We conducted a cross-sectional study in West China Hospital, China, which we intended to find out the number of cancer patients with malnutrition and/or distress and the relationship between psychological and nutritional status. From March 2015 to May 2017, we investigated 525 patients with cancer who underwent treatment in West China Hospital. The inclusion criteria were as follows:patients 1) had pathologically confirmed cancer; 2) had no cognitive impairments to understand and fill out a questionnaire by themselves. The exclusion criterion was that patients had a history of mental illness, such as schizophrenia, anxiety disorder, mood disorder, bipolar disorder, and psychoactive substance abuse. Questionnaires assessing depression, anxiety and nutritional status were given to the patients. This study was approved by the Medical Ethics Committee of West China Hospital. Informed consents were signed by the patients if they agreed to participate in the study.
In this survey, we distributed a total number of 525 questionnaires, and the returning rate was 94.5% (496/525). Thirty questionnaires were excluded due to incomplete answers. Finally, 466 questionnaires were valid for the data analyses.
We created a questionnaire (see Additional file 1) derived from DT, PG-SGA and NRS2002. In addition to basic demographic information, the questionnaire consisted of Patient-Generated Subjective Global Assessment (PG-SGA) and Nutritional Risk Screening 2002 (NRS2002), both measured the nutritional status of patients. Distress Thermometer (DT) measured the level of patients’ psychological distress.
Demographic information included questions about gender, height, weight, age, residence, marital status, living alone or not, level of education, medical insurance, occupation and religion. The occupation was categorized into having medical background or no medical background, as patients with medical background, for example health care providers, might have a different understanding of their diseases and react differently from other people.
Distress Thermometer is a subjective test to measure the level of distress, which is regarded as the most commonly used tool in detecting distress in cancer patients recently . It consists of a scale from 0 to 10, with 0 indicating no distress and 10 indicating extreme distress. Potential advantages of the DT over other screening tools are its simplicity and acceptability for both health care providers and patients. The cut-off value of the DT is usually 4 recommended by NCCN [6, 7, 17].
Modified from the Subjective Global Assessment, PG-SGA is a brief scale for judging the nutritional statuses of cancer patients which is recommended by the Oncology Nutrition Dietetic Practice Group of the Academy of Nutrition and Dietetics [18, 19]. It brings loss of weight, disease, metabolic stress and physical examination into consideration . Scores range from 0 to 16, with scores of ≥4 suggesting requirements of nutritional support and ≥ 9 indicating a critical demand for nutritional intervention .
Recommended by the European Society of Parenteral Enteral Nutrition (ESPEN), NRS2002 is a nutritional risk screening tool in hospitalized patients . The total modules of NRS2002 include three parts: the severity of disease, nutritional status, and age. The cut-off value of NRS2002 is 3, the more severe malnutrition or risk of malnutrition is, the higher the scores will be .
We used the SPSS software (version 19.0 Chicago, IL, USA) to analyze the data. We examined the normal distribution of the scores of every patient. Correlation analyses were used to examine the relationship between the nutritional status and psychological distress. Consistency of PG-SGA and NRS2002 was also analyzed. The cut-off value of DT, PG-SGA and NRS2002 were 4, 4 and 3 respectively. Chi-square tests and Fisher’s exact probabilities were performed to examine the influence factors of DT, PG-SGA and NRS2002 scores. A p value of less than 0.05 was considered as statistically significant.