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ONC: Nutrition Status and Outcomes in Adult Oncology Patients (2013)


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.

PubMed ID: 15821765
Study Design:
Case Study or Case Series
D - Click here for explanation of classification scheme.
Quality Rating:
Positive POSITIVE: See Quality Criteria Checklist below.
Research Purpose:

To determine the nutritional status of patients prior to peripheral blood stem cell transplantation (PBSCT) and examine the impact of nutritional status on hospital length of stay.

Inclusion Criteria:

Admitted to tertiary private hospital for PBSCT over an 18-month period.

Exclusion Criteria:

Not receiving PBSCT at study hospital during specific 18-month period. 

Description of Study Protocol:


Admission to tertiary private hospital for PBSCT.


Consecutive case series of 66 patients admitted to hospital for PBSCT over an 18-month period. Subjects were assessed by adietitian a maximum of two weeks prior to admission to hospital for transplant. A scored Patient Generated Subjective Global Assessment (PG-SGA) was used as a nutrition assessment tool and each patient was classified as either well nourished, moderately or suspected of being malnourished or severely malnourished. A retrospective review of medical record provided information regarding age, diagnosis, conditioning regimen, serum albumin and length of stay. Due to small number of severely malnourished patients, subjects with severe and moderate malnutrition were combined into one malnourished category. Nutrition status of subjects prior to PBSCT and the impact of nutrition status on hospital length of stay was examined.

Statistical Analysis

  • Descriptive statistics used to present patient characteristics
  • Kruskal-Wallis test used to compare median PG-SGA scores for each classification of nutritional status
  • Unpaired T-test used to examine differences in means for body mass index (BMI), serum albumin, overall length of stay and post transplant length of stay between well-nourished and malnourished patients
  • Correlation analysis used to examine association between PG-SGA score and length of stay post-transplant and serum albumin
  • Multiple regression analysis using a stepwise procedure performed to examine relationship between length of stay post transplant as dependent variable and independent variables age, serum albumin, PG-SGA score, diagnosis and conditioning regimen
  • Statistical significance is P<0.05. 
Data Collection Summary:

Timing of Measurements

  • Scored PG-SGA completed a maximum of two weeks prior to admission to hospital for PBSCT
  • Retrospective review of medical record completed.

 Dependent Variables

Hospital length of stay post transplant.

Independent Variables

Nutrition status as determined by scored PG-SGA.

Control Variables

  • Gender
  • Age
  • BMI
  • Weight
  • Albumin
  • Weight loss in past six months
  • Transplant type
  • Diagnosis
  • Conditioning regimen.
Description of Actual Data Sample:
  • Initial N: 66 subjects (46 males, 20 females)
  • Attrition (final N): 66 subjects
  • Age: 58.7±12 years.

Other relevant demographics


  • Multiple myeloma: 41%
  • Non-Hodgkin's lymphoma: 20%
  • B-cell lymphoma: 7%
  • Chronic lymphocytic leukemia: 6%
  • AML: 3%
  • Ewings sarcoma: 3%
  • Other: 20%.


  • BMI (kg/m2):
    • Well nourished: 26.7±4kg/m2
    • Malnourished: 23.8±3.4kg/m2
  • Weight loss in past month (%):
    • Well nourished: 0.3±1.4%
    • Malnourished: 3.6±4.3%
  • Weight loss in past six months (%):
    • Well nourished: 2.7±5%
    • Malnourished: 9.2±10.6.


Brisbane, Australia.

Summary of Results:

 Key Findings

  • According to SGA scores, 48 (73%) patients were well nourished, 15 (23%) were moderately malnourished and three (4%) were severely malnourished
  • Significant difference between median PG-SGA scores for each classification of nutritional status: Three (one to eight), 12 (8 to 20) and 20 (19 to 22), respectively (P<0.001)
  • 89% of patients described no problems eating while 30% reported the presence of two or more nutrition impact symptoms
  • Significant difference in number of patients experiencing two or more nutrition impact symptoms in malnourished compared to well nourished patients (76% vs. 16%; P<0.001)
  • Well-nourished patients had significantly lower post transplant length of stay (P=0.002), higher serum albumin (P=0.005), higher BMI (P=0.010) and lower weight loss in the previous six months (P=0.031) compared to those who were malnourished
  • Significant correlation between PG-SGA score and both length of stay post transplant (R=0.308, P=0.013) and serum albumin (r= -0.338, P=0.006)
  • No significant difference in mortality within six months of transplant between the two groups but there was a trend for higher mortality in malnourished patients (20% vs. 2%, P=0.059)
  • Stepwise multiple regression analysis determined that none of the variables, age, serum albumin, diagnosis or conditioning treatment were significant predictors of the length of stay post transplant.
Variables Well Nourished Malnourished P Value
Age (years) 57.8±11.5 61.3±13.3 0.306
Post-transplant length of stay (days) 16.9+6.3 23.9±9.9 0.002
Albumin (g per L) 40.5±3.8 37.3±4.4 0.005
BMI (kg/m2) 26.7+4 23.8+3.4 0.010
Weight loss in past month (%)




Weight loss in past six months (%)


9.2±10.6 0.031


Author Conclusion:

The aim of study was to determine the nutritional status of patients prior to PBSCT and examine the impact of nutritional status on the length of stay. Malnutrition prior to PBSCT is associated with an increased length of hospital stay. Use of nutrition assessment tools such as the scored PG-SGA enable nutritional status to be assessed and routine nutrition assessment of patients prior to PBSCT should be completed.

Funding Source:
University/Hospital: Wesley Hospital
Wesley Research Institute
Reviewer Comments:

 Generalizability of results limited due to small sample size from one hospital.

Quality Criteria Checklist: Primary Research
Relevance Questions
  1. Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies) Yes
  2. Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about? Yes
  3. Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice? Yes
  4. Is the intervention or procedure feasible? (NA for some epidemiological studies) Yes
Validity Questions
1. Was the research question clearly stated? Yes
  1.1. Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified? Yes
  1.2. Was (were) the outcome(s) [dependent variable(s)] clearly indicated? Yes
  1.3. Were the target population and setting specified? Yes
2. Was the selection of study subjects/patients free from bias? Yes
  2.1. Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study? Yes
  2.2. Were criteria applied equally to all study groups? Yes
  2.3. Were health, demographics, and other characteristics of subjects described? Yes
  2.4. Were the subjects/patients a representative sample of the relevant population? Yes
3. Were study groups comparable? N/A
  3.1. Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT) N/A
  3.2. Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline? N/A
  3.3. Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.) N/A
  3.4. If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis? N/A
  3.5. If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.) N/A
  3.6. If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")? N/A
4. Was method of handling withdrawals described? Yes
  4.1. Were follow-up methods described and the same for all groups? Yes
  4.2. Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.) Yes
  4.3. Were all enrolled subjects/patients (in the original sample) accounted for? Yes
  4.4. Were reasons for withdrawals similar across groups? N/A
  4.5. If diagnostic test, was decision to perform reference test not dependent on results of test under study? N/A
5. Was blinding used to prevent introduction of bias? Yes
  5.1. In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate? N/A
  5.2. Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.) Yes
  5.3. In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded? N/A
  5.4. In case control study, was case definition explicit and case ascertainment not influenced by exposure status? N/A
  5.5. In diagnostic study, were test results blinded to patient history and other test results? N/A
6. Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described? Yes
  6.1. In RCT or other intervention trial, were protocols described for all regimens studied? N/A
  6.2. In observational study, were interventions, study settings, and clinicians/provider described? N/A
  6.3. Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect? Yes
  6.4. Was the amount of exposure and, if relevant, subject/patient compliance measured? Yes
  6.5. Were co-interventions (e.g., ancillary treatments, other therapies) described? Yes
  6.6. Were extra or unplanned treatments described? Yes
  6.7. Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups? Yes
  6.8. In diagnostic study, were details of test administration and replication sufficient? N/A
7. Were outcomes clearly defined and the measurements valid and reliable? Yes
  7.1. Were primary and secondary endpoints described and relevant to the question? Yes
  7.2. Were nutrition measures appropriate to question and outcomes of concern? Yes
  7.3. Was the period of follow-up long enough for important outcome(s) to occur? Yes
  7.4. Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures? Yes
  7.5. Was the measurement of effect at an appropriate level of precision? Yes
  7.6. Were other factors accounted for (measured) that could affect outcomes? Yes
  7.7. Were the measurements conducted consistently across groups? Yes
8. Was the statistical analysis appropriate for the study design and type of outcome indicators? Yes
  8.1. Were statistical analyses adequately described and the results reported appropriately? Yes
  8.2. Were correct statistical tests used and assumptions of test not violated? Yes
  8.3. Were statistics reported with levels of significance and/or confidence intervals? Yes
  8.4. Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)? N/A
  8.5. Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)? Yes
  8.6. Was clinical significance as well as statistical significance reported? Yes
  8.7. If negative findings, was a power calculation reported to address type 2 error? N/A
9. Are conclusions supported by results with biases and limitations taken into consideration? Yes
  9.1. Is there a discussion of findings? Yes
  9.2. Are biases and study limitations identified and discussed? Yes
10. Is bias due to study's funding or sponsorship unlikely? Yes
  10.1. Were sources of funding and investigators' affiliations described? Yes
  10.2. Was the study free from apparent conflict of interest? Yes