Development and validation of a Modified Patient‐Generated Subjective Global Assessment as a nutritional assessment tool in cancer patients

Abstract

Background Completing Patient-Generated Subjective Global Assessment (PG-SGA) questionnaires is time consuming. This study aimed to develop and validate an easy-to-use modified PG-SGA (mPG-SGA) for cancer patients. Methods Seventy professionals assessed the content validity, comprehensibility, and difficulty of the full PG-SGA. A survey including the PG-SGA and other questionnaires was completed by 34 071 adult hospitalized cancer patients with first cancer diagnosis or recurrent disease with any tumour comorbidities from the INSCOC study. Among them, 1558 patients were followed for 5 years after admission. Reliability and rank correlation were estimated to assess the consistency between PG-SGA items and to select mPG-SGA items. The external and internal validity, test-retest reliability, and predictive validity were tested for the mPG-SGA via comparison with both the PG-SGA and abridged PG-SGA (abPG-SGA). Results After deleting items that more than 50% of professionals considered difficult to evaluate (Worksheet 4) and items with an item-total correlation <0.1, the mPG-SGA was constructed. Nutritional status was categorized using mPG-SGA scores as well-nourished (0 points) or mildly (1-2 points), moderately (3-6 points), or severely malnourished (≥7 points) based on the area under curve (0.962, 0.989, and 0.985) and maximal sensitivity (0.924, 0.918, and 0.945) and specificity (1.000, 1.000, and 0.938) of the cut-off scores. The external and internal validity and test-retest reliability were good. Significant median overall survival differences were found among nutritional status groups categorized by the mPG-SGA: 24, 18, 14, and 10 months for well-nourished, mildly malnourished, moderately malnourished, and severely malnourished, respectively (all Ps < 0.05). Neither the PG-SGA nor the abridged PG-SGA could discriminate the median overall survival differences between the well-nourished and mildly malnourished groups. Conclusions We systematically developed and validated the mPG-SGA as an easier-to-use nutritional assessment tool for cancer patients. The mPG-SGA appears to have better predictive validity for survival than the PG-SGA and abridged PG-SGA.

Bioelectrical Impedance Phase Angle as a Predictors of Mortality in Patients with Lung Cancer: a Prospective Study

“…Our present data also showed that there is a close association between the PG-SGA scores and PA in lung The KPS is widely used to assess the functional status of cancer patients. It has good predictive validity for the survival of lung cancer patients [21,54]. The PA has also been associated with the functional status of patients [22] and with a lower KPS score.…”

“…The PG-SGA is a widely used nutritional assessment tool for cancer patients and has been validated in patients with lung cancer [51], gastric cancer [52], colorectal cancer [53] and other cancers [54] in Chinese populations. A study by Abe et al demonstrated that the PA showed the best association with the PG-SGA in terms of sensitivity [55].…”

Preliminary validation of Global Leadership Initiative on Malnutrition criteria in cancer patients: A cross-sectional study

“…[27] The mPG-SGA was built from the PG-SGA by removing the physical examination and questions about metabolic demand. [25] Thus, the mPG-SGA is a more subjective tool for nutritional assessment. In the early stages of disease, patients may feel uncomfortable, but a physical examination may not reveal obvious positive signs.…”

“…[23] Thus, the abridged scored PG-SGA and the mPG-SGA have been developed to improve its performance, and these have also been assessed in Chinese patients. [24,25] In the present study, we aimed to examine the validity of the GLIM criteria for identifying malnutrition compared with the established PG-SGA and mPG-SGA in Chinese cancer patients.…”

Individualized threshold of the involuntary weight loss in prognostic assessment of cancer

“…Thus, involuntary WL is an important prognostic feature in patients with cancer 12,13 . In addition, involuntary WL is an important criterion among several commonly used nutritional screening tools in clinics 7,14 . Involuntary WL can be a prognostic marker for cancer patients, predicting poor survival and increased morbidity.…”