Although malnutrition is associated with cancer patients' ability to tolerate chemotherapy as well as their general health and survivability, the impact of malnutrition on patients with gynecologic cancers has not been widely studied. Santoso and colleagues studied women admitted to a gynecologic oncology hospital service in Texas during 1996 to determine the prevalence of malnutrition and its impact on hospital stay and to evaluate methods of assessing malnutrition in these patients.
Demographic and medical data were gathered from the hospital charts of 76 women. Nutritional status was measured using the Prognostic Nutritional Index (PNI), which combines anthropometric and laboratory measurements into a numeric score. Mal-nourishment is defined as a PNI score of at least 40. Body mass index (BMI) was calculated for each patient.
Data were complete for 67 women. Approximately one half were admitted for surgery and one half for chemotherapy or medical indications. The most common cancer was cervical (58 percent), followed by uterine (24 percent) and ovarian (16 percent). Just over half of the patients (54 percent) were malnourished. The strongest correlation of PNI with other measurements was with serum albumin, and both were related to length of hospital stay. The median length of stay for malnourished women was eight days compared with six days for nourished women. This difference in hospital stays was a result of prolonged stays for women admitted for major abdominal surgery. The malnourished women in this group had a median length of stay of nine days compared with six days for nourished women. The association of malnutrition with prolonged hospital stay persisted after controlling for age, cancer site and evidence of metastases. Only 9 percent of the women studied were cachexic as defined by BMI (below the 15th percentile.) Obesity was common, with 54 percent of patients having a BMI of 27.3 or greater. Obesity did not correlate with nutritional status; of the 36 obese women, 14 were malnourished based on PNI.
The authors conclude that in this population of predominately indigent women with gynecologic cancer, malnutrition and obesity were common. Malnutrition was associated with prolonged hospital stays in this study, and in another study was implicated in other adverse outcomes. Serum albumin can provide a good indicator of nutritional status. While low BMI is a good indicator of malnutrition, obesity may mask underlying malnutrition.
editor's note: When patients are dealing with the complicated business of cancer treatments, simple things often get overlooked. Staying involved with patients and their families is especially important when subspecialists are managing the formal medical treatment. Family physicians do much more than provide psychologic support. We prevent depression; detect, prevent and manage adverse effects of treatment; and we answer many questions—those that are verbalized and those that are too awkward to ask. Among the many other services we can render is addressing nutrition. Encouraging good nutrition and strategizing with patients and their families about how to attain the best possible nutritional status is more than just “a good idea.” It can have a profound effect on the patient's outcome. How ironic it is that one half of patients who receive the world's most advanced and expensive health care are malnourished.—a.d.w.