Clinical usefulness of the Patient-Generated Subjective Global Assessment and modified Glasgow Prognostic Score in decision making concerning the indication of enteral nutritional therapy in patients with incurable cancer receiving palliative care

Predicting Osteoporosis in Elderly Cancer Patients Using the Modified Glasgow Prognostic Index

IntroductionOsteoporosis increases fracture risk and mortality, and cancer treatments worsen bone loss. Although mGPS is a common inflammatory-nutritional marker in oncology, its role in predicting osteoporosis is unknown.MethodsThis cross-sectional retrospective study analyzed 93 cancer patients aged ≥50 who underwent dual-energy X-ray absorptiometry (DXA) scans within a year of the first chemotherapy allocation. The results were categorized into groups regarding T-score as normal (T ≥ -1.0), osteopenia (-2.5 < T < -1.0), and osteoporosis (T ≤ -2). Patients were categorized based on mGPS and body mass index (BMI), and regression analysis was performed to identify predictors of osteoporosis in the lumbar spine, femur neck, and total femur.ResultsAmong the patients, 61.3% were female, the median age was 61 years, 41.9% had osteoporosis in the lumbar spine, and 49.5% had osteopenia in the femoral neck. A significant association was observed between BMI and osteoporosis, with higher BMI linked to lower osteoporosis prevalence, particularly in the femur regions (P < .03). There were no significant associations between bone density in the lumbar spine/femoral neck/total femur and age, gender, disease stage, type of chemotherapy, or BMI (all P values >.05). A significant association between mGPS and bone density was observed in the lumbar spine (P = .001) and femur total (P < .001). In the lumbar spine, patients with an mGPS score of 0 had the highest proportion of normal bone density (71.4%), while those with an mGPS score of 2 had a higher prevalence of osteoporosis (55.6%) (P = .001). In the femur total, 46.7% of patients with an mGPS score of 2 were classified with osteoporosis, compared to only 8.5% of those with an mGPS score of 0 (P < 001). Patients with an mGPS score of 2 were over six times more likely to have osteoporosis in the lumbar spine (OR = 6.25,P = 0.027). In the femur total, an mGPS score of 2 also significantly predicted osteoporosis (OR = 5.472, P = .013).ConclusionmGPS is a cost-effective and reliable tool for predicting osteoporosis in elderly cancer patients, enabling early interventions. Integrating it into routine assessments could enhance patient outcomes by addressing osteoporosis risk.

Enhancing nutritional care in palliative care units: assessing nurse knowledge and quality perception in enteral nutrition practices

BACKGROUND

Adequate, balanced, and individualized nutrition, planned according to the patients' life expectancy in palliative care units, is crucial for maintaining essential functions.

AIM

To determine the knowledge levels of nurses working in palliative care units regarding enteral nutrition practices and their perceptions of nutritional care quality in their units.

METHODS

This descriptive, cross-sectional study was conducted in 25 palliative care units located in Izmir, Türkiye, between June and September 2022. The study sample consisted of 205 nurses working in palliative care units. Data were collected using a Personal Information Form, an Enteral Nutrition Practices Knowledge Form, and the Nurses' Perceived Nutrition Care Quality Assessment Scale. The STROBE checklist was also utilized.

RESULTS

The study found that the majority of participating nurses (94.6%) were female, with 78.5% holding bachelor's degrees. The median knowledge score for enteral nutrition: 15 (range: 2-27), perceived care quality score: 36 (range: 9-45). Those with enteral nutrition training had significantly higher knowledge scores (p < .001); palliative care certificate showed no difference (p = .846). Nurses lacking nutrition counseling knowledge had lower perceived care quality scores (p = .001). Monthly tube feeding applications correlated positively with knowledge scores (r = .173, p = .013), unlike professional experience duration (p = .126) and time spent in palliative care (p = .839).

CONCLUSION

Nurses working in the palliative care unit find the quality of nutrition care provided to patients in their clinics to be sufficient, and the level of knowledge regarding enteral nutrition is at a moderate level. However, in questions related to nursing care such as fluid requirements during enteral nutrition with enteral solutions that affect both nutritional care and medical treatment, maintaining the opening of the jejunostomy tube, and enteral drug administration, correct response rates were low. Low correct response rates on specific issues highlight a need for targeted educational interventions.

The role of the nutrition in malnourished cancer patients: Revisiting an old dilemma

BACKGROUND & AIMS

GLIM definition of malnutrition is recognised all over the world and, when is referring to cancer, it specifies that weight or muscle loss are associated with an inflammatory status. However, the real-world practice shows that GLIM definition cannot encompass all the wide and heterogenous clinical presentations of cancer patients with malnutrition, which involves many other drivers beyond inflammation. Moreover, placing an excessive emphasis on the inflammation can overshadow, in the clinical practice, the role of the nutritional support in malnourished cancer patients. The aim of this paper is not to criticize the rationale of the GLIM definition of cancer cachexia, but to show the complexity and heterogeneity of malnutrition of cancer patients and reasons why nutritional support should deserve such a better consideration among the oncologists.

METHODS

Literature pertinent to pathophysiology of malnutrition of cancer patients is scrutinised and reasons for the frequent underuse of nutritional support are critically analysed.

RESULTS

The appraisal of the literature shows that there are various pathophysiological patterns of malnutrition among cancer patients and inflammatory markers are not universally present in weight-losing cancer patients. Inflammation alone does not account for weight loss in all cancer patients and factors other than inflammation can drive hypophagia and weight loss, and hypophagia appears to be a primary catalyst for weight loss. Furthermore, malnutrition may be the consequence of the presence of several Nutrition Impact Symptoms or of the oncologic therapy. The nutritional support may fail to show benefits in malnourished cancer patients because the golden standard to validate a therapy relies on RCT, but it is ethically impossible to have an unfed control group of malnourished patients. Furthermore, nutritional interventions often fell short of the optimal standards, adherence to treatment plans was often poor, nutritional support was mainly reserved for very advanced patients and the primary endpoints of the studies on nutritional support were sometimes unrealistic.

CONCLUSION

There is a gap between the suggestion of the guidelines which advocate the use of nutritional support to improve the compliance of patients facing intensive oncologic treatments or to prevent an early demise when patients enter a chronic phase of slow nutritional deterioration, and the poor use of nutrition in the real-world practice. This requires a higher level of awareness of the oncologists concerning the reasons for the lacking evidence of efficacy of the nutritional support and an understanding of its potential contribute to improve the outcome of the patients. Finally, this paper calls for a change of the oncologist's approach to the cancer patient, from only focusing on the cure of the tumour to taking care of the patient as a whole.