital Hospital (KNH) and Texas Cancer Centre (TCC).

Methods

The study adopted a hospital based descriptive cross sectional study. Cancer outpatients with confirmed stage 1–4 cancers, physically stable, aged 18 years and above and receiving cancer treatment were recruited and assessed using Scored PGSGA tool. Proportions, measures of central tendency and pearsons’ chi-square test were used in statistical analysis.

Results

Among the 471 participants assessed, 71.8% were female and 28.2% male. Most participants had stage 2, 3 and 4 cancers at 27.2%, 27.2% and 24.3% respectively. Highest proportion of participants had breast (29.7%) and female genital cancers (22.9%). Sixty nine percent of participants were well nourished (SGA-A), 19.7% moderately malnourished (SGA-B) and 11.3% severely malnourished (SGA-C) and this difference was statistically significant. The mean PGSGA score was 6.76 (SD 5.17). Based on the score, 33.8% of participants required critical nutrition care, 34.8% symptoms management, 14.2% constant nutrition education and pharmacological intervention while 17.2% required routine assessments and reassurance. More (m;54.7%, f; 45.3%) males than females were severely malnourished(SGA-C) and this was statistically significant (P < 0.001).Prevalence of severe malnutrition was highest among participants with digestive organ cancers (49.1%) followed by those with lip cancer (17%) and the least prevalence reported in those with Karposi Sarcoma (0%). Most of stage 4 participants were moderately (37.5%) and severely (29.4%) malnourished.

Conclusions

The Scored Patient-Generated Subjective Global Assessment is able to identify cancer patients both at risk of malnutrition and those severely malnourished. It also provides a guideline on the appropriate nutrition intervention hence an important tool in nutrition management of cancer patients.

Patient Generated Subjective Global Assessment as a prognosis tool in women with gynecologic cancer

OBJECTIVES

The aim of this study was to assess the nutritional status (NS) of women hospitalized for gynecologic tumors and relate it to such outcomes as hospital length of stay and 1-y mortality.

METHODS

We assessed 146 women diagnosed with gynecologic tumors who were admitted to a referral oncologic hospital in November 2012. Data collected included medical history, duration and reason for admission, and cases of death within 1 y.

RESULTS

NS was assessed using Patient-Generated Subjective Global Assessment (PG-SGA). The receiver operating characteristic curve was used to define the best cutoff point for discriminating individuals who did or did not die. We used proportional hazards regression to assess associations between malnutrition and 1-y mortality. According to the PG-SGA, 62.4% of the women were classified as being at nutritional risk or having moderate or severe malnutrition. Sorting patients by stage of cancer, there was no statistical difference in NS classification according to the different cancer sites. The median hospital stay, in days, was statistically lower in patients classified as well nourished. Individuals with a score above the cutoff point of 10 were 30.7 times more likely (95% confidence interval, 11.8-79.4) to die. There was a 52.1% rate of mortality within 1 y. Patients classed as having some degree of malnutrition had a significantly lower median survival rate. A diagnosis of cervical cancer and severe malnourishment increases the likelihood of death.

CONCLUSIONS

Our findings suggest that the PG-SGA can be considered not just as an indicator of nutritional risk, but also as a major predictor of prognosis and mortality in this population.