Introduction
Methods
Data sources
Study eligibility criteria
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Study selection
Data collection process
First Author, Year, Study Place | Data Collection Period | Study Design | Sample Size | Nutritional Assessment | Quality of Life Assessment | Groups being compared | Key results | Conclusion |
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Jager-Wittenaar H, 2011, The Netherlands [16] | October 2004 and February 2006 | Convenience sample, cross-sectional study | 115 oral or oropharyngeal cancer | Percentage weight loss was calculated as: [(normal body weight - actual body weight)/normal body weight] *100 | EORTC QLQ C-30 | Weight loss > =10% in 6 months or > =5% in 1 month | Median scores of malnourished patients on physical functioning (p = .007) and fatigue (p = .034) were significantly lower than those of well-nourished patients. | Malnourished patients treated for oral/oropharyngeal cancer score lower on quality of life scales related to physical fitness. |
Capuano G, 2010, Italy [8] | NA | Prospective, consecutive case series | 61 Head & Neck Cancer Oropharynx: n = 21; Oral cavity: n = 19 Nasopharynx: n = 13; Larynx: n = 5; Maxillary sinus: n = 2 Submandibular gland: n = 1 | 1. Unintended weight loss (UWL) 2. PG-SGA score | EORTC QLQ C-30 |
Unintended weight loss –
Non-malnourished: involuntary loss of < 5% of body weight in the last 3 months (n = 36) & Malnourished: ≥ 5% loss of body weight in the last 3 months (n = 25) |
1. Unintended weight loss –
Multivariate:
Malnutrition (UWL) and Hb level independently influenced physical (p = 0.002; p = 0.005), role (p = 0.004; p = 0.001), and social functions (p = 0.024; p = 0.009).
2. PG-SGA score –
Mean ± SD = 3 ± 2 & 9 ± 5 respectively for non-malnourished & malnourished patients, p < 0.001. | An early and intensive nutritional support might reduce weight loss before, during, and after treatment completion, improving outcome, QoL, and PS. |
Morton RP, 2009, New Zealand [17] | Over a 24-month period, ending in 2005 | Retrospectiveconsecutive case series | 36 head and neck cancer | BMI drop over 12 months | UW-QOL | BMI change was taken as a continuous variable | The 12-month BMI drop was inversely correlated with current HRQOL, signifying that weight loss correlated with a poorer subsequent HRQOL score (r = −0.47, P = 0.026). It was significantly related to lower speech and swallowing function scores. | The observed relationship between a drop in BMI and the current HR-QOL may be a function of greater general impact of treatment. |
van den Berg MGA, 2007, the Netherlands [18] | May 2002 to May 2004 | Observationalprospective non-randomized, longitudinal study | 47 Squamous Cell Carcinoma of the oral cavity, oropharynx, hypopharynx. Oral cavity: n = 23; Oropharynx: n = 18; Hypopharynx: n = 5 | Unintended weight loss Malnutrition was defined as unintended weight loss of 10% or more within the previous 6 months before baseline | EORTC QLQ C-30and EORTC QLQ – H&N35 | ≥ 10% & < 10% weight loss at baseline |
1. At baseline: Patients ≥10% weight loss in 6 months before baseline had lower scores for global, physical, role, and emotional functioning. Fatigue, pain, insomnia, appetite loss, swallowing, decreased sexuality, sticky saliva and coughing were worse in the ≥ 10% weight loss group.
2. At the end of treatment: Patients who had lost ≥ 10% weight had lower role and social functioning. Scores significantly differed for global (p = 0.01), fatigue (p = 0.03), pain (p = 0.04), senses problems (0.05), sticky saliva (p = 0.01), coughing (p = 0.02) and feeling ill (p = 0.01) during treatment.
3. Six months after treatment: Patients ≥ 10% weight loss lower on physical, role, emotional and cognitive functioning. | Patients with head and neck cancer treated with radiotherapy are specifically susceptible to malnutrition during treatment with no improvement in body weight or QoL. |
Petruson KM, 2005, Sweden [19] | February 1996 to May 1997 | Prospective, longitudinal study | 49 primary untreated head and neck cancer Pharyngeal: n = 15; Laryngeal: n = 12; Oral: n = 12; Other: n = 10 | Weight loss* * Severe weight loss (malnutrition) defined as loss of more than 10% weight during 6 months | 1. EORTC QLQ-C30 2. EORTC QLQ-H&N35 3. HADS | ≥ 10% weight loss (n = 20) & < 10% weight loss (n = 29) |
(A) At different time-points: Patients who lost ≥ 10% in weight during 6 months had worse HRQL at diagnosis than did patients who lost less at all time-points.
(B) HADS: At diagnosis, 37% of the ≥ 10% weight loss group had Possible/probable depression versus 17% of the <10% weight-loss group. This tendency remained after 3 months (38% vs 20%), at 1-year follow-up (44% vs 5%), and after 3 years (27% vs 15%). | Patients with head and neck cancer who are at risk of severe weight loss developing during treatment may be detected with the aid of HRQL questionnaires at diagnosis. |
Hammerlid E, 1998, Norway, Sweden [12] | NA | Prospective, consecutive case series | 48 head and neck cancer Oral cavity: n = 16 Larynx: n = 11 Sinus: n = 10 Skin: n = 4 Esophagus/ Hypopharynx: n = 4 Other: n = 3 | 1. Weight loss 2. Anthropo-metry: (a) AMC and (b) TSF 3. WI 4. BMI 5. S-alb | EORTC QLQ-C30 supplemented by a provisional H&N cancer module constructed in Norway |
1. Weight loss:
> 5% & ≤ 5% of the body weight
2. Anthropometry: Based on Swedish reference values
3. WI: < 0.80 & ≥ 0.80
4. BMI: ≥ 20 & < 20
5. S-alb: < 33 g/L & ≥ 33 g/L
Groups for analysis
(1) malnutrition (n =25) versus normal (n = 22), (2) weight loss (n = 20) versus no weight loss (n = 24), (3) negative energy balance (n = 18) versus positive energy balance (n = 15) |
1. Malnutrition versus normal nutritional status: Malnourished patients scored worse for 12 of the 16 functions/symptoms. The greatest differences between the two groups were found for Physical Function, global QoL, and Role Function, NS.
2. Weight loss versus no weight loss: Patients with weight loss scored worse for 11 of 16 functions. (a) Swallowing difficulties
Mean score = 52 & 18 for those with weight loss and no weight loss respectively, p < 0.01. (b) Problems swallowing food
Mean score = 62 & 29 for those with weight loss and no weight loss respectively, p < 0.01.
3. Negative and positive energy balance:
The groups of patients with negative energy balance scored better than the group of patients with positive energy balance for 11 of the 16 function/symptoms, NS. | This study demonstrated few significant differences, depending on nutritional status, in some of the QL scales or item scores. |
First Author, Year, Study Place | Data Collection Period | Study Design | Sample Size | Nutritional Assessment | Quality of Life Assessment | Groups being compared | Key results | Conclusion |
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Tian J, 2009, China [20] | January 2007 to December 2007 | Cross-sectional study | 233 advanced stomach cancer | Daily calorie and protein intake using Food Frequency Survey Method and Food Composition Database, BMI, albumin | ECOG performance status | BMI <18 kg/m2 and > =18 kg/m2
Albumin <35 g/L and > =35 g/L Daily Calorie intake <2400 kcal and > =2400 kcal Daily Protein intake <70 g and > =70 g | The relative risk (95% confidence interval) was 1.16 (1.02–1.32) for low level of daily calorie intake versus normal level of daily calorie intake. | Low level of daily calorie intake may be the risk factor of poor performance status of the patients with advanced stomach cancer |
Tian J, 2008, China [21] | January 2006 and June 2006 | Cross-sectional study | 113 esophagus, stomach, and colorectal | Daily calorie and protein intake using Food Frequency Survey Method and Food Composition Database, BMI, albumin | EORTC QLQ-C30 | Calorie intake, BMI and albumin used as continuous variables | After age, sex, and stage of the disease were adjusted, patients with high daily intakes of calories and protein, as well as high level of albumin, had a significantly better quality of life. | Nutrition status 1 year after being discharged from hospitals may be associated with better QoL in patients with esophagus, stomach, and colon cancers |
Correia M, 2007, Portugal [22] | December 2003 to November 2004 | Prospective consecutive case series | 48 with a recent (< 4 weeks) diagnosis of gastric cancer | 1. Percentage of weight loss* 2. PG-SGA 3. BIA for FFMI 4. Hand Grip Dynamometry | EORTC-QLQ C30 |
1. Weight Loss: > 10% in the previous six months or > 5% in the last month & < 10% in the previous six months or < 5% in the last month.
2. PG-SGA
Well-nourished, mild malnutrition (MN) & severe MN.
3. Hand Grip Dynamometry: Below 85% & above 85% | Malnutrition identified through PG-SGA, percentage of weight loss at 1 month, FFMI or dynamometry was positively associated to a worse QoL with the worst performance in all dimensions of QoL being attributed to those patients identified as malnourished by PG-SGA. | PG-SGA was correlated with the several dimensions for QoL evaluation. |
Martin L, 2007, Sweden [23] | 2 April 2001 to 30 October 2004 | Prospective population-based cohort study | 233 with esophageal or cardia cancer Adenocarcinoma cardia: n = 102; esophageal adenocarcinoma: n = 82; Oesophageal squamous cell carcinoma: n = 49 | Postoperative weight change, measured as the difference in BMI between the time of tumor resection and 6 months later | 1. EORTC QLQ-C30 2. QLQ-OES18 |
Postoperative weight change –
Six groups:
Group I: Stable or increased, Group II: decrease of 1–4%,
Group III: 5–9% decrease, Group IV: 10–14% decrease,
Group V: 15–19% decrease, Group VI: ≥ 20% decrease | Patients with a BMI decrease of at least 20 per cent experienced more appetite loss (mean score difference 26; P = 0·002), eating difficulties (mean score difference 18; P < 0·002) and odynophagia (mean score difference 12; P = 0·044) than patients without postoperative weight loss, whereas scores for dysphagia and gastro-oesophageal reflux were similar between these groups. | Malnutrition is a considerable problem after oesophagectomy, and is linked to appetite loss, eating difficulties and odynophagia. |
Gupta D, 2006, USA [24] | March 2001 to June 2003 | Retrospective | 58 histologically confirmed stages III and IV colorectal cancer | 1. Serum albumin, 2. Prealbumin, 3. serum Transferrin, 4. Phase angle by BIA 5. SGA | EORTC-QLQ C30 |
Well nourished: SGA-A (n = 34) &
Malnourished: (SGA-B&C) (n = 24) All others were used as continuous variables. |
SGA: Well-nourished patients had significantly better QoL scores in the global, physical, role function scales and fatigue, pain, insomnia, appetite loss, and constipation symptom scales.
Serum albumin, serum transferrin, and phase angle: were significantly correlated with the physical and role function scales and fatigue and appetite loss symptom scales. | Malnutrition is associated with poor QoL, as measured by the QLQ-C30 in colorectal cancer. |
Tian J, 2005, China [25] | April 2004 to May 2004 | Retrospective | 285 surgical stomach cancer | Daily calorie intake using Food Frequency Survey Method and Food Composition Database | 3 QoL groups: bad (total score under 60), modest (total score within 60–80) and good (total score over 80) | Good, modest and bad quality of life | For both males and females, the daily nutrition intake among three groups, except vitamin C, were statistically different, which suggested that the patients who had a better nutritional status had a higher quality of life. | The nutritional status of the operated patients with stomach cancer may impact their QoL. Exercise for rehabilitation can whet the appetite of the patients and recover their body function, which in turn may improve QoL. |
Andreyev HJN, 1998, UK [26] | April 1990 to March 1996 | Retrospective | 1555 tumors of oesophagus, stomach, pancreas, colon or rectum Oesophageal: n = 179; Gastric: n = 433; Pancreatic: n = 162; Colorectal: n = 781; | Weight loss at presentation | EORTC-QLQ-C30 | With weight loss & no weight loss | Patients with weight loss at presentation had a mean quality of life score which was less than patients with no weight loss, especially in patients with gastric (P < 0.008), pancreatic and colorectal cancers (P < 0.0001) and also when all sites were combined. (P < 0.0001). | Patients with weight loss had a worse quality of life score. |
O’Gorman P, 1998, UK [27] | NA | Prospective | 119 gastrointestinal cancer Colorectal: n = 43; Esophageal: n = 27; Gastric: n = 38; Pancreatic: n = 11 | Weight loss* * defined as loss of more than 5% pre-illness weight in the previous 6 months | 1. EuroQol EQ-5D 2. EORTC QLQ-C30 | Weight-stable (< 5% weight loss) (n = 22) & Weight-losing (> 5% weight loss) (n = 97) |
1. EuroQol EQ-5D –
Median (range) = 0.85 (0.03-1.00) & 0.52 (−0.26-1.00) respectively for weight-stable and weight-losing groups, p < 0.001.
2. EORTC QLQ-C30 –
The results in most subscales of the EORTC QLQ-C30 questionnaire were poorer in the weight-losing group (p < 0.01). | Weight loss and reduction of appetite are important related factors in lowering the quality of life of gastrointestinal cancer patients. |
First Author, Year, Study Place | Data Collection Period | Study Design | Sample Size | Nutritional Assessment | Quality of Life Assessment | Groups being compared | Key results | Conclusion |
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Scott HR, 2003, UK [28] | NA | Prospective | 106 inoperable NSCLC (stage III and IV)
By stage –
Stage III: n = 78 Stage IV: n = 28 | Weight loss* * defined as loss of more than 5% pre-illness weight in the previous 6 months | EORTC-QLQ-C30 |
Weight-stable (< 5% weight loss) (n = 61) & Weight-losing (> 5% weight loss) (n = 45) |
(a) Global QoL:
Median (range) = 50 (0–100) & 33.3 (0–66.7) respectively for weight-stable & weight-losing groups, p = 0.027.
(b) Symptom scores: Fatigue (P < 0.05) and pain (P < 0.01) were significantly greater in the weight-losing group. i. Fatigue: – Median (range) = 55.6 (0–100) & 66.7 (0–100) respectively for weight-stable & weight-losing groups, p = 0.044. ii. Pain: – Median (range) = 16.7 (0–100) & 41.7 (0–100) respectively for weight-stable & weight-losing groups, p = 0.007. | Weight loss has an impact on different aspects of quality of life. |
First Author, Year, Study Place | Data Collection Period | Study Design | Sample Size | Nutritional Assessment | Quality of Life Assessment | Groups being compared | Key results | Conclusion |
---|---|---|---|---|---|---|---|---|
Gil KM, 2007, USA [29] | January 2001 to July 2004 | Prospective longitudinal study, consecutive case series | 157 requiring surgery for a pelvic mass or a positive endometrial biopsy (endometrial cancer) Ovarian cancer: n = 33 Endometrial cancer: n = 45 Benign adnexal mass: n = 79 | BMI (kg/m2) | 1. SF-36 for General Health Status 2. FACT-G | BMI was used as a continuous variable |
Univariate: Increasing BMI was negatively correlated with physical, social and functional well being.
Multivariate: BMI continued to be a significant independent variable included in the model for social well-being, p = 0.03. | BMI was significantly associated with QoL. As treatment options become more complex, these variables are likely to be of increasing importance in evaluating treatment effects on QoL. |
First Author, Year, Study Place | Data Collection Period | Study Design | Sample Size | Nutritional Assessment | Quality of Life Assessment | Groups being compared | Key results | Conclusion |
---|---|---|---|---|---|---|---|---|
Norman K, 2010, Germany [30] | NA | Prospective cross-sectional | 189 Gastrointestinal: 103; Head and Neck: 30; Urinary Tract: 8; Gynecologic: 21; Others: 13 | SGA | EORTC-QLQ-C30 |
SGA-A: Well nourished (n = 109)
SGA-B: Moderately malnourished & SGA-C: Severely malnourished (n = 80) | Most QoL functional scales were significantly reduced in malnutrition and the majority of symptom scales were higher in the malnourished patients. Malnutrition emerged as an independent determinant for functional status (estimated effect size 19.4%, p < 0.001) next to age and gender, which were the strongest predictors. | Malnutrition is a disease independent risk factor for reduced muscle strength and functional status in cancer patients. |
Norman K, 2010, Germany [10] | December 2006 to June 2007 | Prospective consecutive case series | 399 with solid or hematologic tumor disease Gastrointestinal: n = 149; Head and neck or lung: n = 71; Urogenital: n = 23; Gynecologic: n = 35; Neuroendocrine, adrenal, thyroid: n = 30; Others: n = 20; Hematologic disease: n = 71 | 1. SGA 2. Phase angle determined by BIA | EORTC-QLQ-C30 |
1. SGA –
SGA-A: Well nourished (n = 167)
SGA-B: Moderately malnourished (n = 132) & SGA-C: Severely malnourished (n = 100).
2. BIA –
Below fifth percentile (n = 191) & above fifth percentile (n = 208) of the phase angle |
Univariate: All function scales of the EORTC quality-of-life questionnaire apart from emotional function were significantly impaired in patients with a phase angle below the fifth reference percentile, and among the symptom scale, fatigue, nausea and vomiting, pain, dyspnea, appetite loss, and constipation were increased.
Multivariate: The standardized phase angle was an independent predictor of muscle function as were sex, age, and SGA in a GLM regression model and an independent predictor for EORTC global function score next to SGA, BMI, handgrip strength, and age. | The standardized phase angle is an independent predictor for impaired functional and nutritional status than are malnutrition and disease severity in cancer. |
Shahmoradi N, 2009, Malaysia [5] | November 2008 to April 2009 | Prospective | 61 Colon: n = 8; Rectum: n = 8; Breast: n = 11; Lung: n = 7; Stomach: n = 4; Prostate: n = 3; Kidney: n = 3; Nasopharynx: n = 3; Leukemia: n = 3; Liver: n = 2 Brain: n = 2; Cevix uteri: n = 1; Ovary: n = 1; Pancreas: n = 1; Other: n = 4 | PG-SGA | HQLI | Well-nourished, Severely malnourished & Moderately malnourished |
Univariate: The PG-SGA score was significantly correlated to total quality of life score (p = 0.000). PG-SGA score alone was able to explain 38% of the total variation in total quality of life score.
Multivariate: PG-SGA score showed significant correlation with psychophysiological well-being (p = 0.000), functional well-being (p = 0.000) and social/spiritual well-being (p = 0.040). PG-SGA score is able to explain 36.9%, 41.8% and 7% of the total variation in psychophysiological, functional and social/spiritual wellbeing, respectively. | Advanced cancer patients with poor nutritional status have a diminished quality of life. There is a need for a comprehensive nutritional intervention for improving nutritional status and quality of life in terminally ill cancer patients under hospice care. |
Tong H, 2009, Australia [3] | Data collection concluded in 2000, primary data analysis by 2001 | Prospective observational longitudinal study | 219 solid and hematological Head neck: n = 7;Gastrointestinal: n = 47; Breast: n = 63; lung: n = 15; urinary: n = 31; Soft tissue–skin–brain–CNS: n = 7; Primary unknown: n = 3; Hematological: n = 46 | PG-SGA | Global QoL was measured using Life Satisfaction Scale | Both PG-SGA & QoL are used as continuous variables | A small to medium negative correlation was found between PG-SGA scores and life satisfaction scores across all time points.
1. At baseline (n = 218):
r = −0.224, p = 0.001
2. At 6 months (n = 196):
r = −0.350, p < 0.001
3. At 12 months (n = 157):
r = −0.288, p < 0.001). | Nutrition impact symptoms were commonly experienced, even 12 months following commencement of chemotherapy, and were associated with poorer QoL and performance status. |
Nourissat A, 2008, France [31] | Over 2 weeks | Transversal observational study | 883 evolving cancer s
Males (n = 434)
Lung: n = 105; Colorectal: n = 84; Prostate: n = 67
Females (n = 449)
Breast: n = 194; Colorectal: n = 79;Ovary: n = 33 | Weight loss | EORTC-QLQ C30 |
Weight loss < 10% (n = 622) & Weight loss ≥ 10% (n = 261) | (a) Mean Global QoL score = 62.8 & 48.8 respectively for weight loss < 10% & ≥ 10%, p < 0.001. (b) Physical, functional, emotional, cognitive and social functions were significantly higher in weight loss < 10% group. Symptom scores were also lower for fatigue, nausea, vomiting, pain, dyspnea, loss of appetite, constipation and diarrhea. | To improve QoL in patients with cancer, a nutritional intervention should be implemented as soon as cancer is diagnosed. The nutritional therapy should form part of the integral oncological support. |
Trabal J, 2006, Spain [6] | April 2004 to September 2004 | Descriptive cross-sectional study, consecutive case series | 50 non-terminal cancer Lung: n = 20; Breast: n = 7; Gynecologic: n = 6; Esophagus: n = 4; Others: n = 13 | 1. BMI 2. Percentage of usual weight 3. Ideal weight percentage, 4. Percentage weight loss 5. TSF 6. Mid-upper arm circumference 7. Serum albumin 8. Prealbumin 9. Total proteins | EORTC QLQ-C30 | Protein intake < 0.9 g/kg/d & ≥ 0.9 g/kg/d | 1. Patients with hypo albuminemia reported more problems with diarrhea (p = 0.05). 2. Protein intake below 0.9 g/kg was associated to a poorer perception on physical functioning (p = 0.01), and fatigue was close to significance (p = 0.058). 3. No significant differences were found regarding caloric intake though, being fatigue (p = 0.06) the closest relation. 4. No other nutritional parameters, like percentage of weight loss, were statistically related to changes in QoL. | Nutrition is only one of the factors that influence QoL in cancer patients, but nutritional evaluation of cancer patients needs to be improved and individualized nutritional counseling should be done, so as to offer better treatment of symptoms and to improve patients’ QoL. |
Ravasco P, 2004, Portugal [32] | July 2000 to September 2002 | Prospective, cross-sectional, consecutive case series | 271 Head and neck Base of tongue: n = 11; Salivary gland: n = 6; Tonsil: n = 4; Nasopharynx: n = 11; Oropharynx: n = 22; Larynx: n = 33; Oesophagus: n = 14; Stomach: n = 26; Colorectum: n = 144 | Percentage weight loss over the previous 6 months | EORTC-QLQ C30 | ≥ 10% weight loss & < 10% weight loss over the previous 6 months | Malnutrition was associated with poorer function scales and with some symptoms: global QoL (P = 0.05), physical (P = 0.01), role (P = 0.02), cognitive (P = 0.02), emotional (P = 0.01) and social (P = 0.01); anorexia (P = 0.001), increased fatigue (P = 0.03), dyspnea, insomnia and diarrhea (P = 0.04). | Although cancer stage was the major determinant of patients’ QoL globally, there were some diagnoses for which the impact of nutritional deterioration combined with deficiencies in nutritional intake may be more important than the stage of the disease process. |
Isenring E, 2003, Australia [2] | Over a 1 year period | Prospective longitudinal | 60 ambulatory patients receiving radiation therapy to the head, neck, rectal or abdominal area | PG-SGA | EORTC-QLQ C30 | well-nourished (n = 39) malnourished (n = 21) PG-SGA scores and QoL used as continuous variables |
(A) At baseline –
Correlation between PG-SGA score and global QoL
r = − 0.66, P < 0.001
(B) After 4 weeks of radiotherapy –
Correlation between PG-SGA score and global QoL
r = − 0.61, P < 0.001
(C) Correlation between the change in PG-SGA score and change in global QoL
r = − 0.55, P < 0.001 26% of the variation of change in QoL was explained by change in PG-SGA score (P = 0.001). A change in PGSGA score of 9 resulted in a change of 17 in the QoL score. | The scored PG-SGA is a nutrition assessment tool that identifies malnutrition in ambulatory oncology patients receiving radiotherapy and can be used to predict the magnitude of change in QoL. |
Ravasco P, 2003, Portugal [7] | July 2000 to February 2001 | Prospective longitudinal study, Consecutive case series | 125
HR: High Risk
Oesophagus: n = 6;Stomach: n = 5; Colorectal: n = 46; Base of the tongue: n = 3; Salivary gland: n = 1; Tonsil: n = 2 Nasopharynx: n = 3; Oropharynx: n = 3; Larynx: n = 11
LR: Low Risk
Prostate: n = 21; Breast: n = 7; Lung : n = 5; Brain: n = 4; Gallbladder: n = 6; Uterus: n = 2 | SGA | 1. EUROQOL 2. EORTC-QLQ-C30 QoL used as a continuous variable | Normal, moderate and severe malnutrition groups |
(A) EUROQOL –
1. At baseline: In HR patients, baseline malnutrition was associated with lower self reported health status (SRHS) (P = 0.002). 2. At the end of Radiotherapy: Improved nutritional status was associated with higher SRHS (P = 0.03).
(B) EORTC-QLQ-C30 –
(a) At baseline: In HR patients, malnutrition associated with worse function scales: global QoL (P = 0.05), physical (P = 0.01), role (P = 0.02), cognitive (P = 0.02), emotional (P = 0.01) and social (P = 0.01) as well as symptoms: poor appetite (P = 0.001) or increased fatigue (P = 0.03) (b) At the end of Radiotherapy: All associations with function scales were also present at the end of treatment: global QoL (P = 0.01), physical (P = 0.02), role (P = 0.02), cognitive (P = 0.03), emotional (P = 0.01) and social (P = 0.04). In LR patients, nutritional parameters were not significantly associated with QoL dimensions. | Malnutrition as assessed by SGA was associated with a worse QoL in high risk patients. |
Ovesen L, 1993, Denmark [33] | In 1989 | Prospective | 104 biopsy-proven breast cancer, ovarian cancer, or small cell lung cancer. Breast: n = 19; Ovarian: n = 47; Small cell lung: n = 38 | Unintentional weight loss* *defined as weight loss within recent 3 months | 1. GHQ 2. QL |
Weight-losing group (− weight loss): weight loss of ≥ 5% of habitual body weight (n = 56) &
Weight-stable group (+ weight loss): weight loss of < 5% of habitual body weight (n = 48) | General health, as assessed by the GHQ score, was rated significantly worse by patients with weight loss than by weight-stable patients. Similarly, the scores on the social functioning and the outlook/happiness subscales indicated significantly lower quality of life for the patients with weight loss, and this result was confirmed by a significant group difference on the modified QL. | Many ambulatory cancer patients do not eat enough to maintain weight and that even a moderate weight loss is associated with psychological distress and lower quality of life. |