Nutritional and psychosocial status of colorectal cancer patients referred to an outpatient oncology clinic

Purpose

Malnutrition and psychological distress are associated with poorer outcomes following treatment for colorectal cancer. Screening for issues such as malnutrition, depression, and anxiety is being adopted in some oncology settings, but its effectiveness or the relationship between these risk factors in this population are not well understood.

Methods

A retrospective chart review was conducted of 836 health assessment forms provided to colorectal cancer patients referred to an outpatient oncology clinic. Nutritional (Patient-Generated Subjective Global Assessment) and psychological (Psychosocial Screen for Cancer) screening tools were included in the form. Demographic and screening tool information was obtained from completed forms. The prevalence of nutritional risk, depression, and anxiety were determined based on screening tool scores and clinical cutoffs. An ordinal regression model was fitted to determine which demographic and psychosocial factors best predicted nutritional risk.

Results

Only 252 (30%) of the forms were completed enough for inclusion in analysis. The prevalence of nutritional risk, anxiety, and depression were determined to be 29%, 10%, and 7%, respectively. A regression model containing the variables depression, anxiety, gender, health coverage, and marital status was found to best explain the nutritional score. Depression was the most significant predictor, with odds of increased nutritional risk being 5.6 times greater for depressed individuals (P?=?0.0005).

Conclusions

The use of nutritional and psychosocial screening tools is warranted and needs to be emphasized more in oncology settings. There appears to be a relationship between psychosocial issues and increased nutritional risk which should be taken into account when considering cancer care interventions.     

Oral health-related quality of life and malnutrition in patients treated for oral cancer

Purpose

This study examined whether oral health-related quality of life (OHRQoL) is associated with nutritional status in patients treated for oral cancer.

Methods

A cross-sectional study was carried out on with patients treated for oral cancer at least 6 months after treatment. OHRQoL was measured using two questionnaires: Oral Impacts on Daily Performances (OIDP) and Oral Health Impact Profile (OHIP-14); malnutrition risk was assessed through the Mini Nutritional Assessment (MNA). Multivariable regression models assessed the association between the outcomes (OIDP and OHIP-14) and the exposure (MNA), adjusting for sex, age, clinical stage, social class, date of treatment completion, and functional tooth units.

Results

The final simple included 133 patients, 22.6 % of which were malnourished or at risk of malnutrition. More than 95 % of patients reported a negative impact on the OHRQoL for both measures used. Patients with malnutrition or risk of malnutrition had significantly worse OHRQoL than those with no malnutrition, even after adjusting for clinical and socioeconomic data (ß-coefficient?=?8.37 (95 % confidence interval (CI) 1.42–15.32) with the OIDP and ß-coefficient?=?2.08 (95 % CI 0.70–3.46) with the OHIP-14).

Conclusion

Being malnourished or at risk of malnutrition is an important longer-term determinant of worse OHRQoL among patients treated for oral cancer.     

Intensive nutritional counseling improves PG-SGA scores and nutritional symptoms during and after radiotherapy in Korean cancer patients

Purpose

This study was conducted for the nutritional assessment of cancer patients undergoing radiotherapy (RT) and to investigate the changes in nutrition status, oral intake, morbidity and quality of life (QOL) in cancer patients after intensive nutrition counseling.

Methods

Eighty-seven cancer patients were randomized to either a nutrition counseling group (n?=?44, age 58.0?±?2.2 years) or a control group (n?=?43, 62.0?±?1.8 years). Nutrition counseling accompanied RT, and the subjects received at least three sessions of individualized dietary counseling over the duration of RT. Assessment parameters were nutritional intake (24-h recall method), nutritional status Patient-Generated Subjective Global Assessment (PG-SGA), QOL and blood parameters including albumin. All parameters were measured at baseline, at the end of RT, and 1 month after the termination of RT.

Results

Body weight, body mass index (BMI), and energy and protein intake for the intervention and control groups did not differ significantly between baseline and the end of RT. However, at 1 month follow-up, protein intake was significantly decreased in the control group (p?Conclusion We suggest that repetitive and intensive nutritional counseling is necessary to improve QOL and to prevent deterioration of nutritional status in cancer patients receiving RT.     

Early nutritional intervention improves treatment tolerance and outcomes in head and neck cancer patients undergoing concurrent chemoradiotherapy

Goals of work

Patients with head and neck cancer (HNC) undergoing chemoradiotherapy are at high risk of malnutrition, which is related to complication rate. The aim of this study was to investigate the impact of an early intensive nutritional intervention on nutritional status and outcomes in patients undergoing chemoradiotherapy for HNC.

Materials and methods

We analysed retrospectively the clinical documentation of 33 HNC patients who were referred for early nutritional intervention (nutrition intervention group, NG) before they were submitted to chemoradiotherapy. The outcome of these patients was compared to that of 33 patients who received chemoradiotherapy without receiving a specifically designed early nutrition support programme (control group, CG).

Main results

NG patients lost less weight during chemoradiotherapy compared to CG patients (?4.6?±?4.1% vs ?8.1?±?4.8% of pre-treatment weight, p?<?0.01, at the completion of treatment). Patients in the NG experienced fewer radiotherapy breaks (>5 days) for toxicity (30.3% vs 63.6%, p?<?0.01); the mean number of days of radiation delayed for toxicity was 4.4?±?5.2 in NG vs 7.6?±?6.5 in CG (p?<?0.05); a linear correlation was found between percentage of weight lost from baseline to chemoradiotherapy completion and days of radiation delays (p?<?0.01). There were less patients who had an unplanned hospitalisation in the NG relative to the CG (16.1% vs 41.4%, p?=?0.03). In the NG, symptoms having an effect on the nutritional status developed early and were present in the nearly totality of patients at chemotherapy completion; 60.6% of NG patients needed tube feeding.

Conclusions

Early nutrition intervention in patients with HNC receiving chemoradiotherapy resulted in an improved treatment tolerance and fewer admissions to hospital. This result suggests that nutritional intervention must be initiated before chemoradiotherapy, and it needs to be continued after treatment completion.     

Nutrition outcomes following implementation of validated swallowing and nutrition guidelines for patients with head and neck cancer

Purpose

Head and neck cancer patients have a high risk of malnutrition and swallowing dysfunction. This study reports on adherence and nutrition outcomes with the use of local evidence-based guidelines for the nutrition management of patients with head and neck cancer, including placement of proactive gastrostomy tubes for high risk patients.

Methods

This study is a prospective observational audit in patients treated for head and neck cancer at a tertiary hospital from 2007 to 2008 (n?=?539). Nutrition outcomes (weight, nutritional status and type of nutrition support) were compared for each nutrition risk category. Primary outcome was 10 % or more weight loss at 3 months post-treatment (n?=?219).

Results

Overall adherence to the guideline tube feeding recommendations was 81 %. High risk patients had mean weight loss of 6 % on completion of treatment and 9 % at 3 months post-treatment, despite the majority having a proactive gastrostomy tube. Medium and low risk patients also lost weight over this time. Univariate analysis found that non-adherence to the guidelines was associated with weight loss at 3 months (p?=?0.013). Multivariate analysis found overweight patients had 1.82 greater odds, and obese patients had 3.49 greater odds of losing weight (p?=?0.021). Patients with significant weight loss at diagnosis had decreased odds of losing weight later (p?=?0.011).

Conclusion

Clinically significant weight loss was still prevalent in this population despite proactive interventions. Predictors of weight loss support the evidence-based guidelines’ risk categories, and adherence was important to improve outcomes. Further research is required to determine the impact of significant weight loss in patients with high body mass index (BMI).     

A dietitian-led clinic for patients receiving (chemo)radiotherapy for head and neck cancer

Purpose

Malnutrition is prevalent in head and neck cancer patients and is associated with poorer outcomes and increased health care costs. This study aimed to evaluate the acceptability, organisational efficiency and clinical outcomes of a dietitian-led head and neck cancer clinic.

Methods

Two consecutive, independent, patient cohorts were studied with a pre–post-test design of 98 patients prior to the introduction of a dietitian-led clinic (DLC) and the subsequent 100 patients who attended the newly formulated DLC. The two groups were compared for frequency of dietitian intervention, weight loss, enteral feeding, hospital admissions and post-treatment medical follow-up requirements.

Results

Nutritional management in a DLC was associated with reduced nutrition-related admissions from 12% to 4.5% (p?=?0.0029), unplanned nasogastric tube insertions from 75% to 39% (p?=?0.02), improved transition to oral diet post-radiotherapy from 68.3% to 76.7% (p?=?0.10) and reduced radiation oncologist review at 2?weeks post-radiotherapy from 32% to 15% patients (p?=?0.009) compared to the cohort prior to the DLC.

Conclusions

A dietitian-led head and neck cancer clinic is associated with improved efficiency and nutritional management of head and neck cancer patients and offers a feasible model of care.     

Neutropenia management and granulocyte colony-stimulating factor use in patients with solid tumours receiving myelotoxic chemotherapy—findings from clinical practice

Purpose

Clinical practice adherence to current guidelines that recommend primary prophylaxis (PP) with granulocyte colony-stimulating factors (G-CSFs) for patients at high (≥20 %) overall risk of febrile neutropenia (FN) was evaluated.

Methods

Adult patients with breast cancer, non-small cell lung cancer (NSCLC), small-cell lung cancer (SCLC), or ovarian cancer were enrolled if myelotoxic chemotherapy was planned, and they had an investigator-assessed overall FN risk ≥20 %. The primary outcome was FN incidence.

Results

In total, 1,347 patients were analysed (breast cancer, n?=?829; NSCLC, n?=?224; SCLC, n?=?137; ovarian cancer, n?=?157). Patients with breast cancer exhibited fewer individual FN risk factors than patients with other cancers and were far more likely to have received a high-FN-risk chemotherapy regimen. However, a substantial proportion of all patients (45–80 % across tumour types) did not receive G-CSF PP in alignment with investigator risk assessment and guideline recommendations. FN occurred in 127 patients overall (9 %, 95% confidence interval (CI) 8–11 %), and incidence was higher in SCLC (15 %) than other tumour types (8 % in ovarian and NSCLC, 9 % in breast cancer). A post hoc analysis of G-CSF use indicated that G-CSF prophylaxis was not given within the recommended timeframe after chemotherapy (within 1–3 days) or was not continued across all cycles in 39 % of patients.

Conclusions

FN risk assessment was predominantly based on clinical judgement and individual risk factors, and guidelines regarding G-CSF PP for patients at high FN risk were not consistently followed. Improved education of physicians may enable more fully informed neutropenia management in patients with solid tumours.     

Potential benefits of early nutritional intervention in adults with upper gastrointestinal cancer: a pilot randomised trial

Purpose

This study aimed to test whether a very early nutrition intervention delivered over the telephone was feasible and could improve outcomes amongst patients with upper gastrointestinal cancer.

Methods

Participants with a histologically proven new diagnosis of primary oesophageal or stomach cancer and who were to undergo surgery and/or chemotherapy were randomised to receive either standard nutrition care (SC) or early and intensive nutrition intervention (NI) over the telephone/face-to-face. Participants were followed for 6 months. The primary outcome was quality of life (QoL), assessed using the European Organization for Research and Treatment of Cancer Global Quality of Life questionnaire C30 (EORTC QLQ-C30) and the European Quality of Life Instrument (EQ-5D) tool; secondary outcomes were nutritional status and survival.

Results

Twenty-one participants were recruited (11 SC and 10 NI). At baseline, the prevalence of malnutrition was 90 %. Compared with SC, the NI group had a significantly higher EORTC global QoL score at the first mid-study follow-up (coefficient (95 % CI) 21.0 (12.1, 29.9) adjusted for baseline, p?p?p?p?p?=?0.06). The mean time spent with a dietitian per contact was significantly less for the NI group compared with SC (16(3) vs 40(6) min per dietetic contact, p?Conclusions This pilot study has shown the potential of a novel telephone-based early and intensive dietetic model of care for newly diagnosed upper gastrointestinal cancer patients.     

High rates of burnout among maternal health staff at a referral hospital in Malawi: A cross-sectional study

Background

The usefulness of the nutritional screening tool Minimal Eating Observation and Nutrition Form - Version II (MEONF-II) relative to Nutritional Risk Screening 2002 (NRS 2002) remains untested. Here we attempted to fill this gap by testing the diagnostic performance and user-friendliness of the MEONF-II and the NRS 2002 in relation to the Mini Nutritional Assessment (MNA) among hospital inpatients.

Methods

Eighty seven hospital inpatients were assessed for nutritional status with the 18-item MNA (considered as the gold standard), and screened with the NRS 2002 and the MEONF-II.

Results

The MEONF-II sensitivity (0.61), specificity (0.79), and accuracy (0.68) were acceptable. The corresponding figures for NRS 2002 were 0.37, 0.82 and 0.55, respectively. MEONF-II and NRS 2002 took five minutes each to complete. Assessors considered MEONF-II instructions and items to be easy to understand and complete (96-99%), and the items to be relevant (87%). For NRS 2002, the corresponding figures were 75-93% and 79%, respectively.

Conclusions

The MEONF-II is an easy to use, relatively quick and sensitive screening tool to assess risk of undernutrition among hospital inpatients. With respect to user-friendliness and sensitivity the MEONF-II seems to perform better than the NRS 2002, although larger studies are needed for firm conclusions. The different scoring systems for undernutrition appear to identify overlapping but not identical patient groups. A potential limitation with the study is that the MNA was used as gold standard among patients younger than 65 years.     

Home parenteral nutrition improves quality of life and nutritional status in patients with cancer: a French observational multicentre study

Purpose

Malnutrition is a predictor of poor outcomes in patients with cancer. Little is known about the benefit of nutritional support in these patients. The purpose of this study was to assess the impact of home parenteral nutrition (HPN) on quality of life (Qol) in cancer patients.

Methods

We performed an observational prospective study to determine the impact of HPN on Qol in a population of patients with heterogeneous cancer. Physicians, patients and family members had to complete a questionnaire before HPN administration and 28 days after the course of HPN. Qol was evaluated using the self-administered questionnaire FACT-G.

Results

We included 767 patients with cancer of whom 437 ended the study. Mean patient age was 63?±?11.4 years and 60.5 % were men. Primary gastrointestinal cancer was reported in 50 % of patients and 65.3 % were presenting metastases. Malnutrition was reported in 98.3 %. After 28 days of HPN intake, significant improvement was observed in the Qol (49.95?±?5.82 vs. 48.35?±?5.01 at baseline, p?<?0.0001). The mean weight, serum albumin and the nutrition risk index had also improved significantly. Most patients (78 %) had perceived a positive impact of the HPN. A significant improvement in patient’s well-being was perceived also by family members and physicians.

Conclusions

Our data suggest that preventing and correcting malnutrition using HPN in patients with cancer might have a significant benefit on their well-being. Randomized controlled studies are required to confirm this finding.     

Changes in nutritional status, body composition, quality of life, and physical activity levels of cancer patients undergoing autologous peripheral blood stem cell transplantation

Purpose

This pilot exploratory study aimed to describe the changes in nutritional status, body composition, quality of life (QoL), and physical activity levels (PAL) of cancer patients undergoing high-dose conditioning and autologous peripheral blood stem cell transplantation (PBSCT) at pre-admission, hospital discharge, and at 100 days post-transplantation, and to examine if changes in these parameters are interrelated.

Methods

Twenty-four patients (56.2?±?12.9 years; 7 females, 17 males) were recruited from an Australian transplant center. Assessment was prospectively conducted at pre-admission, hospital discharge, and 100 days post-transplantation using the scored patient-generated subjective global assessment, air displacement plethysmography, EORTC QLQ-C30 (version 3), and the international physical activity questionnaire.

Results

At discharge, nutritional status deteriorated (patient-generated subjective global assessment (PG-SGA) median, +8.0; interquartile range, 6.0–13.0; p?<?0.001) and the number of malnourished patients increased (n?=?8/23; p?=?0.023). Patients experienced significant loss of lean body mass (LBM; ?2.2 kg, CI 95 % ?3.0, ?1.4; p?<?0.001), and decrease in QoL (?10.6, CI 95 % ?24.1, 2.9; p?=?0.117); the proportion of patients with high PAL decreased (p?=?0.012). By 100 days post-transplantation, all patients were well-nourished; however, LBM remained lower ?1.0 kg (CI 95 % ?1.9, ?0.1; p?=?0.028). Change in nutritional status (PG-SGA score) was associated with weight (r?=??0.46; p?=?0.039) and fat mass (r?=??0.57; p?=?0.013). Change in QoL was associated with nutritional reservoir (i.e., fat; r?=?0.54; p?=?0.024); QoL was consistently higher for patients with high PAL.

Conclusions

High-dose conditioning and autologous PBSCT is associated with deterioration in nutritional status, QoL and PAL, with LBM remaining below baseline levels at 100 days post-transplantation. A nutrition and exercise intervention program post-hospital discharge may be beneficial for these patients.     

The Distress Thermometer in Spanish cancer patients: convergent validity and diagnostic accuracy

Purpose

International organizations such as National Comprehensive Cancer Network and NICE recommend implementation of routine screening programs for detecting and managing psychosocial distress among cancer patients. The selection of an adequate screening tool is crucial to the effectiveness of these programs. The present study examines the emotional symptomatology captured by the Distress Thermometer (DT) and its accuracy and validity as a screening tool in cancer. It also explores the possible discrepancy between patient distress and the use of psycho-oncology resources.

Methods

A heterogeneous sample of 962 adult cancer patients completed the DT, the Problem List (PL), the Brief Symptom Inventory-18 (BSI-18), and the Psychosocial Questionnaire.

Results

The DT was significantly correlated with BSI-18 symptoms and the emotional problems listed on the PL. Receiver Operating Characteristic analysis showed good diagnostic accuracy for the DT (area under the curve?=?.82, 95 %CI [.79–.85]). For a selected DT cutoff of 5, standard measures (sensitivity?=?90 %, specificity?=?64 %, predictive positive value?=?35 %, and negative predictive value?=?97 %) and Clinical Utility Indexes (utility index negative?=?.62 and utility index positive?=?.32) indicated that the DT was adequate for “screening” while it was limited for “case finding.” Finally, 81.30 % of patients with clinical distress had not sought or were not receiving professional psychosocial support at the time of the study.

Conclusion

The DT is appropriate for use as a rapid screening instrument for cancer patients in a Spanish population because it assesses a broad concept of distress including both anxiety and depression symptoms. The diagnostic accuracy of the DT could be improved with minor proposed modifications to the DT and the inclusion of nonemotional ultrashort measures.     

Prevalence of anxiety and depression and their risk factors in Chinese cancer patients

Purpose

This paper aimed to obtain information on the levels of anxiety and depression among cancer patients in China. The factors influencing these psychological problems were also analyzed.

Methods

A total of 1,217 cancer patients were interviewed, and each participant was asked to complete a self-administered questionnaire. The anxiety status, depression status, disease stage, tumor site, pain status, and performance status of the patients during the week prior to the interview were assessed.

Results

The anxiety and depression prevalence rates were 6.49 and 66.72 %, respectively. The prevalence rates of depression were 60.62 % for head and neck cancer, 77.19 % for lung cancer, 57.9 % for breast cancer, 75.81 % for esophagus cancer, 63.40 % for stomach cancer, 68.42 % for liver cancer, 54.37 % for colorectal cancer, and 71.13 % for cervix cancer. The factors influencing depression of patients were performance status (P?<?0.0001), pain (P?=?0.0003), age (P?<?0.0001), and education level (P?<?0.0001). The risk factors of anxiety were performance status (P?=?0.0007), age (P?<?0.0001), and gender (P?<?0.0001).

Conclusions

Depression was a more important psychological problem than anxiety in cancer patients. Compared with 3.8 % of the prevalence of depression in normal population, depression level was high among Chinese cancer patients. Patients with lung, esophagus, and cervix cancers were the high-risk groups for depression. Poor performance status, pain, old age, and low-level education were the predicting factors for depression.     

Pediatric cancer type predicts infection rate,need for critical care intervention,and mortality in the pediatric intensive care unit

Purpose

Up to 38 % of children with cancer require pediatric intensive care unit (PICU) admission within 3 years of diagnosis, with reported PICU mortality of 13–27 % far exceeding that of the general PICU population. PICU outcomes data for individual cancer types are lacking and may help identify patients at risk for poor clinical outcomes.

Methods

We performed a retrospective multicenter analysis of 10,365 PICU admissions of cancer patients no greater than 21 years old among 112 PICUs between 1 January 2009 and 30 June 2012. We evaluated the effect of cancer type, age, gender, genetic syndrome, stem cell transplantation, PRISM3 score, infections, and critical care interventions on PICU mortality.

Results

After excluding scheduled perioperative admissions, cancer patients represented 4.2 % of all PICU admissions (10,365/246,346), had overall mortality of 6.8 % (708/10,365) vs. 2.4 % (5,485/230,548) in the general PICU population (RR = 2.9, 95 % CI 2.7–3.1, p < 0.001), and accounted for 11.4 % of all PICU deaths (708/6,215). Hematologic cancer patients had greater median PRISM3 score (8 vs 2, p < 0.001), rates of sepsis (27 vs 9 %, RR = 2.9, 95 % CI 2.6–3.1, p < 0.001), and mortality (9.6 vs 4.5 %, RR = 2.1, 95 % CI 1.8–2.5, p < 0.001) compared to solid cancer patients. Among hematologic cancer patients, stem cell transplantation, diagnosis of acute myeloid leukemia, PRISM3 score, and infection were all independently associated with PICU mortality.

Conclusions

Children with cancer account for 4.2 % of PICU admissions and 11.4 % of PICU deaths. Hematologic cancer patients have significantly higher admission illness severity, rates of infections, and PICU mortality than solid cancer patients. These data may be useful in risk stratification for closer monitoring and patient counseling.     

A correlational study of suicidal ideation with psychological distress,depression, and demoralization in patients with cancer

Purpose

This study aims to study the effects of depression and demoralization on suicidal ideation and to determine the feasibility of the Distress Thermometer as a screening tool for patients with cancer who experience depression and demoralization, and thus to establish a model screening process for suicide prevention.

Methods

Purposive sampling was used to invite inpatients and outpatients with lung cancer, leukemia, and lymphoma. Two hundred participants completed the questionnaire, which included the Distress Thermometer (DT), Patient Health Questionnaire-9 (PHQ-9), Demoralization Scale-Mandarin Version (DS-MV), and Beck Scale for Suicide Ideation. All data obtained were analyzed using SPSS 18.0 and SAS 9.3.

Results

Tobit regression analysis showed that demoralization influenced suicidal ideation more than depression did (t?=?2.84, p?PHQ-9?≥?10 and DS-MV ≥42 were used as criteria for the DT, receiver operating characteristic analysis revealed that the AUC values were 0.77–0.79, with optimal cutoff points for both of DT ≥5; sensitivity 76.9 and 80.6 %, respectively; and specificity of 73.9 and 72.2 %, respectively.

Conclusions

Demoralization had more influence on suicidal ideation than depression did. Therefore, attention should be paid to highly demoralized patients with cancer or high demoralization comorbid with depression for the purposes of suicide evaluation and prevention. The DT scale (with a cutoff of ≥5 points) has discriminative ability as a screening tool for demoralization or depression and can also be used in clinical settings for the preliminary screening of patients with cancer and high suicide risk.     

Combination of angiographic and clinical characteristics for the prediction of clinical outcomes in elderly patients undergoing multivessel PCI

Background

Risk stratification is essential for the clinical decision-making process in elderly patients undergoing multivessel revascularization, since the optimal revascularization strategy remains subject of ongoing debate.

Aims

To assess the prognostic value of angiographic versus clinical characteristics for the prediction of a first adverse cardiac and cerebrovascular events (MACCE) (all-cause mortality, non-fatal myocardial infarction, stroke, and target lesion revascularization) and to develop a combined risk model.

Methods

After multivessel percutaneous coronary intervention (MV-PCI), SYNTAX score and EuroSCORE were calculated as combined risk model in 328 elderly patients who were followed up for a first MACCE.

Results

328 patients with a mean age of 77.5 ± 5.1 years were followed up for 2.7 ± 1.5 years. A first MACCE occurred in 50.0 % (164/328) of the patients. To improve predictability, a combined risk score model with receiver operating characteristic curve validated cut-off values for EuroSCORE (>5 %) and SYNTAX score (>25) was developed. High risk patients had a 3.5-fold higher risk for MACCE after 3 years (HR 7.1, 95 % CI 1.9–6.5; p < 0.001).

Conclusions

For adequate risk assessment in elderly patients undergoing MV-PCI, consideration of both comorbidities and coronary anatomic complexity is essential. A combined angiographic and clinical risk score provides superior prediction of 3-year MACCE risk in elderly patients.     

Screening for malnutrition in lung cancer patients undergoing radiotherapy

Purpose

The assessment of nutritional problems is vital to support patients undergoing radiotherapy. Poor nutritional status may occur as a result of preexisting problems, older age, the cancer itself, or treatment side effects. Malnutrition impairs the outcome of the disease and affects patients. This prospective study aimed at developing two simple tools to screen malnutrition before radiotherapy and to assess, prior to treatment, the risk of malnutrition after radiotherapy.

Methods

Forty-seven lung cancer patients treated with curative intent were evaluated before radiotherapy and after completion of the treatment. To assess patient’s malnutrition, two well-known screening tools (PG-SGA and NRS-2002) were used, complemented by patient-specific characteristics, yielding a 59-item questionnaire. Malnutrition status was defined using Thoresen’s criteria. The two screening tools derived by multivariate analyses were validated by comparing anthropometric, biological, and nutritional variables between patients at risk of malnutrition and those who are not.

Results

Malnutrition detection prior to radiotherapy was based on the equation “MDS?=?5.88 ? 0.20?×?BMI?+?0.05?×?(percent weight loss over past 6 months),” while malnutrition prediction after radiotherapy was given by “MPS?=?3.67?+?0.98?×?(age ≥70) ? 0.12?×?BMI?+?1.20?×?edema.” Agreement between observed and estimated outcomes was quite high for the two scores (kappa coefficient 0.80 and 0.85, respectively).

Conclusions

The two assessment tools were found parsimonious and easy to use. Further studies are needed to validate them in larger lung cancer groups and in other cancer populations.     

Impact of clinical pharmacist-based parenteral nutrition service for bone marrow transplantation patients: a randomized clinical trial

Purpose

Parenteral nutrition (PN) is a well-documented supportive care which maintains the nutritional status of patients. Clinical pharmacists are often involved in providing PN services; however, few studies have investigated the effect of a clinical pharmacy-based PN service in resource-limited settings.

Methods

We designed a randomized clinical trial to compare the clinical pharmacist-based PN service (intervention group) with the conventional method (control group) for adult patients undergoing hematopoietic stem cell transplantation in Shariati Hospital, Tehran, Iran (2011–2012). In the intervention group, the clinical pharmacists implemented standard guidelines of nutrition support. The conventional method was a routine nutrition support protocol which was pursued for all patients in the bone marrow transplantation wards. Main study outcomes included nutritional status (weight, albumin, total protein, pre-albumin, and nitrogen balance), length of hospital stay, time to engraftment, rate of graft versus host disease, and mortality rate. Patients were followed for 3 months.

Results

Fifty-nine patients were randomly allocated to a study group. The overall intake (oral and parenteral) in the control group was significantly lower than standard daily needed calories (P?<?0.01). Patients in the intervention group received fewer days of PN (10.7?±?4.2 vs. 18.4?±?5.5 days, P?<?0.01). All nutritional outcomes were either preserved or improved in the intervention group while the nutritional status in the control group was deteriorated (P values?<?0.01). Length of hospital stay was significantly shorter in the intervention group (P?<?0.01). Regarding PN complications, hyperglycemia was observed more frequently in the intervention group (34.5 %, P?=?0.01). Two patients in the control group expired due to graft versus host disease at the 3-month follow-up.

Conclusion

A clinical pharmacist-based nutrition support service significantly improved nutritional status and clinical outcomes in comparison with the suboptimal conventional method. Future studies should assess the cost effectiveness of clinical pharmacists’ PN services.