Patient-generated subjective global assessment (PG-SGA), a validated tool for nutritional assessment, has been associated with worse clinical outcomes in patients with cancer. However, studies assessing its relationship in chemoradiotherapy outcomes are scarce. The study aimed to determine the prevalence of malnutrition according to PG-SGA and its association with the incidence of toxicity to chemoradiotherapy treatment in women with cervical cancer.
In a single-centre prospective observational study, we enrolled 391 women with locally advanced cervical cancer. Patients were assessed on the day of their first chemotherapy infusion, when nutritional status was evaluated by the PG-SGA form and anthropometric measurements. Sociodemographic and clinical data were also collected. Toxicity to chemoradiotherapy was assessed weekly and toxicity-induced modification of treatment (TIMT) was defined as any serious adverse event that resulted in treatment delay, interruption, or dose reduction. Multivariate mixed-effects Poisson and Logistic regression models were performed to identify the factors contributing to the outcome number of adverse events ≥ grade 3 and TIMT, respectively.
Malnutrition was found in 47.6% of the population. Roughly 1/3 had TIMT and 54.2% experienced at least one symptom ≥grade 3. In the adjusted models, PG-SGA B and C, as well as the score ≥9 were independent predictors of the number of toxicity events ≥grade 3 and higher incidence of TIMT.
PG-SGA may represent an important assessment tool to predict toxicity outcomes in women with cervical cancer, besides being considered a simple, fast, and low-cost tool, which allows early nutritional care.
This is a preview of subscription content, access via your institution
Subscribe to Journal
Get full journal access for 1 year
only $9.92 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Tax calculation will be finalised during checkout.
Get time limited or full article access on ReadCube.
All prices are NET prices.
The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71:209–49. https://doi.org/10.3322/caac.21660.
Chemoradiotherapy for Cervical Cancer Meta-Analysis Collaboration. Reducing uncertainties about the effects of chemoradiotherapy for cervical cancer: a systematic review and meta-analysis of individual patient data from 18 randomized trials. J Clin Oncol. 2008;26:5802–12. https://doi.org/10.1200/JCO.2008.16.4368.
Ræder H, Henriksen C, Bøhn SK, O de Fey Vilbo A-R, Henriksen HB, Kværner AS, et al. Agreement between PG-SGA category and fat-free mass in colorectal cancer patients. Clin Nutr ESPEN. 2018;27:24–31. https://doi.org/10.1016/j.clnesp.2018.07.005.
National Comprehensive Cancer Network (NCCN). Clinical Practice Guidelines in Oncology. Antiemesis (Version 12021) 2021;28:fev.
Das U, Patel S, Dave K, Bhansali R. Assessment of nutritional status of gynecological cancer cases in India and comparison of subjective and objective nutrition assessment parameters. South Asian J Cancer. 2014;3:38 https://doi.org/10.4103/2278-330X.126518.
Aredes MA, Garcez MR, Chaves G. Influence of chemoradiotherapy on nutritional status, functional capacity, quality of life and toxicity of treatment for patients with cervical cancer. Nutr Diet. 2018;75:263–70. https://doi.org/10.1111/1747-0080.12414.
Bauer J, Capra S, Ferguson M. Use of the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in patients with cancer. Eur J Clin Nutr. 2002;56:779–85. https://doi.org/10.1038/sj.ejcn.1601412.
Jager-Wittenaar H, Ottery FD. Assessing nutritional status in cancer: role of the Patient-Generated Subjective Global Assessment. Curr Opin Clin Nutr Metab Care. 2017;20:322–9. https://doi.org/10.1097/MCO.0000000000000389.
Nakyeyune R, Ruan X, Shen Y, Shao Y, Niu C, Zang Z, et al. Diagnostic performance of SGA, PG-SGA and MUST for malnutrition assessment in adult cancer patients: a systematic literature review and hierarchical bayesian meta-analysis. Nutr Cancer 2021:1–13. https://doi.org/10.1080/01635581.2021.1942080.
Rodrigues CS, Lacerda MS, Chaves GV. Patient Generated Subjective Global Assessment as a prognosis tool in women with gynecologic cancer. Nutrition. 2015;31:1372–8. https://doi.org/10.1016/j.nut.2015.06.001.
Laky B, Janda M, Cleghorn G, Obermair A. Comparison of different nutritional assessments and body- composition measurements in detecting malnutrition among gynecologic cancer patients. Am J Clin Nutr. 2008;87:1678–85. https://doi.org/10.3748/wjg.v16.i26.3310.
Härter J, Orlandi SP, Gonzalez MC. Nutritional and functional factors as prognostic of surgical cancer patients. Support Care Cancer. 2017;25:2525–30. https://doi.org/10.1007/s00520-017-3661-4.
Gallois C, Artru P, Lièvre A, Auclin E, Lecomte T, Locher C, et al. Evaluation of two nutritional scores’ association with systemic treatment toxicity and survival in metastatic colorectal cancer: an AGEO prospective multicentre study. Eur J Cancer. 2019;119:35–43. https://doi.org/10.1016/j.ejca.2019.07.011.
Hill A, Kiss N, Hodgson B, Crowe TC, Walsh AD. Associations between nutritional status, weight loss, radiotherapy treatment toxicity and treatment outcomes in gastrointestinal cancer patients. Clin Nutr. 2011;30:92–8. https://doi.org/10.1016/j.clnu.2010.07.015.
Esfahani A, Ghoreishi Z, Abedi Miran M, Sanaat Z, Ostadrahimi A, Eivazi Ziaei J, et al. Nutritional assessment of patients with acute leukemia during induction chemotherapy: Association with hospital outcomes. Leuk Lymphoma. 2014;55:1743–50. https://doi.org/10.3109/10428194.2013.853766.
Sjøblom B, Grønberg BH, Benth JŠ, Baracos VE, Fløtten Ø, Hjermstad MJ, et al. Low muscle mass is associated with chemotherapy-induced haematological toxicity in advanced non-small cell lung cancer. Lung Cancer. 2015;90:85–91. https://doi.org/10.1016/j.lungcan.2015.07.001.
Srdic D, Plestina S, Sverko-Peternac A, Nikolac N, Simundic A-M, Samarzija M. Cancer cachexia, sarcopenia and biochemical markers in patients with advanced non-small cell lung cancer-chemotherapy toxicity and prognostic value. Support Care Cancer. 2016;24:4495–502. https://doi.org/10.1007/s00520-016-3287-y.
Pereira FO, Mota AP, Aredes MA, Chaves GV, Cardoso ICR. Association between scored patient-generated subjective global assessment and skeletal muscle determined by computed tomography in patients with cervical cancer. Nutr Cancer. 2020;72:595–601. https://doi.org/10.1080/01635581.2019.1645866.
Duarte Bonini Campos JA, Dias do Prado C. Cross-cultural adaptation of the Portuguese version of the Patient-Generated Subjective Global Assessment. Nutr Hosp. 2012;27:583–9. https://doi.org/10.1590/S0212-16112012000200035.
Micromedex® Healthcare Series [Proprietary Database on the Internet]. Greenwood Village (CO): Thomson MICROMEDEX, 2011.
WHO Collaborating Centre for Drug Statistics Methodology, Anatomical Therapeutic Chemical classification index with Defined Daily Doses, 2022. Oslo, Norway 2021.
Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0. US Department of Health and Human Services, National Institutes of Health, National Cancer Institute.
Kok DE, Winkels RM, van Herpen CM, Kampman E. Toxicity-induced modification of treatment: what is in a name. Eur J Cancer. 2018;104:145–50. https://doi.org/10.1016/j.ejca.2018.09.018.
BRASIL. Ministério da Saúde. National Cancer Institute José Alencar Gomes da Silva (INCA). 2020 Estimate: Cancer incidence in Brazil. Rio de Janeiro 2020.
Bonassa EMA, Gato MIR. Oncology Therapy for Nurses and Pharmacists. 4o ed. São Paulo: 2012.
Prado CMM. Body composition in chemotherapy: the promising role of CT scans. Curr Opin Clin Nutr Metab Care. 2013;16:525–33. https://doi.org/10.1097/MCO.0b013e328363bcfb.
Vega MCM Dela, Laviano A, Pimentel GD. Sarcopenia and chemotherapy-mediated toxicity. Einstein. 2016;14:580–4. https://doi.org/10.1590/s1679-45082016md3740.
Bozzetti F. Forcing the vicious circle: sarcopenia increases toxicity, decreases response to chemotherapy and worsens with chemotherapy. Ann Oncol. 2017;28:2107–18. https://doi.org/10.1093/annonc/mdx271.
Prado CMM, Heymsfield SB. Lean tissue imaging: a new era for nutritional assessment and intervention. JPEN J Parenter Enter Nutr. 2014;38:940–53. https://doi.org/10.1177/0148607114550189.
Chantragawee C, Achariyapota V. Utilization of a scored patient-generated subjective global assessment in detecting a malnourished status in gynecologic cancer patients. Asian Pac J Cancer Prev. 2016;17:4401–4.
Rodrigues CS, Chaves GV. Patient-Generated Subjective Global Assessment in relation to site, stage of the illness, reason for hospital admission, and mortality in patients with gynecological tumors. Support Care Cancer. 2015;23:871–9. https://doi.org/10.1007/s00520-014-2409-7.
Phippen NT, Lowery WJ, Barnett JC, Hall LA, Landt C, Leath CA. Evaluation of the Patient-Generated Subjective Global Assessment (PG-SGA) as a predictor of febrile neutropenia in gynecologic cancer patients receiving combination chemotherapy: a pilot study. Gynecol Oncol. 2011;123:360–4. https://doi.org/10.1016/j.ygyno.2011.07.093.
Riechelmann RP, Krzyzanowska MK. Drug interactions and oncological outcomes: a hidden adversary. E Cancer Med Sci. 2019;13:ed88 https://doi.org/10.3332/ecancer.2019.ed88.
Büchner T, Berdel WE, Haferlach C, Haferlach T, Schnittger S, Müller-Tidow C, et al. Age-related risk profile and chemotherapy dose response in acute myeloid leukemia: a study by the German Acute Myeloid Leukemia Cooperative Group. J Clin Oncol. 2009;27:61–9. https://doi.org/10.1200/JCO.2007.15.4245.
We thank Taiara Poltronieri and Fernanda Maciel for their valuable support in data collection. This research was supported by Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (Jovem Cientista do Nosso Estado-2020 grant).
The authors declare no competing interests.
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Table 2 Frequency of adverse events reported during cisplatin infusions in women with cervix cancer (n= 391).
About this article
Cite this article
Mota, A.P., Aredes, M.A., De Oliveira Miguel, J. et al. Nutritional status assessed by Patient-Generated Subjective Global Assessment is associated with toxicity to chemoradiotherapy in women with cervical cancer: a prospective study. Eur J Clin Nutr (2022). https://doi.org/10.1038/s41430-022-01180-9