Malnutrition and Quality of Life in Chinese Cancer Patients: a Clinical Study of 23,994 Subjects

Background Malnutrition is common in patients with cancer,and can negatively impact their quality of life(QoL)and even survival.However,there is currently no large data available on the prevalence of malnutrition in Chinese cancer patients.This study evaluated the prevalence of malnutrition and the QoL of Chinese patients with locoregional,recurrent or metastatic cancer.Methods We conducted a nationwide observational,multi-center,hospital-based cross-sectional study within the Chinese Society of Nutritional Oncology(CSNO)Network.All of the patients were diagnosed with one of the following 18 different types of malignant tumors:lung cancer,gastric cancer,liver cancer,colorectal cancer,breast cancer,esophageal cancer,cervical cancer,endometrial cancer,nasopharyngeal carcinoma,malignant lymphoma,leukemia,pancreatic cancer,ovarian cancer,prostate cancer,bladder cancer,brain cancer,biliary tract malignant tumors or gastrointestinal stromal tumors.These patients were enrolled from 72 hospitals located in different regions of China.The patients’nutritional status was evaluated based on the body mass index(BMI),loss of bodyweight,laboratory measurements and patient generated-subjective global assessment(PG-SGA)scores.The cancer patients’physical status and QoL were assessed by the Karnofsky Performance Status(KPS)questionnaire and the European Organization for Research and Treatment of Cancer(EORTC)QLQ-C30 questionnaire,respectively.Results From December 2013 to April 2016,23,994 patients hospitalized for cancer treatment(such as surgery,chemotherapy or radiotherapy)were enrolled in the study.The patients included 12,494(52.9%)males and 11,124(47.1%)females.The mean age was 55.8±13.7 years.The proportions of patients in cancer stagesⅠ,Ⅱ,Ⅲ,Ⅳand uncertain were 11.5%,20.3%,27.5%,30.2%and 10.5%,respectively.Among the 23,994 inpatients,the proportions of patients who were underweight(BMI<18.5 kg/m2),normal(18.5 kg/m2<BMI<24 kg/m2),overweight(24 kg/m2≤BMI<28 kg/m2)and obese(BMI≥28 kg/m2)were 9.3%,59.9%,26.1%and 4.7%,respectively.A total of 18.3%(4,101/22,424)of patients had lost 5%or more of their bodyweight within the past month and 19.6%(2,463/12,538)of patients had lost 10%or more of their bodyweight within the past 6 months.According to the PG-SGA scores,26.6%of the patients were severely malnourished(score≥9),31.3%were moderately malnourished(scores 4~8).A total of 22.2%of patients had a serum albumin level lower than 35g/L.Only 8.6%(2056/23,991)of the patients had severe KPS scores(≤60).The patients with these severe KPS scores were most frequently among those with cancers of the brain(19.7%),prostate(18.0%),pancreas(15.5%)and bladder(15.0%).Based on the QLQ-C30 score,11.6%of patients had a poor QoL.The PG-SGA score and global QoL were correlated(r=-0.593,P<0.001).Conclusion The prevalence of malnutrition in patients with cancer is relatively high,and is related to a poorer QoL.The present findings should be kept in mind when assessing cancer patients,because addressing the patient’s problems in nutritional status would be expected to improve both the clinical outcomes and QoL in cancer patients with malnutrition.

Validity of the Chinese Version of the Patient-Generated Subjective Global Assessment (PG-SGA) in Lung Cancer Patients

The prevalence of malnutrition is high among oncology patients in China. Although the Patient- Generated Subjective Global Assessment (PG-SGA) is widely recognized as an important nutritional assessment tool, it has not been validated for Chinese cancer patients. The purpose of this study was to conduct an analysis of nutrition screening and assessment data to validate the Chinese version of the PG-SGA in Chinese patients with lung cancer. This was an observational, cross-sectional study of 2,000 consecutive adult patients with lung cancer treated at several tertiary hospitals in China. Anthropometric and patient descriptive data were collected. The PG-SGA generated a score for the nutritional risk and a global rating for the nutritional status. The internal consistency, external consistency, and construct validity were evaluated, and a known-groups comparison and principal component analyses were conducted to evaluate the reliability and validity of the PG-SGA. The known-groups comparison demonstrated the ability of the PG-SGA to differentiate lung cancer patients of different nutritional and body mass index (BMI) groups. A confirmatory factor analysis supported the original four-factor structure of the PG-SGA. In terms of the internal and external consistency, the PG-SGA demonstrated intra-class correlation coefficients (ICC) up to 0.987. Alternative form validity was also demonstrated between Box 4 of the PG-SGA and the Karnofsky Performance Status score, with excellent external consistency (r = 0.972, P < 0.001). The construct validity was supported, and selected questionnaire dimensions were evident in the principal component analysis. Significant Spearman correlations (P < 0.001) were demonstrated. The Chinese version of the PG-SGA demonstrated significant reliability and sufficient exploratory properties to support its validity. It seems to be a valid tool that can be used to access the nutritional status of Chinese lung cancer patients. The validity of the PG-SGA in Chinese cancer patients warrants further investigation in other cancer types.

Validity of the Chinese Version of the Patient-Generated Subjective Global Assessment (PG-SGA) in Gastric Cancer Patients

Purpose Malnutrition is severe among gastric cancer patients in China. While the Patient-Generated Subjective Global Assessment (PG-SGA) is a widely used nutritional assessment tool, the validation for Chinese patients with gastric cancer has not been performed yet. The aim of this research is to validate the Chinese version of the PGSGA in Chinese gastric cancer patients by conducting analyses of nutrition screening and assessment data. Methods Two thousand consecutive adult patients with gastric cancer were included in this observational, cross-sectional study in several tertiary hospitals in China. A survey was made among those patients, which included several questionnaires and some anthropometric parameters. We calculated the parameters to validate the use of PG-SGA categorizing the nutritional status of gastric cancer patients. Then we performed statistical analysis to evaluate the internal consistency, external consistency, and construct validity. Results This study verified the ability of the PG-SGA to differentiate gastric cancer patients into different nutritional groups. The confirmatory factor analysis verified the original four-factor structure of the PG-SGA. The internal and external consistency was measured by a concordance analysis which showed an intraclass correlation coefficients (ICC) of 0.987. The correlations of the Box 4 score with the Karnofsky performance status score demonstrated alternative form validity with good external consistency (Pearson, r = 0.643, P < 0.001). All three anthropometric dimensions of the PG-SGA were supported by principal component analysis. Spearman correlations (P < 0.001) were significant in the majority of tests. Conclusion The Chinese version of the PG-SGA is a valid tool to access the patients’ nutritional status for Chinese gastric patients.

Extension Protocol for the Investigation on Nutrition Status and Clinical Outcome of Patients with Common Cancers in China(INSCOC)Study:2021 update

Background Malnutrition is common in patients with cancer,and this adversely affects the survival and quality of life of patients.Chinese Society for Nutritional Oncology issued a multi-center,large-scale,long-term follow-up prospective study,the Investigation on Nutrition Status and Clinical Outcome of Patients with Common Cancers in China(INSCOC study)since 2013.This is an extension to the previous 2013-2020 study protocol.This study still sought to:①address the prognostic impact of nutritional factors and quality of life on cancer patient survival;②describe the overall and cancer-specific incidence and/or distribution of malnutrition and different measurements of patient quality of life.Methods and study design This is an observational,multi-centered,hospital-based prospective cohort study.Data collection will be performed at baseline(within 48 hours after patient admission),during the hospital stay and 30 days after hospital admission.Follow-up will be conducted for 1-20 years after enrollment.The primary outcome will be the all-cause mortality/overall survival,and secondary outcomes will be the length of hospital stay and costs of hospitalization.Study factors will include demographic characteristics,tumor characteristics,information about chronic diseases,hematological measurements(e.g.,red blood cell count,total lymphocyte counts,hemoglobin,albumin,prealbumin,creatinine,C-reactive protein,IL-6),anthropometric measurements(e.g.,height,weight,arm circumference,arm muscle circumference,triceps skinfold thickness,and waist circumference),body composition parameters,PG-SGA scores,quality of life(as indicated by the QLQ-C30 questionnaire),muscle mass(as indicated by the calf circumference),muscle strength(as indicated by the handgrip strength),muscle function(as indicated by the six-meter walking speed test)and physical status assessments(as indicated by the Karnofsky Performance Status scores).This clinical study protocol was approved by local Ethics Committees of all the participating hospitals.Written informed consent is required for each subject included.Discussion This multi-center,large-scale,long-term follow up prospective study will help improve the diagnosis of malnutrition in cancer patients and identify the risk factors associated with adverse clinical outcomes.The anticipated results of this study will highlight the need for a truly scientific appraisal of nutrition therapy in Chinese oncology populations,and finally help treat the potentially reversible elements of malnutrition in cancer patients to improve their clinical outcomes in the future.

Malnutrition Increases the Risk of Mortality in Hospitalized Lung Cancer Patients

Background The Global Leadership Initiative on Malnutrition(GLIM)recently developed a new set of diagnostic criteria for identifying patients with malnutrition.Because the GLIM criteria were only introduced a little over 3 years ago,additional validation and reliability testing are needed in a variety of populations.Methods We performed an observational,multicenter cohort study.From July 2013 to October 2018,lung cancer patients were recruited from the Daping Hospital of Army Medical University and the First Hospital of Jilin University as part of the INSCOC project.Previously-established cut-off values for the calf circumference(CC,male<30 cm,female<29.5 cm)were applied as the reduced muscal mass of phenotypic criteria to establish the GLIM diagnosis.Multivariate Cox regression analyses were performed to analyze the association between the GLIM criteria and survival.Results A total of 1219 patients with lung cancer were studied as subjects.Their age was 58.81±9.92 years old,and 820 were male and 399 were female.According to the GLIM diagnostic criteria using the CC as a muscle mass measurement,303 patients(24.9%)were categorized as malnourished,142 patients(23.1%)in the adult group(18≤age<60)and 161 patients(26.7%)in the older group(age≥60 years).The patients with malnutrition had a higher incidence of anemia than the nourished patients(P=0.012).The QLQ-C30 score and KPS score indicating that the malnourished patients had a consistently worse quality of life compared to the nourished group(all P<0.001).The median survival of the malnutrition group was 42(95%CI:34-50)months,which was much shorter than the 62(95%CI:57-66)months in the nourished group(P<0.001).In the adult group,the median survival decreased from 65(95%CI:55-72)months in nourished group to 34(95%CI:25-48)months in the patients with malnutrition(P<0.001).In the older group,it decreased from 61(95%CI:55-67)months to 48(95%CI:39-59)months(P=0.001).A Cox regression analysis showed that GLIM-diagnosed malnutrition was associated with an increased risk of death among adult group(HR=1.670,95%CI:1.29-2.16),older group(HR=1.332,95%CI:1.05-1.69)and overall(HR=1.453,95%CI:1.22-1.72).Conclusion All of these results demonstrate that GLIM-diagnosed malnutrition is associated with a poorer survival for all lung cancer patients,independent of age.

Validity of the Patient-Generated Subjective Global Assessment(PG SGA)in Colorectal Cancer Patients in China

Objective The patient-generated subjective global assessment(PG-SGA)is a nutritional assessment tool specially designed for cancer patients.This study tested the validity of the PG-SGA for the nutritional assessment of colorectal cancer(CRC)patients in China.Methods A total of 8,093 Chinese patients with any stage CRC were enrolled in this cross-sectional,observational study.Within the first 48 hours of admission,patients were evaluated using the PG-SGA,nutritional risk screening 2002(NRS 2002),Karnofsky Performance Status(KPS),and some anthropometric parameters,including the triceps skinfold thickness(TSF),mid-arm circumference(MAC),mid-arm muscle circumference(MAMC),hand grip strength(HGS),maximum left calf circumference(MLCC),and maximum right calf circumference(MRCC),among others.Spearman’s correlation test was performed to analyze item-total score correlations and correlations between the total PG-SGA score and other parameters or performance scores,further testing convergent validity.The discriminative ability of the PG-SGA was measured by comparing different characteristics between several nutritional groups.A principal component analysis was performed with selected parameters to evaluate the construct validity.Results The average total PG-SGA score of all patients was 5.69±4.46,and they had a median age of 59 years(interquartile range(IQR),51-67 years)and an average body mass index(BMI)of 22.57±3.29 kg/m^(2).The item-total correlations of the total PG-SGA score between the global PG-SGA rating(Spearman,r=0.94)and PG-SGA score(patient-generated)(Spearman,r=0.97)were strong.Significant correlations were also found between the total PG-SGA score and other nutritional screening tools,including the BMI(Spearman,r=-0.26),KPS(Spearman,r=-0.36),and NRS 2002(Spearman,r=-0.47).Well-nourished(41.2%),mildly or moderately malnourished(35.3%)and severely malnourished(23.5%)groups defined according to the PG-SGA had significantly different characteristics.Patients with a worse nutritional status tended to have a decreased BMI(well-nourished,23.32 kg/m^(2)vs.mildly or moderately malnourished,22.52 kg/m^(2)vs.severely malnourished,21.35 kg/m^(2);P<0.001),hemoglobin,body fat mass,muscle mass,protein mass,TSF,MAC,HGS,MAMC,and MLCC,and a dramatically increased C-reactive protein level.The Kaiser-Meyer-Olkin measure was>0.7,and the P value of Bartlett’s test of sphericity was<0.001.One component was extracted by the principal component analysis,and the analysis showed that the total PG-SGA score explained the total variances of 97.3%.Conclusion The PG-SGA is a valid tool for evaluating the nutritional status for Chinese CRC patients.

The Contradictory Effects of Equol on Breast Cancer

Natural products and their derivatives provide an attractive source for novel preventive and therapeutic agents.Epidemiological studies have indicated that the low incidence of breast cancer in Asian women may be related to a high consumption of soy foods.Equol,a metabolite of the soybean isoflavone daidzein,has been suggested to have preventive and therapeutic activity for breast cancer.However,conflicting data have been reported.There are two optical isomers of equol,S-equol and R-equol,with S-equol appearing to be the clinically-relevant compound.While equol is considered to be a selective estrogen receptor modulator,the molecular mechanisms underlying the biological activities of equol have not been fully elucidated.In addition,only part of the population can metabolize daidzein into equol due to differences in gut flora.This article will help provide a better understanding of the molecular mechanisms underlying the anti-(or potentially pro-)cancer and invasion activities of this unique secondary metabolite of a natural product,and will provide a basis for the development of equol and/or its analogs as novel cancer preventive or therapeutic agents.

Bioelectrical Impedance Phase Angle as a Predictors of Mortality in Patients with Lung Cancer:a Prospective Study

Objective Bioelectrical impedance analysis(BIA)is used to measure a patient's body composition.The phase angle(PA),the major parameter in BIA,is one of the most sensitive indicators of malnutrition.The aim of the current study was to investigate whether the PA can be used to predict survival in lung cancer patients.Methods One hundred sixty-six lung cancer patients were prospectively included from January 2014 to August 2016 in Daping Hospital.Anthropometric measurements,hematological values,the nutritional risk screening(NRS 2002)score,patient generated-subjective global assessment(PG-SGA)score,Karnofsky performance status(KPS)scale,European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire(EORTC QLQ C-30)score,and BIA were investigated within 48 hours after admission to the hospital.A Spearman correlation analysis was applied to test the correlations between the study characteristics and PA.A Kaplan-Meier analysis and log-rank test were conducted to analyze the association between the overall survival(OS)and PA.Results The mean age for all patients was 63 years old(42 females and 124 males).The median PA was 5.5°(4.70°,6.23°).The PA was positively associated with the body mass index,hand grip strength,mid-arm circumference,mid-arm muscle circumference,albumin,prealbumin,C-reactive protein,red blood cells,hemoglobin and KPS score.The PG-SGA scores,QLQ-C30 score,and NRS2002 score showed a significant negative association with the PA.According to a multivariate analysis,the PA(HR=0.47;95%CI:0.27-0.81)was independent predictor of the lung cancer patients'long-term OS.Patients with a higher PA(≥5°)had better overall survival(median=426 days)compared to those with a lower PA(<5°)(median=96 days)based on the one-year follow-up data(P<0.0001).Conclusions These studies indicate that the PA is a sensitive and early indicator to predict survival in lung cancer patients.

Research Progress in Clinical Diagnostics and Interventions for Frailty

A cluster of symptoms,including falls,disability,cognitive impairment,decreased autonomic activity,unintentional weight loss and fatigue,are common in older people.This“core symptom complex”defines frailty.Frailty is often related to malnutrition,but is distinguished with the presence of sarcopenia.Frailty embodies a decline in a patient’s overall function,which is not entirely explained by a loss of skeletal muscle mass or decreases in muscle function.Frailty occurs when the individual’s physiological reserve decreases in conjunction with internal dynamic balance disorders and physiological debility.Frailty is associated with adverse clinical outcomes including an increased risk of complications of other conditions and surgery,unintentional injury(falls and fractures),disability,a poor quality of life,and even death.Frailty is common not only in the elderly,but also in patients with cancer,cardiovascular diseases,respiratory diseases,and malnutrition.The prevalence of frailty has been reported to be between 4.0%-59.1%in different reports,and increases with age.Frailty can be diagnosed by the presence of the core symptom complex(frailty phenotype)or based on the frailty index.Early assessment and treatment can significantly improve the health prognosis of patients.Treatments aimed at maintaining an individual's homeostasis can be more beneficial for preventing or resolving frailty than specifically treating any underlying disease(s).Improving the patient’s nutritional status,implementing physical exercise,and developing individualized multidisciplinary interventions may be the best ways to prevent adverse clinical outcomes in patients with frailty.This article reviews the definitions,diagnosis,epidemiology.

Associations of the Fat-age-infl ammation Index with Overall Survival in Patients with Metastatic Lung Cancer

Background Metastatic lung cancer(LC)is a threat to human health.We previously proposed a fat age-inflammation(FAIN)index which showed prognostic value in patients with certain cancers.However,whether a similar association exists in patients with metastatic LC remains unknown.Methods We performed a cohort study including 1360 patients with metastatic LC from January 2013 to April 2019.The FAIN index was defined as:(triceps skinfold thickness+albumin)/[age+5×(neutrophil count/lymphocyte count)]×100%.Sex-specific cutoffs of the FAIN were determined using an optimal stratification approach.The associations of the FAIN index with the nutrition related factors,short-term outcomes and overall survival(OS)of patients were comprehensively assessed.Results The study enrolled 865 males and 495 females with a median age of 59.9 years.The continuous FAIN was significantly associated with the OS in both genders(both P<0.05).The optimal stratification-defined FAIN cutoffs were 82 for women and 60 for men.A total of 623 patients(45.8%)were categorized as having a low FAIN.A low FAIN was associated with poorer nutrition-related factors and impaired short-term outcomes including the thirty-day mortality,length of hospital stay,intensive care unit stay and cost(all P<0.05).Multivariate Cox regression analysis revealed that a lower FAIN was also associated with an increased death hazard(HR=1.428,95%CI=1.209-1.686).Conclusion This study assessed the FAIN index,which might act as a feasible tool to monitor nutrition-related factors and help develop management strategies to optimize the clinical outcomes of patients with metastatic LC.

Protein Supplementation for the Prevention and Management of Sarcopenia in the Elderly

Sarcopenia is common in patients with many physiological or pathological conditions, especially in aging people. Nutrition plays an important role in the prevention and treatment of sarcopenia. Sarcopenia is often related to insufficient protein intake in the elderly. Muscle protein synthesis occurs mainly through mTORC1 pathway, and degradation occurs by ubiquitination-mediated pathways. This review summarizes the growing body of evidence, including substantial clinical trials, which increasing the protein intake can serve as the basis for preventing and managing muscle loss in patients with sarcopenia. Supplementation of essential amino acids (EAA), branched chain amino acids (BCAA), and especially leucine-rich whey protein may promote muscle protein synthesis by activating the mTORC1 signaling pathway, and may inhibit protein degradation by decreasing ubiquitin-mediated degradation. Taking in sufficient energy and protein and engaging in active exercise are the main methods of stimulating muscle protein synthesis and preventing or managing sarcopenia. Therefore, it is necessary to strengthen research on the use of protein supplements for not only elderly patients, but also those with tumor cachexia and other diseases related to sarcopenia.

Immunonutrition Intervention for Treatment of Postoperative Malnutrition in Testicular Cancer Patients:A Case Report

A young patient with testicular cancer appeared severe malnutrition and poor surgical incision healing,following an orchiectomy and post-abdominal lymphadenectomy.After treated with immunonutrition designed by the nutritional specialist of our department,the patient’s malnutrition was reversed,and the wound was healed.

Nutritional Risk Screening with NRS2002 among Hospitalized Cancer Patients in China

Objective The Nutritional Risk Screening 2002(NRS 2002)was used to assess the nutritional risk of hospitalized oncology patients in China.This study explored the factors affecting the risk of nutrition to provide a scientific basis for the assessment and treatment of malnutrition in oncology patients.Methods We used the NRS 2002 to evaluate the nutritional risk in 48,831 hospitalized cancer patients.Descriptive statistical methods were used to describe the general patient information.A Chi-squared test was applied to analyze the relationship between NRS 2002 scores and different demographic characteristics,and the NRS 2002 scores of cancer patients with different characteristics were compared by one-way ANOVA.Results Among 48,831 patients,43.3%were women and 57.7%were men,and 36.5%(17,802)of patients were at risk of nutrition(score≥3).The NRS 2002 score was the highest in leukemia patients(2.93±1.28).A one-way ANOVA revealed that the differences in NRS 2002 scores among patients of different gender,ages,TNM stages,education levels,occupations and areas of residence were statistically significant(P<0.001).Male patients had slightly higher NRS 2002 scores than females(2.33 vs.2.17).The lowest NRS 2002 scores were in patients aged 45-59(2.00±1.26)years and the highest scores were in patients aged≥70(2.76±1.43)years.The NRS 2002 score of patients receiving surgery was the highest(2.45±1.41),and patients receiving surgery plus radiotherapy/chemotherapy was the lowest(2.00±1.26).The risk of nutrition was highest in patients who were farmers(2.34±1.37 scores)and lowest in office staff(2.15±1.32 scores).Patients living in rural areas had the highest risk of nutrition(2.32±1.37 scores).There were significant differences in the NRS 2002 scores for different cancer sub-types for different ethnic groups(P<0.05),except for Zhuang individuals(P=0.124).The risk of nutrition was highest in Uyghur patients(3.35±1.33 scores)and lowest in Mongolians(2.04±1.37 scores).Conclusion More attention should be paid to people at high risk of nutrition,such as elderly patients,patients with a high TNM stage,patients receiving surgical treatment,and patients living in rural areas.Active nutritional interventions should be carried out to improve the nutritional status of malnourished patients.

Cocoa Flavanols Intake and Cognitive Functions: a Systematic Review and Meta-analysis of Randomised Controlled Trials

Objective The influence of cocoa flavanols(CFs)on cognitive functions in human has been investigated in some clinical trials,but the results are inconclusive.We conduct this systematic review and meta-analysis of randomized controlled trials(RCTs)to figure out whether CFs intervention have a positive effect on cognitive functions.Methods A comprehensive literature search of articles published until June 2019 was performed in PubMed,Cochrane Library,Medline,and Web of Science.Weighted mean difference(WMD)and 95%confidence interval(95%CI)were calculated to reflect the size of the combined effect.Random effect models were used for all analyses.Results A total of 9 RCT studies were finally enrolled in this meta-analysis.CFs has no notable effect on Trail Making Test-A(TMT-A)(WMD:-5.75s,95%CI:-16.71-5.21),which reflects the shifting subdomain of executive function and global executive function.CFs has no significant effect on Trail Making Test-B(TMT-B)(WMD:-11.32s,95%CI:-26.14-3.50),which reflects another specific aspect of the shifting subdomain.Gross cognitive changed as measured by mini mental state examination(MMSE)which consists of a series of items covering cognitive functions except for the executive function domain,but significantly associated with composite z score of several subdomains tests of executive function(WSD:0.40s,95%CI:0.29-0.46).Conclusion This study suggests CFs may have a positive effect on cognitive function,especially executive function.However,large scale and high quality RCTs are needed to further confirm/refute this conclusion.

Nutritional Assessment of Gynecological Cancer Patients in China

Background Malnutrition is common among cancer patients,but few studies have evaluated the nutritional status among gynecological cancer patients in China.This study aimed to assess the nutritional status of women with gynecological cancer using the patient-generated subjective global assessment(PG-SGA).Methods Data for gynecological cancer patients treated at 44 tertiary hospitals were retrieved from a multicenter study on tumor nutrition.The R Software was used for statistical analyses.Univariate analyses of PG-SGA scores were performed using the Chi-squared test for categorical variables and the Wilcoxon-rank sum test or Kruskal-Wallis test for continuous variables,as appropriate.The significance level was 0.05.Results Data for 1962 women with three types of gynecological cancer(cervical,uterine and ovarian cancer)were used for the data analysis.The median PG-SGA score was 4(interquartile range,IQR:1,8),the median participants’age was 51(IQR:46,59)years old,and the patients had a median BMI of 22.9(IQR:20.7,25.4).The percentages of women who had a medical co-morbidity,or had undergone any radical resection,chemotherapy,or radiotherapy were approximately 27.7%,55.4%,52.5%,and 30.2%,respectively.The levels of serum albumin and high density lipoprotein cholesterol(HDL-C)were 40.1g/L(IQR:36.8,43.1)and 1.2mmol/L(IQR:1.0,1.5),respectively.The identified risk factors for malnutrition based on the PG-SGA score were age(0.05±0.01,p=0.002),BMI(-0.34±0.04,p<0.001),having a medical co-morbidity(0.95±0.33,p=0.004),receiving radiotherapy(1.52±0.31,p<0.001),the serum albumin level(-0.18±0.03,p<0.001),and the HDL-C(-1.12±0.35,p=0.001)as indicated by a linear regression analysis.Conclusions A higher PG-SGA score is positively associated with the age of the patient,having a medical co-morbidity,and receiving radiotherapy,and is negatively related to the patients’BMI and serum albumin and HDL-C levels.

Comparison of the Clinical Outcomes of Early Enteral Nutrition Versus Convenience Diet by Tube Feeding Following Laryngectomy in Chinese Patients

The purpose of the present study was to evaluate the efficiency of early enteral nutritional support in patients undergoing laryngectomy. We retrospectively reviewed and analyzed 329 laryngeal cancer patients who underwent total or partial laryngectomy from November 2003 to July 2013 in our hospital. Of those patients, 278 were given enteral nutrition (EN group) with elemental formulations through a nasogastric tube beginning within 24 hours after the surgery, while 51 chose not to receive the elemental formulations and were on a homogenate diet (convenience diet group, CD group), which was also given through a nasogastric tube. The clinical outcomes were compared between the two groups. Thirteen patients in the EN group (13/278, 4.68%) and six patients in the CD group (6/51, 11.76%) developed fistulas. The difference was statistically significant (P < 0.046). The differences in the post-surgical infection rate, average length of hospitalization and other clinical indicators between the two groups were not statistically significant. In conclusion, early enteral nutrition should be recommended in patients undergoing laryngectomy, and convenience diet is not as effective as the commercial formulation in reducing the risk of fistula formation.

High Risk of Malnutrition in Uyghur Patients with Cancer in China

Background Patients with advanced cancer often present with malnutrition.Globally,minority populations frequently suffer from higher rates of malnutrition than the majority group.It was unknown whether the nutritional status of cancer patients is different between ethicality groups(i.e.Uyghur and Han)in China.Methods A total of 251 Uyghur cancer patients were enrolled from the Xinjiang Kashgar First People's Hospital in the INSCOC Program.The Han patients were 1∶1 matched to Uyghur patients by age,gender and type of cancer from 72 hospitals around China in INSCOC Program.The nutritional risk and nutritional status were assessed using the Nutrition Risk Screening 2002(NRS 2002)and Patient-Generated Subjective Global Assessment(PG-SGA),respectively.Then,the functional status of cancer patients was determined based on the Karnofsky Performance Status(KPS).Results The incidence of an abnormal NRS-2002(≥3),PG-SGA(≥4),and KPS(≤70)was significantly different(86.1%vs 59.0%,70.5%vs 27.5%,and 18.7%vs 4.0%,respectively P<0.05).The abnormal rate of laboratory indicators in Uyghur cancer patients was significantly higher than that in Han cancer patients,including total protein,albumin,serum total bilirubin,direct bilirubin,HDL-C,white blood cell,lymphocyte,red blood cell,and platelet(all P<0.05).The abnormal rates of TSF,HGS and CC were significantly higher than that of Han nationality patients(17.5%vs 9.7%,39.6%vs 19.6%,29.1%vs 15.2%,P<0.001).The nutritional support rate of Uyghur patients was lower than that of Han patients(0%vs 16.3%).After adjusting for potential risk factors,malnutrition was associated with gender(female,OR=0.35,95%CI=0.13-0.92,P=0.034),age(>60 years,OR=5.32,95%CI=1.46-19.41,P=0.011),cancer type(gastroesophageal tumor,OR=33.62,95%CI=3.42-330.67,P=0.003),and treatment methods(received radical tumor resection,OR=5.78,95%CI=1.45-23.08,P=0.008;received radiotherapy or chemotherapy:OR=7.69,95%CI=2.27-26.04,P<0.001).Conclusions The nutritional status of Uyghur cancer patients is worse than that of Han patients and the Uyghur patients with poor nutritional status lack the necessary nutritional support.

Exercise for Cancer Therapy

The number of new cancer cases in China is increasing rapidly,and China now ranks first in the world for the number of cancer patients.Traditional oncology treatment is based on surgery,radiotherapy and chemotherapy,but all three treatments are often accompanied by a poor quality of life,impaired physical function,and significant anxiety and depression.Exercise therapy can provide both prognostic improvement and a better quality of life for cancer patients,and can be adapted to serve patients at all stages from perioperative recovery to hospice.Although the impact of exercise alone is difficult to assess given the influence of lifestyle and other factors,data suggest that consistent exercise can improve the prognosis of cancer patients.Exercise enhances cardiopulmonary function,induces protein synthesis,improves physiological performance and increases physiological reserves;it also helps to improve the metabolic and immune functions,creating an anti-cancer environment in the body.An appropriate exercise plan can reduce adverse effects associated with cancer treatment,improve patients'physiological function,reduce fatigue and improve quality of life.Of note,exercise may also reduce the risk of cancer recurrence and metastasis.In recent years,exercise oncology has received increasing attention,thus,this article reviews the progress made in the clinical application of exercise therapy in oncology patients.

Factors Affecting the Quality of Life in Esophageal Cancer Patients

Objective The aim of the study was to assess the quality of life(QoL)of patients with esophageal cancer,and to explore the main socioeconomic factors that affect the QoL.Method A multicenter cross-sectional study design was used.Data were collected using scales including the interviewer-administered general situation questionnaire designed by the authors,the Quality of Life Questionnaire-core 30 Version 3 in Chinese(QLQ-C30),and the Patientgenerated Subjective Global Assessment(PG-SGA)from a nationwide survey conducted previously in China.The role of each covariate in the full model was assessed using the QoL as the primary outcome in a multilevel ordinal logistic regression analysis.Results In total,1223 patients were included,among whom 1009(82.5%)were males,and 504(41.2%)were older than 65 years old.The findings indicate that patients with esophageal cancer in China face a poor quality of life with a mean global quality of life scored of 58.33(66.67).The most significant factors influencing quality of life were the nutritional support,PG-SGA scores and level of education.Compared with patients who had a PG-SGA score≥9,patients with scores between 0-1 had significantly better scores in five scales:the PF(physical functioning),RF(role functioning),CF(cognitive functioning),EF(emotional functioning)and SF(social functioning)(OR:4.75,4.84,2.12,2.81,and 3.00).Conclusion Nutritional support and PG-SGA scores significantly influenced the quality of life of patients with esophageal cancer.It appears that most patients with esophageal cancer are in urgent need of symptom alleviation and/or concurrent intervention.

More Cycles of Intravenous Chemotherapy are Associated with Reduced Growth in Children with Retinoblastoma

Background Chemotherapy can have a negative impact on the growth of children with different cancers.However,few studies have examined whether intravenous chemotherapy(IVC)affects the growth of children with retinoblastoma(RB).The present study evaluated the height differences(actual height compared to the age standardized value)and survival of pediatric RB patients treated with IVC.Methods This was an observational cohort study.A total of 87 pediatric RB patients were included.The study population was stratified into two groups based on the number of chemotherapy cycles administered(≤4 versus>4).The height at baseline(before IVC),height after IVC and overall survival were compared between the two groups.Results Before IVC,no height differences were observed between the two groups(P=0.585).After IVC,all of the patients had a reduced height compared to the age standardized height(P=0.035).Patients who underwent more cycles of chemotherapy had a greater height difference compared to those who received fewer cycles(P=0.008).For those who had reduced height,the difference was positively associated with the number of chemotherapy cycles(r=0.279,P=0.043).Among the patients who exhibited a greater height difference,those who underwent more than four cycles of chemotherapy had a decreased overall survival(P=0.042).Conclusions Pediatric RB patients who underwent more cycles of chemotherapy were more likely to have a reduced height.Further studies are needed to determine the optimal treatment strategy to prevent the reduced growth while maintaining the benefits of chemotherapy.