One-Year Mortality in Older Patients with Cancer: Development and External Validation of an MNA-Based Prognostic Score

Abstract

PurposeThe MNA (Mini Nutritional Assessment) is known as a prognosis factor in older population. We analyzed the prognostic value for one-year mortality of MNA items in older patients with cancer treated with chemotherapy as the basis of a simplified prognostic score.MethodsThe prospective derivation cohort included 606 patients older than 70 years with an indication of chemotherapy for cancers. The endpoint to predict was one-year mortality. The 18 items of the Full MNA, age, gender, weight loss, cancer origin, TNM, performance status and lymphocyte count were considered to construct the prognostic model. MNA items were analyzed with a backward step-by-step multivariate logistic regression and other items were added in a forward step-by-step regression. External validation was performed on an independent cohort of 229 patients.ResultsAt one year 266 deaths had occurred. Decreased dietary intake (p = 0.0002), decreased protein-rich food intake (p = 0.025), 3 or more prescribed drugs (p = 0.023), calf circumference <31cm (p = 0.0002), tumor origin (p<0.0001), metastatic status (p = 0.0007) and lymphocyte count <1500/mm3 (0.029) were found to be associated with 1-year mortality in the final model and were used to construct a prognostic score. The area under curve (AUC) of the score was 0.793, which was higher than the Full MNA AUC (0.706). The AUC of the score in validation cohort (229 subjects, 137 deaths) was 0.698.ConclusionKey predictors of one-year mortality included cancer cachexia clinical features, comorbidities, the origin and the advanced status of the tumor. The prognostic value of this model combining a subset of MNA items and cancer related items was better than the full MNA, thus providing a simple score to predict 1-year mortality in older patients with an indication of chemotherapy.

Effects of a physical activity programme to prevent physical performance decline in onco‐geriatric patients: a randomized multicentre trial

“…MNA is currently used as a marker of cancer cachexia and has a strong prognostic value, mainly for appetite and sarcopenia. 36 A correlation between the biochemical markers of cachexia and MNA score has been shown in older patients with cancer. 37 In addition, although exercise could be an attractive therapy for cancer cachexia, there is still a lack of studies focusing on the efficacy of exercise programmes in older cancer population with regard to functional issues.…”

“…The anti‐anabolic consequences of cancer cachexia may explain this lack of effect at 1 year. MNA is currently used as a marker of cancer cachexia and has a strong prognostic value, mainly for appetite and sarcopenia . A correlation between the biochemical markers of cachexia and MNA score has been shown in older patients with cancer .…”

Estado nutricional como predictor de mortalidad en el adulto mayor con cáncer gástrico evaluado en un hospital de referencia

“…En conclusión, el estado nutricional deficiente es un factor pronóstico en la mortalidad del cáncer gástrico en personas mayores. El MNA-SF es el instrumento que mejor predice la mortalidad comparada con la medición únicamente del IMC (22) .…”

Nutritional status and quality of life of patients with lymphoma

“…U našem istraživanju MNA upitnik je pokazao čak i veći procenat pothranjenih bolesnika -64%. U radu koji je evaluirao nutritivni status pomoću MNA upitnika u populaciji bolesnika starijih od 70 godina pokazano je da je 65% bolesnika u riziku ili pothranjeno što je slično našim podacima (9). Onkolozi u rutinskoj kliničkoj praksi ne koriste upitnike za pothranjenost, iako prema dosadašnjim radovima postoji značajan broj pothranjenih bolesnika.…”