Validation of the scored Patient‐Generated Subjective Global Assessment Short Form as a prognostic tool for incurable cancer patients

Abstract

Background:The Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF) is a standardized tool for assessing nutrition risk in patients with cancer.The aim of this study was to propose and validate a cutoff point for the PG-SGA SF related to the prognosis of patients with incurable cancer in exclusive palliative care. Methods: This is a prospective cohort study of patients with incurable cancer at the National Cancer Institute in Brazil. A total sample (n = 2,144) was randomly divided into groups: (1) training (n = 1,072), to determine the most accurate PG-SGA SF cutoff, and (2) validation (n = 1,072), to test the predictive accuracy of this cutoff point. The receiver operating characteristic curve was plotted to determine the best cutoff point of the PG-SGA SF related to death. Concordance statistics (C statistic) were used to test the predictive accuracy of the models. Kaplan-Meier curve and the Cox hazard model were used to verify a prognostic value of the cutoff point. Results: PG-SGA SF score ≥15 was found to be the best cutoff based on 90-day mortality with good accuracy discrimination (C statistic ≥ 0.74). Patients whose PG-SGA SF score was ≥15 had a shorter survival of 32 (interquartile range [IQR], 12-75) vs 83 days (IQR, 31-90) (p-value < .001) and higher risk of death (hazard ratio: 2.20; 95% CI, 1.64-2.95). Conclusions:The proposed PG-SGA SF cutoff score is valid and, alongside its usefulness in nutrition triage, could provide prognostic value for patients with incurable cancer.

Proposal of a nutrition screening algorithm for patients with incurable cancer receiving palliative care: Data from a prospective cohort

“…Regarding the PG‐SGA SF score, our median values were similar to those found in other studies with patients with incurable cancer 9,36 . This could be explained by the progression of the disease, which leads to increased systemic inflammatory response and consequently more significant nutritional impact symptoms and worse functionality, 37 which are important PG‐SGA SF domains, yielding higher scores.…”

“…Nutritional screening is important in incurable cancer as these patients are more susceptible to nutritional risk; 5 however, these patients are also known to have different expected OS 9 . Considering that stratifying patients with incurable cancer into two single groups by PG‐SGA SF may lead to an oversimplification in nutritional risk assessments and that systemic inflammatory response is one of the recognized etiological factors of nutritional disorders in patients with cancer, our findings suggest that supplementing the PG‐SGA SF with GPS was important for increment the accuracy of the algorithm and better distinguishing the four degrees of nutritional risk.…”

“…All the patients who were alive by the end of follow‐up (120 days) were censored for the survival analysis. In previous Brazilian studies of patients with incurable cancer receiving palliative care, the follow‐up was between 90 and 180 days 9,28 …”

Managing Nutrition Impact Symptoms in Cancer Cachexia: A Case Series and Mini Review

“…A validated abridged version, the PG-SGA Short Form, completed by patients in less than 5 minutes, allows for quick identification and prioritization of malnutrition in cancer patients. It is important to note that the short form of the PG-SGA has demonstrated value in prognostication, of several patient populations with cancer including elderly oncology patients ( 20 ); ambulatory patients receiving chemotherapy; patients with cervical cancer ( 21 ); and palliative care patients ( 22 ). Additionally, the Head and Neck patient symptom checklist (HNSC) is a comprehensive NIS assessment tool evaluating total symptom burden in patients with HNC.…”

Managing Nutrition Impact Symptoms in Cancer Cachexia: A Case Series and Mini Review

“…A validated abridged version, the PG-SGA Short Form, completed by patients in less than 5 minutes, allows for quick identification and prioritization of malnutrition in cancer patients. It is important to note that the short form of the PG-SGA has demonstrated value in prognostication, of several patient populations with cancer including elderly oncology patients [20]; ambulatory patients receiving chemotherapy; patients with cervical cancer [21]; and palliative care patients [22]. Additionally, the Head and Neck patient symptom checklist (HNSC) is a comprehensive NIS assessment tool evaluating total symptom burden in patients with HNC.…”