Use of the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in patients with cancer

OBJECTIVE: To evaluate the use of the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in patients with cancer. DESIGN: An observational study assessing the nutritional status of patients with cancer. SETTING: Oncology ward of a private tertiary Australian hospital. SUBJECTS: Seventy-one cancer patients aged 18-92 y. INTERVENTION: Scored PG-SGA questionnaire, comparison of scored PG-SGA with subjective global assessment (SGA), sensitivity, specificity. RESULTS: Some 24% (17) of 71 patients were well nourished, 59% (42) of patients were moderately or suspected of being malnourished and 17% (12) of patients were severely malnourished according to subjective global assessment (SGA). The PG-SGA score had a sensitivity of 98% and a specificity of 82% at predicting SGA classification. There was a significant difference in the median PG-SGA scores for each of the SGA classifications (P<0.001), with the severely malnourished patients having the highest scores. Re-admission within 30 days of discharge was significantly different between SGA groups (P=0.037). The mortality rate within 30 days of discharge was not significantly different between SGA groups (P=0.305). The median length of stay of well nourished patients (SGA A) was significantly lower than that of the malnourished (SGA B+C) patients (P=0.024). CONCLUSION: The scored PG-SGA is an easy to use nutrition assessment tool that allows quick identification and prioritisation of malnutrition in hospitalised patients with cancer.     

Nutritional status assessed by the Patient-Generated Subjective Global Assessment (PG-SGA) is associated with qualities of diet and life in Korean cerebral infarction patients

ObjectiveAssessment of the nutritional status of patients with cerebral infarction (CI) is important because their nutritional status influences disease outcome. The purpose of this study was to assess the nutritional status of patients with CI using the scored Patient-Generated Subjective Global Assessment (PG-SGA) and to investigate the relation of the quality of their diet and life with their nutritional status.MethodsSeventy-three patients with CI were recruited from Kyung Hee University Oriental Medical Center in Seoul, Korea, from May to July 2007. The subjects' PG-SGA, dietary quality (Dietary Diversity Score, Dietary Variety Score, and Diet Quality Index–International), and quality of life (Stroke-Specific Quality of Life, modified Barthel Index, and Beck Depression Inventory) were investigated.ResultsThe patients were classified by PG-SGA categories as well nourished (26.0%), moderately malnourished (49.3%), or severely malnourished (24.7%). Quality of diet assessed by the Dietary Diversity Score and Dietary Variety Score was significantly lower in severely malnourished patients (P < 0.001). The overall dietary quality expressed by the Diet Quality Index–International was significantly greater in the well-nourished group, followed by the moderately malnourished and severely malnourished groups. Quality of life assessed by the Stroke-Specific Quality of Life and modified Barthel Index was significantly lower in the malnourished group (P < 0.05). Quality of diet (P < 0.001) and life (P < 0.05) in patients with CI were significantly correlated with their nutritional status.ConclusionThe PG-SGA is a useful nutritional assessment tool for patients with CI with stable vital signs. When patients with CI were categorized according to their PG-SGA score, well-nourished patients demonstrated better diet quality and better quality of life.     

Nutritional assessment in cancer: comparing the Mini-Nutritional Assessment (MNA) with the scored Patient-Generated Subjective Global Assessment (PGSGA)

The evaluation of nutritional status in cancer patients is often neglected in spite of the fact that poor nutritional status may adversely affect prognosis and treatment tolerance. In day-to-day oncology practice, a sensitive but simply applied nutritional assessment tool is needed to identify at-risk patients. Several tools exist; however, none has been universally accepted. The aim of this study was to compare two potential tools, the Mini-Nutritional Assessment (MNA) and the scored Patient Generated Subjective Global Assessment (PGSGA). The MNA is more simply applied and does not require a trained dietitian. The PGSGA has been previously validated in cancer patients. One hundred fifty-seven newly diagnosed cancer patients were assessed using both tools. Of these, 126 were reassessed at 4-6 wk, and 104 were reassessed at Weeks 8-12 after initial assessment. A significant negative correlation was found between the tools at all three time periods (at baseline r = -0.76; P < 0.001). Taking the PGSGA as the most accepted nutritional assessment tool, at baseline the MNA demonstrated a sensitivity of 97% and specificity of 54%. At 4-6 wk MNA sensitivity was 79% and specificity was 69%. At 8-12 wk MNA sensitivity was 93% and specificity was 82%. When comparing the tools in elderly patients alone (>65 yr), similar results were obtained. Both tools were able to correctly classify patients as malnourished, although the MNA lacks specificity. Therefore, the PGSGA should be the tool of choice for nutritional assessment in cancer patients.     

主观评价方法(SGA)在肿瘤病人营养状况评价中的应用

将主观全面评价方法(SGA)应用于肿瘤病人的营养状况评价,并与传统的评价方法进行比较,发现其与传统评价方法有较高的符合率(>80%);SGA评价结果与传统评价方法中多项评价指标显著相关(P<0,01).肿瘤病人大多存在不同程度的营养问题,SGA以其无创性、易掌握、简便易行的优点,在肿瘤病人动态营养状况评价中具有特别的意义.但在应用过程中可能会受一些因素的干扰,在SGA与传统评价方法结果不符时,应以传统方法为准.     

Subjective quality of life in patients with chronic fatigue syndrome

The aim of this study was to (1) assess Subjective Quality of Life (SQOL) of patients with Chronic Fatigue Syndrome (CFS) using a generic concept and to compare the findings with those in groups with mental disorders and healthy subjects, and (2) investigate whether and, if so, to what extent socio-demographic and clinical variables predict SQOL in CFS patients. Seventy-three patients diagnosed with CFS were randomly selected and interviewed from two specialised clinics. CFS was diagnosed using the Oxford Criteria. SQOL was assessed on the Manchester Short Assessment of Quality of Life (MANSA) and Health-Related Quality of Life (HRQOL) on the Medical Outcome Study Short-Form 36 (MOS) SF-36. A battery of mood and symptom questionnaires, including the Symptom Checklist Questionnaire (SCL-90-R), was administered to assess various aspects of symptomatology as potential predictor variables. Multiple regression analyses were conducted to identify predictors of SQOL. Overall, SQOL was low in CFS patients and less favourable than in groups with mental disorders and healthy subjects. Satisfaction was particularly low with life as a whole, leisure activities and financial situation. Whilst SQOL was only moderately correlated with HRQOL, the SCL-90-R score, especially SCL-90-R Depression scale score, was the best predictor of SQOL explaining 35% of the variance. HRQOL and generic SQOL appear distinct despite some overlap. The findings underline that SQOL is significantly disrupted in CFS patients. Depressive symptoms are statistically the strongest ‘predictor’ of SQOL, although the direction of the relationship is not established. These data suggest that treatment of depression associated with CFS, regardless of causation, could help to improve SQOL in CFS patients.     

Temporal assessment of quality of life of head and neck cancer patients receiving radical radiotherapy

The study was undertaken to evaluate physical, psychological and functional aspects in quality of life (QoL) assessment prospectively in biopsy-proven head and neck cancer patients receiving radical radiotherapy. Fifty male patients were assessed using Karnofsky's Performance Status (KPS), Beck's Depression Inventory (BDI) and the Functional Living Index – Cancer (FLIC). Patient questionnaires were completed before radiotherapy, during 3–4 weeks of radiotherapy and 3 months after radiotherapy. Before the start of radiotherapy, KPS was 91±10.26, FLIC was 129.98±33.41 and BDI was 7.10±4.57. This indicated good performance and functional status with lower depression. In weeks 3–4 of radiotherapy, KPS (71.00±20.12) and FLIC (81.34±45.23) decreased, while BDI(16.56 ±9.01) increased, indicating impairment in QoL. Three months after radiotherapy, KPS (78.37±23.0), FLIC (119.51± 43.62) and BDI(9.02±7.81) improved but were not restored to pre-treatment levels. When patients were scheduled for radical radiotherapy, maximum deterioration in QoL was seen in weeks 3–4. This is the time when maximum supportive care and psychologic counselling is required.     

Prognostic significance of Subjective Global Assessment (SGA) in advanced colorectal cancer

OBJECTIVE: To evaluate the prognostic significance of Subjective Global Assessment (SGA) in advanced colorectal cancer and create statistically distinct prognostic groups of colorectal cancer patients based on clinical and nutritional variables. DESIGN: A retrospective clinical epidemiologic study. SETTING: A private tertiary care American Cancer Center. SUBJECTS: In total, 234 colorectal cancer patients aged 29-82 y treated at Cancer Treatment Centers of America at Midwestern Regional Medical Center between January 1995 and March 2001. INTERVENTION: SGA Questionnaire. SGA A-well nourished; SGA B-moderately malnourished; and SGA C-severely malnourished. Malnutrition was defined as either SGA B or SGA C. RESULTS: The prevalence of malnutrition in this patient population, as determined by SGA, was 52% (113/217). The median survival of patients with SGA A was 12.8 months (95% CI; 9.1-16.5), those with SGA B was 8.8 months (95% CI; 6.7-10.9) and those with SGA C was 6 months (95% CI; 3.9-8.1); the difference being statistically significant at P=0.0013. Regression tree analysis identified prior treatment history, lactate dehydrogenase (LDH) and SGA to be important predictors of survival for our patient cohort. Patients with no prior treatment history (newly diagnosed disease), low LDH scores, and SGA A had the best overall survival of 40.4 months (95% CI; 30.45-50.4), whereas patients with prior treatment history (progressive disease), high LDH scores, and SGA B/C had the worst overall survival of 4.5 months (95% CI; 2.22-6.76). CONCLUSION: The SGA provides useful prognostic information in patients with advanced colorectal cancer.     

Nutritional screening with Subjective Global Assessment predicts hospital stay in patients with digestive diseases

OBJECTIVE: Nutritional status is an important factor that determines hospital stay, and the Subjective Global Assessment (SGA) is a candidate tool for nutritional screening on admission. However, the significance of the SGA has not been evaluated well in the ward for digestive diseases. We conducted the present study to test whether the SGA predicts hospital stay of these patients. METHODS: Two hundred sixty-two patients with digestive diseases were consecutively enrolled between July 2004 and April 2005. They consisted of 145 males and 117 females and included 110 patients with cancer. Disease category was gastrointestinal in 94, hepatic in 111, and biliary/pancreatic in 57. The SGA was performed by a certified dietician. Effects of SGA and other nutritional parameters on hospital stay were examined by simple and multiple regression analysis. RESULTS: Among tested variables, simple regression analysis identified the SGA, disease category, presence of malignancy, serum albumin level, percent triceps skinfold thickness, and percent arm muscle circumference as significant predictive parameters for hospital stay. Multiple regression analysis revealed that the SGA had the best predictive power, followed by the presence of malignancy and disease category. CONCLUSION: The SGA is a simple and reliable predictor for hospital stay in patients with digestive diseases.     

Health-related quality of life (QoL) in patients with advanced melanoma receiving immunotherapies in real-world clinical practice settings

Quality of Life Research - Pembrolizumab (PEMBRO) and ipilimumab?+?nivolumab (IPI?+?NIVO) are approved advanced melanoma (AM) immunotherapies. To address limited...     

Radiation related morbidities and their impact on quality of life in head and neck cancer patients receiving radical radiotherapy

Although 50-70% of head and neck cancer patients in India receive radiotherapy (RT), radiation-related acute and late morbidities and their impact on quality of life (QOL) are infrequently reported. Acute and late radiation morbidities and QOL were assessed in a prospective longitudinal study of 45 patients with head and neck cancers receiving radical RT to a dose of 7000 cGy in conventional fractionation. Grade II acute morbidities experienced by the largest percent of the sample during the course of RT pertained to the mucosa (66.4%), salivary gland (84%), and oesophagus (53%). These morbidities led to an increase in the symptom scores of appetite loss (76.46), fatigue (65.75) and pain (44.77). This increase in the symptom scores consequently led to a significant decline in physical, social and emotional functioning as well as global health status score during the course of RT (p < 0.001). Scores improved after 1 month of RT but did not reach the pre-RT value. Future studies may consider correlating QOL assessment to significant patient and disease related parameters such as performance status, weight loss, stage and site of disease.     

主观全面营养评价法对血液病人化疗期的营养评估

血液肿瘤病人常有不同程度的营养不良 [1 ] ,而营养状况是疾病预后好坏的重要变量。全身状况良好 ,机体抵抗力较强 ,促进骨髓造血恢复 ,缩短疗程间歇 ,可使病人尽快骨髓缓解 ,取得长期生存的机会[2 ] 。因此早期发现营养不良 ,增强营养 ,是改善远期预后的重要方面。作者应用 SGA法结合血清白蛋白测定 ,对 1 3 0例血液肿瘤病人化疗期间的营养进行调查分析 ,现报道如下 :1　对　象　与　方　法1 .1　观察对象　　我院 2 0 0 1年 1～ 1 2月 ,住院资料完整的 1 3 0例血液肿瘤病人 ,包括白血病 ,淋巴瘤 ,多发性骨髓瘤。女 44例 ,男 86例 ,年龄 …     

Potentially inappropriate medications use and its association with health-related quality of life among elderly cardiac patients

Quality of Life Research - Previous studies identified alarming use of potentially inappropriate medications (PIMs) in Pakistani population but its effect on health-related quality of life (HRQoL)...     

Health-related quality of life with KDQOL-36 and its association with self-efficacy and treatment satisfaction in Korean dialysis patients

Background and objectives

This study was conducted to measure the level of health-related quality of life (HRQOL) and to reveal the association of self-efficacy and treatment satisfaction with it in Korean dialysis patients.

Design, setting, participants, and measurements

The study subjects were 237 patients receiving either hemodialysis (HD) or peritoneal dialysis (PD) from two university hospitals, from February to June in 2010. We investigated HRQOL using the Korean version of Kidney Disease Quality of Life Short Form 36 (KDQOL-36), and self-efficacy and treatment satisfaction by self-administrative questionnaire and their dialysis-related variables by reviewing clinical records. The associations of self-efficacy and treatment satisfaction with HRQOL were assessed using multiple linear regression analysis.

Results

The mean HRQOL results were as follows: Physical component score (PCS) was 39.1 ± 8.5, Mental component score (MCS) 44.6 ± 6.8, symptom/problem list was 67.6 ± 17.1, effects of disease score was 58.5 ± 19.6, and burden of disease score was 41.1 ± 28.4. Between PD and HD patients, we could find significant difference only in the symptom/problem list. After removing confounder’s effects by multivariate analysis, respectively, treatment goal self-efficacy and treatment management self-efficacy were significantly related with all 5 domains, except PCS. Treatment satisfaction was significantly related with PCS, MCS, and effects of kidney disease.

Conclusions

Patients’ self-efficacy and treatment satisfaction could influence their HRQOL. Regular and systematic monitoring using KDQOL-36 and interventions to increase self-efficacy and treatment satisfaction should be considered in dialysis care in Korea.     

Health-related quality of life of patients with overactive bladder receiving immediate-release tolterodine

Overactive bladder (OAB) imposes a burden on many aspects of a patient's life. The health-related quality of life (HRQOL) of OAB patients has been shown to be lower than healthy or control patients. A goal of successful treatment is to improve the HRQOL of OAB patients. With newer OAB treatments becoming available, HRQOL is an important outcome to measure. Thus, the objective of this study was to compare the HRQOL of patients being treated with tolterodine immediate-release (IR) versus placebo for OAB. The King's Health Questionnaire (KHQ) and the Medical Outcomes Study Short Form 36 (SF-36) were administered at baseline and end of treatment (12 weeks) in a randomized, parallel groups, placebo-controlled, double-blind, multinational study designed to compare the clinical efficacy and safety of tolterodine to placebo in the treatment of OAB. At end of treatment KHQ domains selected a priori as primary HRQOL endpoints (incontinence impact and role limitations) significantly improved (PА.0001) with tolterodine IR. Domains selected a priori as secondary HRQOL or symptom endpoints (physical limitations, emotions, sleep and energy, severity (coping) measures, and symptom severity) were also significantly improved (PА.0074) following treatment with tolterodine IR. The tolterodine IR group had less severity of individual symptoms and significantly better patient rating of bladder control than the placebo group at end of treatment. As expected, the SF-36 did not detect treatment differences. In conclusion, many aspects of HRQOL, as measured by the KHQ, significantly improved with tolterodine IR treatment. These HRQOL improvements were consistent with clinical efficacy results. The findings demonstrate that tolterodine IR patients experience overall improvement in their condition that resulted in important impacts on their HRQOL.     

Health-related quality of life of patients with overactive bladder receiving immediate-release tolterodine

Overactive bladder (OAB) imposes a burden on many aspects of a patient's life. The health-related quality of life (HRQOL) of OAB patients has been shown to be lower than healthy or control patients. A goal of successful treatment is to improve the HRQOL of OAB patients. With newer OAB treatments becoming available, HRQOL is an important outcome to measure. Thus, the objective of this study was to compare the HRQOL of patients being treated with tolterodine immediate-release (IR) versus placebo for OAB. The King's Health Questionnaire (KHQ) and the Medical Outcomes Study Short Form 36 (SF-36) were administered at baseline and end of treatment (12 weeks) in a randomized, parallel groups, placebo-controlled, double-blind, multinational study designed to compare the clinical efficacy and safety of tolterodine to placebo in the treatment of OAB. At end of treatment KHQ domains selected a priori as primary HRQOL endpoints (incontinence impact and role limitations) significantly improved (P≤0.0001) with tolterodine IR. Domains selected a priori as secondary HRQOL or symptom endpoints (physical limitations, emotions, sleep and energy, severity (coping) measures, and symptom severity) were also significantly improved (P≤0.0074) following treatment with tolterodine IR. The tolterodine IR group had less severity of individual symptoms and significantly better patient rating of bladder control than the placebo group at end of treatment. As expected, the SF-36 did not detect treatment differences. In conclusion, many aspects of HRQOL, as measured by the KHQ, significantly improved with tolterodine IR treatment. These HRQOL improvements were consistent with clinical efficacy results. The findings demonstrate that tolterodine IR patients experience overall improvement in their condition that resulted in important impacts on their HRQOL.     

Expectations and quality of life of cancer patients undergoing radiotherapy

Expectations, real or false, affect the way patients respond to their illnesses. We assessed therapy-related expectations in relation to global quality of life in 55 cancer patients before and after radiotherapy. Factor analysis indicated that therapy-related expectations come into three broad categories--pain/emotional control, healing and tumour/symptom control. 35 patients expected 'healing' even though curative treatment was intended in only 19 and all patients had been fully informed. The expectation of healing was associated with high quality of life, and the same was true of perception of healing after radiotherapy. In the group as a whole, quality of life was little altered by radiotherapy, but it became substantially worse in those patients who had expected healing but perceived that this had failed, even though physician-assessed Karnofsky status did not change. These findings indicate that the expectation of healing, in cancer patients, is a component of a good global quality of life, whereas more limited expectations (pain control, tumour control) relate to lower quality of life. Patients' expectations deserve further study as a novel approach to improving care.