ONC: Nutrition Status and Outcomes in Adult Oncology Patients (2013)
The Oncology Work Group reviewed the relationship between nutrition status and the following morbidity outcomes in adult oncology patients:
- Hospital Admissions or Re-admissions
- Hospital Length of Stay
- Quality of Life
- Radiation Treatment Tolerance
- Chemotherapy Treatment Tolerance
The National Cancer Institute (NCI) at the National Institutes of Health defines morbidity as "a disease or the incidence of disease within a population. Morbidity also refers to adverse effects caused by a treatment." In the case of cancer, examples of morbidity include, but are not limited to side effects of chemotherapy, radiation therapy treatment or surgery, infection, and hospitalization. Morbidity is classified and reported using tools such as the NCI Common Toxicity Criteria (Jaques, 2004).
The studies included in this morbidity topic may have included other outcomes that were not reviewed in our analysis.
In addition, the relationship between nutrition status and mortality, as it relates to the cancer diagnosis was also reviewed.
For an overview of the studies included in this analysis and relationship between nutrition status and outcomes, click here.
For the Oncology Work Group's suggestions for future research on this topic, see ONC: Future Research Suggestions on the left.
Reference: Jaques D. Measuring morbidity. Ann Surg. 2004 August; 240(2): 214–215.
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Basic Research
What is the relationship between nutrition status and hospital admissions or re-admissions in adult oncology patients?
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Conclusion
Poor nutrition status is associated with higher rates of hospital admissions or re-admissions in adult oncology patients. Five studies found that a decreased nutrition status is associated with greater numbers of hospital admissions. A sixth study showed the same effect, but was not statistically significant.
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Grade: II
- Grade I means there is Good/Strong evidence supporting the statement;
- Grade II is Fair;
- Grade III is Limited/Weak;
- Grade IV is Expert Opinion Only;
- Grade V is Not Assignable.
- High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
- Moderate (B) means we are moderately confident in the effect estimate;
- Low (C) means our confidence in the effect estimate is limited;
- Very Low (D) means we have very little confidence in the effect estimate.
- Ungraded means a grade is not assignable.
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Evidence Summary: What is the relationship between nutrition status and hospital admissions or re-admissions in adult oncology patients?
- Detail
- Quality Rating Summary
For a summary of the Quality Rating results, click here.
- Worksheets
- Barlow R, Price P, Reid TD, Hunt S, Clark GW, Havard TJ, Puntis MC, Lewis WG. Prospective multicentre randomised controlled trial of early enteral nutrition for patients undergoing major upper gastrointestinal surgical resection. Clin Nutr. 2011 Oct; 30(5): 560-566.
- Capuano G, Grosso A, Gentile PC, Battista M, Bianciardi F, Di Palma A, Pavese I, Satta F, Tosti M, Palladino A, Coiro G, Di Palma M. Influence of weight loss on outcomes in patients with head and neck cancer undergoing concomitant chemoradiotherapy. Head Neck. 2008 Apr; 30(4): 503-508.
- Hill A, Kiss N, Hodgson B, Crowe TC, Walsh AD. Associations between nutritional status, weight loss, radiotherapy treatment toxicity and treatment outcomes in gastrointestinal cancer patients. Clin Nutr. 2011; 30: 92-98.
- Kathiresan AS, Brookfield KF, Schuman SI, Lucci JA 3rd. Malnutrition as a predictor of poor postoperative outcomes in gynecologic cancer patients. Arch Gynecol Obstet. 2011 Aug; 284(2): 445-451.
- Piquet MA, Ozsahin M, Larpin I, Zouhair A, Coti P, Monney M, Monnier P, Mirimanoff RO, Roulet M. Early nutritional intervention in oropharyngeal cancer patients undergoing radiotherapy. Support Care Cancer. 2002 Sep; 10(6): 502-504. Epub 2002 Aug 2.
- Detail
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Search Plan and Results: ONC: Malnutrition Screening, Nutrition Assessment Tools and Outcomes for Oncology Patients 2011
What is the relationship between nutrition status and hospital length of stay (LOS) in oncology patients?-
Conclusion
Poor nutrition status is associated with increased hospital length of stay (LOS) in adult oncology patients. Ten studies found that a decreased nutrition status is associated with longer LOS, while one study found no statistical difference between groups.
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Grade: I
- Grade I means there is Good/Strong evidence supporting the statement;
- Grade II is Fair;
- Grade III is Limited/Weak;
- Grade IV is Expert Opinion Only;
- Grade V is Not Assignable.
- High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
- Moderate (B) means we are moderately confident in the effect estimate;
- Low (C) means our confidence in the effect estimate is limited;
- Very Low (D) means we have very little confidence in the effect estimate.
- Ungraded means a grade is not assignable.
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Evidence Summary: What is the relationship between nutrition status and hospital length of stay (LOS) in oncology patients?
- Detail
- Quality Rating Summary
For a summary of the Quality Rating results, click here.
- Worksheets
- Amaral TF, Antunes A, Cabral S, Alves P, Kent-Smith L. An evaluation of three nutritional screening tools in a Portuguese oncology centre. J Hum Nutr Diet. 2008; 21: 575-583.
- Antoun S, Rey A, Béal J, Montange F, Pressoir M, Vasson MP, Dupoiron D, Gourdiat-Borye A, Guillaume A, Maget B, Nitenberg G, Raynard B, Bachmann P. Nutritional risk factors in planned oncologic surgery: What clinical and biological parameters should be routinely used? World J Surg. 2009 Aug; 33(8): 1,633-1,640.
- Barlow R, Price P, Reid TD, Hunt S, Clark GW, Havard TJ, Puntis MC, Lewis WG. Prospective multicentre randomised controlled trial of early enteral nutrition for patients undergoing major upper gastrointestinal surgical resection. Clin Nutr. 2011 Oct; 30(5): 560-566.
- Braga M, Gianotti L, Vignali A, Cestari A, Bisagni P, Di Carlo V. Artificial nutrition after major abdominal surgery: Impact of route of administration and composition of the diet. Crit Care Med.1998; 26(1): 24-30.
- Horsley P, Bauer J, Gallagher B. Poor nutritional status prior to peripheral blood stem cell transplantation is associated with increased length of hospital stay. Bone Marrow Transplantation. 2005; 35: 1,113-1,116.
- Hyltander A, Bosaeus I, Svedlund J, Liedman B, Hugosson I, Wallengren O, Olsson U, Johnsson E, Kostic S, Henningsson A, Körner U, Lundell L, Lundholm K. Supportive nutrition on recovery of metabolism, nutritional state, health-related quality of life, and exercise capacity after major surgery: A randomized study. Clin Gastroenterol Hepatol. 2005 May; 3(5): 466-474.
- Ionescu D, Iancu C, Ion D, Al-Hajjar N, Margarit S, Mocan L, Mocan T, Deac D, Bodea R, Vasian H. Implementing fast-track protocol for colorectal surgery: A prospective randomized clinical trial. World J Surg. 2009 Nov; 33(11): 2,433-2,438.
- Laky B, Janda M, Kondalsamy-Chennakesavan S, Cleghorn G, Obermair, A. Pretreatment malnutrition and quality of life-association with prolonged length of hospital stay among patients with gynecological cancer: A cohort study. BMC Cancer. 2010; 10: 232.
- Pressoir M, Desne S, Berchery D, Rossignol G, Poiree B, Meslier M, Traversier S, Vittot M, Simon M, Gekiere JP, Meuric J, Serot F, Falewee MN, Rodriquez I, Senesse P, Vasson MP, Chelle F, Maget B, Antoun S, Bachmann P. Prevalence, risk factors and clinical implications of malnutrition in French comprehensive cancer centers. British Journal of Cancer. 2010: 102, 966-971.
- Sorensen J, Kondrup J, Prokopowicz J, Schiesser M, Krähenbühl L, Meier R, Liberda M; EuroOOPS study group. EuroOOPS: An international, multicentre study to implement nutritional risk screening and evaluate clinical outcome. Clin Nutr. 2008 Jun; 27(3): 340-349.
- Detail
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Search Plan and Results: ONC: Malnutrition Screening, Nutrition Assessment Tools and Outcomes for Oncology Patients 2011
What is the relationship between nutrition status and quality of life (QOL) in oncology patients?-
Conclusion
Poor nutrition status is associated with lower quality of life (QoL) in adult oncology patients. Thirteen studies found that a decreased nutrition status is associated with a lower QoL. Only one study found minimal correlation between nutrition status and QoL. All eight of the studies utilizing the Patient-Generated Subjective Global Assessment (PG-SGA) found that a higher score (higher nutrition risk) was associated with a lower QoL in oncology patients.
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Grade: I
- Grade I means there is Good/Strong evidence supporting the statement;
- Grade II is Fair;
- Grade III is Limited/Weak;
- Grade IV is Expert Opinion Only;
- Grade V is Not Assignable.
- High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
- Moderate (B) means we are moderately confident in the effect estimate;
- Low (C) means our confidence in the effect estimate is limited;
- Very Low (D) means we have very little confidence in the effect estimate.
- Ungraded means a grade is not assignable.
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Evidence Summary: What is the relationship between nutrition status and quality of life (QoL) in oncology patients?
- Detail
- Quality Rating Summary
For a summary of the Quality Rating results, click here.
- Worksheets
- Bauer JD, Capra S. Nutrition intervention improves outcomes in patients with cancer cachexia receiving chemotherapy-a pilot study. Support Care Cancer. 2005; 13: 270-274.
- Carey S, Storey D, Biankin AV, Martin D, Young J, Allman-Farinelli M.Long-term nutritional status and quality of life following major upper gastrointestinal surgery: A cross-sectional study. Clin Nutr. 2011 Dec; 30(6): 774-779.
- Correia M, Cravo M, Marques-Vidal P, Grimble R, Dias-Pereira A, Faias S, Nobre-Leitão C. Serum concentrations of TNF-alpha as a surrogate marker for malnutrition and worse quality of life in patients with gastric cancer. Clin Nutr. 2007 Dec; 26(6): 728-735.
- Fearon KC, Voss AC, Hustead DS. Definition of cancer cachexia: Effect of weight loss, reduced food intake and systemic inflammation on functional status and prognosis. American Society of Nutrition. 2006; 83: 1,345-1,350.
- Hammerlid E, Wirblad B, Sandin C, Mercke C, Edstrom S, Kaasa S, Sullivan M, Westin T. Malnutrition and food intake in relation to quality of life in head and neck cancer patients. Head & Neck. 1988; 20: 540-548.
- Hyltander A, Bosaeus I, Svedlund J, Liedman B, Hugosson I, Wallengren O, Olsson U, Johnsson E, Kostic S, Henningsson A, Körner U, Lundell L, Lundholm K. Supportive nutrition on recovery of metabolism, nutritional state, health-related quality of life, and exercise capacity after major surgery: A randomized study. Clin Gastroenterol Hepatol. 2005 May; 3(5): 466-474.
- Isenring E, Bauer J, Capra, S. The scored patient-generated subjective global assessment (PG-SGA) and its association with quality of life in ambulatory patients receiving radiotherapy. European Journal of Clinical Nutrition. 2003; 57, 305-309.
- Iversen PO, Wisløff F, Gulbrandsen N. Reduced nutritional status among multiple myeloma patients during treatment with high-dose chemotherapy and autologous stem cell support. Clin Nutr. 2010 Aug; 29(4): 488-491.
- Nourissat A, Vasson MP, Merrouche Y, Bouteloup C, Goutte M, Mille D, Jacquin JP, Collard O, Michaud P, Chauvin F. Relationship between nutritional status and quality of life in patients with cancer. Eur J Cancer. 2008 Jun; 44(9): 1,238-1,242.
- Ravasco P, Monteiro-Grillo I, Vidal PM, Camilo ME. Impact of nutrition on outcome: A prospective randomized controlled trial in patients with head and neck cancer undergoing radiotherapy. Head and Neck. 2005 Aug; 659-668.
- Shahmoradi N, Kandiah M, Peng LS. Impact of nutritional status on the quality of life of advanced cancer patients in hospice home care. Asian Pac J Cancer Prev. 2009; 10(6): 1,003-1,009.
- Detail
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Search Plan and Results: ONC: Malnutrition Screening, Nutrition Assessment Tools and Outcomes for Oncology Patients 2011
What is the relationship between nutrition status and radiation treatment tolerance in oncology patients?-
Conclusion
Poor nutrition status is associated with decreased tolerance to radiation treatment in adult oncology patients undergoing radiotherapy. All six studies found positive associations between nutrition status and two or more of the following: Reduced treatment interruptions, unplanned hospital admissions, treatment toxicity, Patient-Generated Subjective Global Assessment (PG-SGA) score over time and quality of life.
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Grade: I
- Grade I means there is Good/Strong evidence supporting the statement;
- Grade II is Fair;
- Grade III is Limited/Weak;
- Grade IV is Expert Opinion Only;
- Grade V is Not Assignable.
- High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
- Moderate (B) means we are moderately confident in the effect estimate;
- Low (C) means our confidence in the effect estimate is limited;
- Very Low (D) means we have very little confidence in the effect estimate.
- Ungraded means a grade is not assignable.
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Evidence Summary: What is the relationship between nutrition status and radiation treatment tolerance in oncology patients?
- Detail
- Quality Rating Summary
For a summary of the Quality Rating results, click here.
- Worksheets
- Capuano G, Grosso A, Gentile PC, Battista M, Bianciardi F, Di Palma A, Pavese I, Satta F, Tosti M, Palladino A, Coiro G, Di Palma M. Influence of weight loss on outcomes in patients with head and neck cancer undergoing concomitant chemoradiotherapy. Head Neck. 2008 Apr; 30(4): 503-508.
- Hill A, Kiss N, Hodgson B, Crowe TC, Walsh AD. Associations between nutritional status, weight loss, radiotherapy treatment toxicity and treatment outcomes in gastrointestinal cancer patients. Clin Nutr. 2011; 30: 92-98.
- Ravasco P, Monteiro-Grillo I, Vidal PM, Camilo ME. Impact of nutrition on outcome: A prospective randomized controlled trial in patients with head and neck cancer undergoing radiotherapy. Head and Neck. 2005 Aug; 659-668.
- Detail
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Search Plan and Results: ONC: Malnutrition Screening, Nutrition Assessment Tools and Outcomes for Oncology Patients 2011
What is the relationship between nutrition status and chemotherapy treatment tolerance in oncology patients?-
Conclusion
Poor nutrition status is associated with decreased tolerance to chemotherapy treatment in adult oncology patients undergoing chemotherapy. Ten studies found positive associations in one or more of the following: Treatment interruptions, infections, unplanned hospital admissions, treatment toxicity (including dose-limiting treatment toxicity) neutropenic fever, fatigue and severe thrombocytopenia. One study showed a similar trend toward fewer dose reductions, but the difference was not significant.
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Grade: I
- Grade I means there is Good/Strong evidence supporting the statement;
- Grade II is Fair;
- Grade III is Limited/Weak;
- Grade IV is Expert Opinion Only;
- Grade V is Not Assignable.
- High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
- Moderate (B) means we are moderately confident in the effect estimate;
- Low (C) means our confidence in the effect estimate is limited;
- Very Low (D) means we have very little confidence in the effect estimate.
- Ungraded means a grade is not assignable.
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Evidence Summary: What is the relationship between nutrition status and chemotherapy treatment tolerance in oncology patients?
- Detail
- Quality Rating Summary
For a summary of the Quality Rating results, click here.
- Worksheets
- Alexandre J, Gross-Goupil M, Falissard B, Nguyen ML, Gornet JM, Misset JL, Goldwasser F. Evaluation of the nutritional and inflammatory status in cancer patients for the risk assessment of severe haematological toxicity following chemotherapy. Ann Oncol. 2003; 14: 36-41.
- Capuano G, Grosso A, Gentile PC, Battista M, Bianciardi F, Di Palma A, Pavese I, Satta F, Tosti M, Palladino A, Coiro G, Di Palma M. Influence of weight loss on outcomes in patients with head and neck cancer undergoing concomitant chemoradiotherapy. Head Neck. 2008 Apr; 30(4): 503-508.
- Eriksson KM, Cederholm T, Palmblad JE. Nutrition and acute leukemia in adults: Relation between nutritional status and infectious complications during remission induction. Cancer. 1998; 82: 1,071-1,077.
- Hill A, Kiss N, Hodgson B, Crowe TC, Walsh AD. Associations between nutritional status, weight loss, radiotherapy treatment toxicity and treatment outcomes in gastrointestinal cancer patients. Clin Nutr. 2011; 30: 92-98.
- Phippen NT, Lowery WJ, Barnett JC, Hall LA, Landt C, Leath CA 3rd. Evaluation of the Patient-Generated Subjective Global Assessment (PG-SGA) as a predictor of febrile neutropenia in gynecologic cancer patients receiving combination chemotherapy: A pilot study. Gynecol Oncol. 2011; 123(2): 360-364.
- Prado CM, Baracos VE, McCargar JL, Mourtzakis M, Mulder KE, Reiman T, Butter CA, Scarfe AG, Sawyer MB. Body composition as an independent determinant of 5-fluorouracil-based chemotherapy toxicity. Clin Cancer Res. 2007 Jun 1; 13(11): 3,264-3,268.
- Prado CM, Baracos VE, McCargar LJ, Reiman T, Mourtzakis M, Tonkin K, Mackey JR, Koski S, Pituskin E, Sawyer MB. Sarcopenia as a determinant of chemotherapy toxicity and time to tumor progression in metastatic breast cancer patients receiving capecitabine treatment. Clin Cancer Res. 2009 Apr 15; 15(8) :2,920-2,926.
- Prado CM, Lima IS, Baracos VE, Bies RR, McCargar LJ, Reiman T, Mackey JR, Kuzma M, Damaraju VL, Sawyer MB. An exploratory study of body composition as a determinant of epirubicin pharmacokinetics and toxicity. Cancer Chemother Pharmacol. 2011; 67(1): 93-101.
- Robinson DW Jr, Eisenberg DF, Cella D, Zhao N, de Boer C, DeWitte M. The prognostic significance of patient-reported outcomes in pancreatic cancer cachexia. J Support Oncol. 2008; 6(6): 283-290.
- Ross PJ, Norton A, Priest K, Waters JS, Eisen T, Smith IE, O'Brien MER. Do patients with weight loss have a worse outcome when undergoing chemotherapy for lung cancers? British Journal of Cancer. 2004; 90: 1,905-1,911.
- Detail
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Search Plan and Results: ONC: Malnutrition Screening, Nutrition Assessment Tools and Outcomes for Oncology Patients 2011
What is the relationship between nutrition status and mortality in oncology patients?-
Conclusion
Poor nutrition status is associated with mortality in adult oncology patients. Sixteen of seventeen studies found positive associations among one or more of the following and mortality: Weight loss, malnutrition, poor scores on validated malnutrition and quality of life screening tools, sarcopenia, cachexia and fatigue.
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Grade: I
- Grade I means there is Good/Strong evidence supporting the statement;
- Grade II is Fair;
- Grade III is Limited/Weak;
- Grade IV is Expert Opinion Only;
- Grade V is Not Assignable.
- High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
- Moderate (B) means we are moderately confident in the effect estimate;
- Low (C) means our confidence in the effect estimate is limited;
- Very Low (D) means we have very little confidence in the effect estimate.
- Ungraded means a grade is not assignable.
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Evidence Summary: What is the relationship between nutrition status and mortality in oncology patients?
- Detail
- Quality Rating Summary
For a summary of the Quality Rating results, click here.
- Worksheets
- Capuano G, Grosso A, Gentile PC, Battista M, Bianciardi F, Di Palma A, Pavese I, Satta F, Tosti M, Palladino A, Coiro G, Di Palma M. Influence of weight loss on outcomes in patients with head and neck cancer undergoing concomitant chemoradiotherapy. Head Neck. 2008 Apr; 30(4): 503-508.
- Dewys WD, Begg C, Lavin PT, Band PR, Bennett JM, Bertino JR, Cohen MH, Douglass HO Jr, Engstrom PF, Ezdinli EZ, Horton J, Johnson GJ, Moertel CG, Oken MM, Perlia C, Rosenbaum C, Silverstein MN, Skeel RT, Sponzo RW, Tormey DC. Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern Cooperative Oncology Group. Am J Med. 1980; 69(4): 491-497.
- Fearon KC, Voss AC, Hustead DS. Definition of cancer cachexia: Effect of weight loss, reduced food intake and systemic inflammation on functional status and prognosis. American Society of Nutrition. 2006; 83: 1,345-1,350.
- Gioulbasanis I, Georgoulias P, Vlachostergios PJ, Baracos V, Ghosh S, Giannousi Z, Papandreou CN, Mavroudis D, Georgoulias V. Mini Nutritional Assessment (MNA) and biochemical markers of cachexia in metastatic lung cancer patients: Interrelations and associations with prognosis. Lung Cancer. 2011 Dec; 74(3): 516-520.
- Gupta D, Lis CG, Vashi PG, Lammersfeld CA. Impact of improved nutritional status on survival in ovarian cancer. Support Care Cancer. 2010 Mar; 18(3): 373-381.
- Hammerlid E, Wirblad B, Sandin C, Mercke C, Edstrom S, Kaasa S, Sullivan M, Westin T. Malnutrition and food intake in relation to quality of life in head and neck cancer patients. Head & Neck. 1988; 20: 540-548.
- Hyltander A, Bosaeus I, Svedlund J, Liedman B, Hugosson I, Wallengren O, Olsson U, Johnsson E, Kostic S, Henningsson A, Körner U, Lundell L, Lundholm K. Supportive nutrition on recovery of metabolism, nutritional state, health-related quality of life, and exercise capacity after major surgery: A randomized study. Clin Gastroenterol Hepatol. 2005 May; 3(5): 466-474.
- Martin L, Lagergren P. Long-term weight change after oesophageal cancer surgery. B J Surg. 2009; 96 (11): 1,308-1,314.
- Martin L, Watanabe S, Fainsinger R, Lau F, Ghosh S, Quan H, Atkins M, Fassbender K, Downing GM, Baracos V. Prognostic factors in patients with advanced cancer: Use of the patient-generated subjective global assessment in survival prediction. J Clin Oncol. 2010 Oct 1; 28(28): 4,376-4,383.
- Persson C, Sjoden PO, Glimellius B. The Swedish version of the patient-generated subjective global assessment of nutritional status: gastrointestinal vs urological cancers. Clin Nutr. 1999; 18 (2): 71-77.
- Prado CM, Lieffers JR, McCargar LJ, et al. Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: A population-based study. Lancet Oncol. 2008; 9(7): 629-635.
- Pressoir M, Desne S, Berchery D, Rossignol G, Poiree B, Meslier M, Traversier S, Vittot M, Simon M, Gekiere JP, Meuric J, Serot F, Falewee MN, Rodriquez I, Senesse P, Vasson MP, Chelle F, Maget B, Antoun S, Bachmann P. Prevalence, risk factors and clinical implications of malnutrition in French comprehensive cancer centers. British Journal of Cancer. 2010: 102, 966-971.
- Robinson DW Jr, Eisenberg DF, Cella D, Zhao N, de Boer C, DeWitte M. The prognostic significance of patient-reported outcomes in pancreatic cancer cachexia. J Support Oncol. 2008; 6(6): 283-290.
- Ross PJ, Norton A, Priest K, Waters JS, Eisen T, Smith IE, O'Brien MER. Do patients with weight loss have a worse outcome when undergoing chemotherapy for lung cancers? British Journal of Cancer. 2004; 90: 1,905-1,911.
- Sorensen J, Kondrup J, Prokopowicz J, Schiesser M, Krähenbühl L, Meier R, Liberda M; EuroOOPS study group. EuroOOPS: An international, multicentre study to implement nutritional risk screening and evaluate clinical outcome. Clin Nutr. 2008 Jun; 27(3): 340-349.
- Tan BH, Birdsell LA, Martin L, Baracos VE, Fearon KC. Sarcopenia in an overweight or obese patient is an adverse prognostic factor in pancreatic cancer. Clin Cancer Res. 2009 Nov 15; 15(22): 6,973-6,979.
- Yoon H, Lewis M, Shi Q, Khan M, Cassivi S, Diasio R, Sinicrope F. Prognostic impact of body mass index stratified by smoking status in patients with esophageal adenocarcinoma. J Clin Oncol. 2011; 29: 4,561-4,567.
- Detail
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Search Plan and Results: ONC: Malnutrition Screening, Nutrition Assessment Tools and Outcomes for Oncology Patients 2011
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Conclusion