Quantifying the impact of standardized assessment and symptom management tools on symptoms associated with cancer-induced anorexia cachexia syndrome

Abstract

The objective of this study was to quantify the impact of standardized assessment and management tools on patient symptom scores in cancer-induced anorexia cachexia syndrome (ACS) using a within-group study design. Baseline assessments included the Patient Generated Subjective Global Assessment (PG-SGA) tool and an amended Symptoms and Concerns Checklist (SCC). Symptom management strategies, written for this project, were instigated. Follow-up SCC scores were collected at 2 and 4 weeks. Forty out of 79 patients referred were recruited; 29/79 (36.7%) were too unwell or had died prior to consent. At baseline, the PG-SGA tool revealed 250 active symptoms associated with ACS. Total PG-SGA score was above 9 for all patients. Predominant interventions involved simple dietary advice and prescription of artificial saliva, mouthwash and prokinetic antiemetics. Median total SCC score improved sequentially from 11 at baseline, to 7 and 4 at first and second review, respectively (visit 1 to 2, p = 0.001; visit 1 to 3, p < 0.001; and visit 2 to 3, p = 0.02). We conclude that patients with ACS are recognised late in their disease and have a considerable burden of active symptoms. A structured approach to assessment and management has a significant impact on symptom burden.

Performance of Patient‐Generated Subjective Global Assessment (PG‐SGA) in Patients With Advanced Cancer in Palliative Care

“…Of all reported symptoms by the PG‐SGA in our study, only xerostomia was associated with reduced survival. Other studies have shown that xerostomia is quite prevalent and is 1 of the most distressing symptoms reported by patients with cancer, 28 , 29 as well as being a prognostic factor in advanced cancer 7 …”

“…For patients with a shorter expectation of survival, nutrition counseling should be considered to alleviate symptoms and the burden of the disease. For example, predominant interventions for xerostomia involve dietary advice and improvement of active mouth care, prescription of artificial saliva, mouthwash, and so on 29 . On the other hand, in patients with a longer expectation of survival, nutrition interventions aim at improving nutrition aspects, including the maintenance or improvement of nutrition status, body weight stabilization, adequate food intake, and improvement of quality of life 11 , 12 …”

Health care professionals’ experience, understanding and perception of need of advanced cancer patients with cachexia and their families: The benefits of a dedicated clinic

“…Although there has been relatively few studies in this area, previous research indicates that many professionals find managing cachexia in patients with advanced cancer challenging [17, 22, 23]. Qualitative research carried out in the UK found that healthcare professionals’ professional practice was influenced by a combination of their existing knowledge, the culture within their clinical area and the availability of resources; variation in these areas contributed to inconsistent and potentially sub-optimal care [14, 15, 17].…”

Nutritional support for malnourished patients with cancer

“…A small prospective study assessing symptom burden demonstrated that the number of symptoms reported could be reduced by a standardized assessment and symptom management tool comprising nutritional and pharmacological interventions in patients with advanced cancers [31]. A small prospective study assessing symptom burden demonstrated that the number of symptoms reported could be reduced by a standardized assessment and symptom management tool comprising nutritional and pharmacological interventions in patients with advanced cancers [31].…”