J Nutr Health.  2017 Dec;50(6):595-602. 10.4163/jnh.2017.50.6.595.

The impact of malnutrition on survival in patients with gynecologic cancer undergoing chemotherapy

• Nho JH
• Kwon YS
• Jo S

• KMID: 2401016
• DOI: http://doi.org/10.4163/jnh.2017.50.6.595

Abstract

PURPOSE
Malnutrition is a major concern in patients with gynecologic cancer receiving chemotherapy. The aim of this study was to evaluate the prognostic significance of malnutrition in patients with gynecologic cancer undergoing chemotherapy.
METHODS
A prospective, observational study was conducted on a total of 99 subjects who were treated at a tertiary hospital in Korea. Data regarding demographic, clinical, nutritional, and psychological characteristics at baseline and survival were obtained.
RESULTS
Performance status, nutritional status, depression, and annual income were significantly different between survivors and non-survivors. Multivariate Cox modeling after adjusting for other factors showed that a malnourished status in patients with gynecologic cancer undergoing chemotherapy was a significant and independent negative influencing factor for survival.
CONCLUSION
These findings provide evidence that adequate nutritional assessment and intervention may assist in improving survival in patients with gynecologic cancer undergoing chemotherapy.

Keyword

gynecologic neoplasm; malnutrition; survival; chemotherapy

MeSH Terms

Depression
Drug Therapy*
Female
Genital Neoplasms, Female
Humans
Korea
Malnutrition*
Nutrition Assessment
Nutritional Status
Observational Study
Prospective Studies
Survivors
Tertiary Care Centers

Figure

• 

  Fig. 1 Adjusted survival curve of gynecologic cancer patients

Reference

1. American Cancer Society. Cancer facts & figures 2014. Atlanta (GA): American Cancer Society;2014.

2. Korea Central Cancer Registry. National Cancer Center. Annual report of cancer statistics in Korea in 2014. Sejong: Ministry of Health and Welfare;2016.

3. Delgado G, Bundy B, Zaino R, Sevin BU, Creasman WT, Major F. Prospective surgical-pathological study of disease-free interval in patients with stage IB squamous cell carcinoma of the cervix: a Gynecologic Oncology Group study. Gynecol Oncol. 1990; 38(3):352–357.

4. Japan Society of Obstetrics and Gynecology. the Japanese Pathological Society. Japan Radiological Society. The general rules for clinical and pathological management of uterine cervical cancer. Tokyo: Kanehara Shuppan Kabushiki Kaisha;1987.

5. Chida Y, Hamer M, Wardle J, Steptoe A. Do stress-related psychosocial factors contribute to cancer incidence and survival? Nat Clin Pract Oncol. 2008; 5(8):466–475.

6. Falagas ME, Zarkadoulia EA, Ioannidou EN, Peppas G, Christodoulou C, Rafailidis PI. The effect of psychosocial factors on breast cancer outcome: a systematic review. Breast Cancer Res. 2007; 9(4):R44.

7. Pasquini M, Biondi M. Depression in cancer patients: a critical review. Clin Pract Epidemiol Ment Health. 2007; 3:2.

8. Lehto US, Ojanen M, Dyba T, Aromaa A, Kellokumpu-Lehtinen P. Baseline psychosocial predictors of survival in localised breast cancer. Br J Cancer. 2006; 94(9):1245–1252.

9. Hess LM, Barakat R, Tian C, Ozols RF, Alberts DS. Weight change during chemotherapy as a potential prognostic factor for stage III epithelial ovarian carcinoma: a Gynecologic Oncology Group study. Gynecol Oncol. 2007; 107(2):260–265.

10. Gupta D, Lammersfeld CA, Vashi PG, Dahlk SL, Lis CG. Can subjective global assessment of nutritional status predict survival in ovarian cancer? J Ovarian Res. 2008; 1(1):5.

11. Barrera R. Nutritional support in cancer patients. JPEN J Parenter Enteral Nutr. 2002; 26:5 Suppl. S63–S71.

12. Nho JH, Kim SR, Kang GS, Kwon YS. Relationships among malnutrition, depression and quality of life in patients with gynecologic cancer receiving chemotherapy. Korean J Women Health Nurs. 2014; 20(2):117–125.

13. Laky B, Janda M, Bauer J, Vavra C, Cleghorn G, Obermair A. Malnutrition among gynaecological cancer patients. Eur J Clin Nutr. 2007; 61(5):642–646.

14. Bauer J, Capra S, Ferguson M. Use of the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in patients with cancer. Eur J Clin Nutr. 2002; 56(8):779–785.

15. Beck AT. Depression: clinical, experimental, and theoretical aspects. New York (NY): Hoeber;1967.

16. Lee YH, Song JY. A study of the reliability and the validity of the BDI, SDS, and MMPI-D scales. Korean J Clin Psychol. 1991; 10(1):98–113.

17. Jo SA, Park MH, Jo I, Ryu SH, Han C. Usefulness of Beck Depression Inventory (BDI) in the Korean elderly population. Int J Geriatr Psychiatry. 2007; 22(3):218–223.

18. Kil SY, Oh WO, Koo BJ, Suk MH. Relationship between depression and health-related quality of life in older Korean patients with chronic obstructive pulmonary disease. J Clin Nurs. 2010; 19(9-10):1307–1314.

19. R Core Team. R: A language and environment for statistical computing. Vienna: R Foundation for Statistical Computing;2017.

20. Akaike H. A new look at the statistical model identification. IEEE Trans Automat Contr. 1974; 19(6):716–723.

21. Chan JK, Tian C, Monk BJ, Herzog T, Kapp DS, Bell J, Young RC. Gynecologic Oncology Group. Prognostic factors for high-risk early-stage epithelial ovarian cancer: a Gynecologic Oncology Group study. Cancer. 2008; 112(10):2202–2210.

22. Chi DS, Liao JB, Leon LF, Venkatraman ES, Hensley ML, Bhaskaran D, Hoskins WJ. Identification of prognostic factors in advanced epithelial ovarian carcinoma. Gynecol Oncol. 2001; 82(3):532–537.

23. Winter WE 3rd, Maxwell GL, Tian C, Carlson JW, Ozols RF, Rose PG, Markman M, Armstrong DK, Muggia F, McGuire WP. Gynecologic Oncology Group Study. Prognostic factors for stage III epithelial ovarian cancer: a Gynecologic Oncology Group Study. J Clin Oncol. 2007; 25(24):3621–3627.

24. Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F, Fearon K, Hütterer E, Isenring E, Kaasa S, Krznaric Z, Laird B, Larsson M, Laviano A, Mühlebach S, Muscaritoli M, Oldervoll L, Ravasco P, Solheim T, Strasser F, de van der Schueren M, Preiser JC. ESPEN guidelines on nutrition in cancer patients. Clin Nutr. 2017; 36(1):11–48.

25. Capra S, Ferguson M, Ried K. Cancer: impact of nutrition intervention outcome--nutrition issues for patients. Nutrition. 2001; 17(9):769–772.

26. Grant M, Kravits K. Symptoms and their impact on nutrition. Semin Oncol Nurs. 2000; 16(2):113–121.

27. Van Cutsem E, Arends J. The causes and consequences of cancer-associated malnutrition. Eur J Oncol Nurs. 2005; 9:Suppl 2. S51–S63.

28. Garssen B, Goodkin K. On the role of immunological factors as mediators between psychosocial factors and cancer progression. Psychiatry Res. 1999; 85(1):51–61.

29. Radzikowska E, Głaz P, Roszkowski K. Lung cancer in women: age, smoking, histology, performance status, stage, initial treatment and survival. Population-based study of 20 561 cases. Ann Oncol. 2002; 13(7):1087–1093.

30. Scott HR, McMillan DC, Forrest LM, Brown DJ, McArdle CS, Milroy R. The systemic inflammatory response, weight loss, performance status and survival in patients with inoperable non-small cell lung cancer. Br J Cancer. 2002; 87(3):264–267.

31. Subramanian S, Chen A. Treatment patterns and survival among low-income medicaid patients with head and neck cancer. JAMA Otolaryngol Head Neck Surg. 2013; 139(5):489–495.

32. Cykert S, Dilworth-Anderson P, Monroe MH, Walker P, McGuire FR, Corbie-Smith G, Edwards LJ, Bunton AJ. Factors associated with decisions to undergo surgery among patients with newly diagnosed early-stage lung cancer. JAMA. 2010; 303(23):2368–2376.

33. McCann J, Artinian V, Duhaime L, Lewis JW Jr, Kvale PA, DiGiovine B. Evaluation of the causes for racial disparity in surgical treatment of early stage lung cancer. Chest. 2005; 128(5):3440–3446.