Relationship between patient-generated subjective global assessment and survival in patients in palliative care.

BACKGROUND: A significant number of cancer deaths is partly due to late diagnosis of the disease at an advanced stage beyond cure. In this context, by applying the adequate tools, palliative care provides terminal cancer patients with the proper support for survival with a higher quality of life. The objective of this study was to describe the nutritional profile of terminal cancer patients and to evaluate the relationship among Patient-Generated Subjective Global Assessment (PG-SGA) score, clinical-functional characteristics and survival. METHODS: The present work is a retrospective cohort study with 104 terminal cancer patients. The Karnofsky Performance Status (KPS) was used to obtain socio-demographic data and clinical history and assess functional capacity. Furthermore, patients were classified by groups and PG-SGA score ranges. RESULTS: In the first medical consultation, the PG-SGA revealed that most patients were moderately or severely malnourished and in critical need of immediate symptom management. Functional capacity of almost half of all patients lay within a KPS score of 40 to 70. Survival analysis revealed that the median time of mortality by cancer was 5 (3.3-6.7) months. Furthermore, patients with an SGA-C, i.e., severely malnourished (P<0.001), a PG-SGA score ≥9 (P=0.036) and a KPS score ≤40 (P<0.001) had a lower median time of survival. CONCLUSIONS: In addition to evaluating nutritional status, the PG-SGA is directly related with survival in terminal cancer patients. The use of this tool in the studied population is of paramount importance to provide individualised and adequate support for these patients.

Cutoff point of the phase angle in pre-radiotherapy cancer patients / El punto de corte de ángulo de fase en pacientes con cáncer en la pre-radioterapia

Introduction: malnutrition is a common complication for cancer patients. The phase angle (PA), direct measurement of bioelectrical impedance analysis (BIA), has been considered a predictor of body cell mass and prognostic indicator. Cutoff points for phase angle (PA) associated with nutritional risk in cancer patients have not been determined yet. Objectives: assess the possibility of determining the cutoff point for PA to identify nutritional risk in pre-radiotherapy cancer patients. Methods: sample group: Patients from both genders diagnosed with cancer and sent for ambulatory radiotherapy. Variables studied: body mass index (BMI), percentage of weight loss (% WL), mid-arm circumference (MAC), triceps skinfold thickness (TST), mid-arm muscle circumference (MAMC), mid-arm muscle area (MAMA), score and categorical assessment obtained using the Patient-Generated Subjective Global Assessment (PG-SGA) form, PA and standardized phase angle (SPA). Kappa coefficient was used to test the degree of agreement between the diagnoses of nutritional risk obtained from several different methods of nutritional assessment. Cutoff points for the PA through anthropometric indicators and PG-SGA were determined by using Receiver Operating Characteristic (ROC) curves, and patient survival was analyzed with the Cox regression method. Results: the cutoff points with the greatest discriminatory power were those obtained from BMI (5.2) and the categorical assessment of PG-SGA (5.4). The diagnosis obtained using these cutoff points showed a significant association with risk of death for the patients in the sample group. Conclusion: we recommend using the cutoff point 5.2 for the PA as a criterion for identifying nutritional risk in pre-radiotherapy cancer patients (AU)

Introducción: la desnutrición es una complicación frecuente en los pacientes con cáncer. El ángulo de fase (AF), medición directa del análisis de impedancia bioeléctrica (AIB), puede ser considerado un factor de predicción de la masa celular corporal e indicador de pronóstico. Los puntos de corte para el ángulo de fase (PA) que se asocian con el riesgo nutricional en pacientes con cáncer aún no han sido determinados. Objetivos: evaluar la posibilidad de determinar el punto de corte para el AF para identificar riesgo nutricional en pacientes con cáncer antes de la radioterapia. Métodos: grupo muestreado: pacientes de ambos sexos con diagnóstico de cáncer y enviados para radioterapia ambulatoria. Variables estudiadas: índice de masa corpórea (IMC), porcentaje de pérdida de peso (% PP), circunferencia del brazo (CB), pliegue cutáneo del tríceps (PCT), circunferencia muscular del brazo (CMB), área muscular del brazo (AMB), puntuación y evaluación categóricas obtenidas utilizando la Valoración Global Subjetiva Generada por el Paciente (VGS-GP), AF y ángulo de fase estandarizado (AFS). El coeficiente Kappa se utilizó para probar el grado de concordancia entre los diagnósticos de riesgo nutricional obtenidos de diferentes métodos de evaluación nutricional. Los puntos de corte del AF a través de indicadores antropométricos y VGS-GP se determinaron utilizando la curva ROC (Receiver Operating Characteristic), y la sobrevivencia de los pacientes se analizó con el método de regresión de Cox. Resultados: los puntos de corte con mayor poder discriminatorio fueron los obtenidos de IMC (5,2) y la evaluación categórica del VGS-GP (5,4). El diagnóstico obtenido mediante estos puntos de corte mostró una asociación significativa con el riesgo de muerte de los pacientes incluidos en este trabajo. Conclusión: se recomienda utilizar el punto de corte 5.2 para el AF como criterio para la identificación de riesgo nutricional en pacientes con cáncer antes de la radioterapia (AU)

Relationship between the phase angle and volume of tumours in patients with lung cancer.

BACKGROUND/AIMS: The phase angle (PA) obtained by bioelectrical impedance has been used as a predictor of nutritional status in cancer. This study aimed to verify the association between the PA and tumour volume in non-small cell lung cancer (NSCLC) patients. METHODS: Volumetric determination of the tumour mass was performed using a computerised image analysis system incorporated in helical tomography. Lesion segmentation was performed by a semi-automatic process using a region growth algorithm with voxel aggregation. The PA was measured by bioelectrical impedance. RESULTS: A total of 30 male patients with a mean age of 65.6 years were evaluated. The mean values observed for body mass index, PA and tumour volume were 22.5 ± 4.19, 5.66 ± 0.9° and 163.2 ± 207.5 ml, respectively. The tumour volumes were negatively correlated with the PA (r = -0.55; p < 0.001) and positively correlated with the ratio between the extracellular mass and the body cell mass (ECM/BCM) (r = 0.59; p < 0.001). In multivariate analysis, independent predictors for both PA and ECM/BCM were tumour volume and Karnofsky performance status score. CONCLUSIONS: In NSCLC, the PA is closely associated with tumour volume, which may be important in early nutritional intervention.