Pretreatment malnutrition and quality of life - association with prolonged length of hospital stay among patients with gynecological cancer: a cohort study

Abstract

BackgroundLength of hospital stay (LOS) is a surrogate marker for patients' well-being during hospital treatment and is associated with health care costs. Identifying pretreatment factors associated with LOS in surgical patients may enable early intervention in order to reduce postoperative LOS.MethodsThis cohort study enrolled 157 patients with suspected or proven gynecological cancer at a tertiary cancer centre (2004-2006). Before commencing treatment, the scored Patient Generated - Subjective Global Assessment (PG-SGA) measuring nutritional status and the Functional Assessment of Cancer Therapy-General (FACT-G) scale measuring quality of life (QOL) were completed. Clinical and demographic patient characteristics were prospectively obtained. Patients were grouped into those with prolonged LOS if their hospital stay was greater than the median LOS and those with average or below average LOS.ResultsPatients' mean age was 58 years (SD 14 years). Preoperatively, 81 (52%) patients presented with suspected benign disease/pelvic mass, 23 (15%) with suspected advanced ovarian cancer, 36 (23%) patients with suspected endometrial and 17 (11%) with cervical cancer, respectively. In univariate models prolonged LOS was associated with low serum albumin or hemoglobin, malnutrition (PG-SGA score and PG-SGA group B or C), low pretreatment FACT-G score, and suspected diagnosis of cancer. In multivariable models, PG-SGA group B or C, FACT-G score and suspected diagnosis of advanced ovarian cancer independently predicted LOS.ConclusionsMalnutrition, low quality of life scores and being diagnosed with advanced ovarian cancer are the major determinants of prolonged LOS amongst gynecological cancer patients. Interventions addressing malnutrition and poor QOL may decrease LOS in gynecological cancer patients.

Depression and appetite: predictors of malnutrition in gynecologic cancer

“…Approximately 20-26 % of gynecologic cancer patients were found to have a nutritional disorder [13,16,18], while 50-67 % of ovarian cancer patients were reported to have a nutritional disorder [16,17]. The incidence of malnutrition in gynecologic cancer is 19 times higher than that in patients with benign conditions [16].…”

“…In addition, changes in protein metabolism may provoke loss of appetite and body weight as well as cachexia [5]. As a result, malnutrition results in poor clinical outcomes, such as prolonged length of hospital stay [13] and high mortality in cancer patients [14]. Therefore, malnutrition is a major problem for cancer patients in general, and the same is true for gynecologic cancer patients.…”

Role of Nutritional Status in Predicting the Length of Stay in Cancer: A Systematic Review of the Epidemiological Literature

“…Reducing the LOS, therefore, has the potential to decrease health care costs, the risk of infections, and other hospital-acquired diseases and to improve patients’ quality of life [14]. Malnourished patients often experience a significantly prolonged treatment duration in association with increased morbidities, thereby increasing the LOS [15].…”

“…LOS has been used as a surrogate marker of patients’ well-being during hospital treatment [14] and is considered to reflect integration of the severity of illness and the patient’s health status affected by genetics, the extent or severity of the trauma or disease, the overall medical or surgical treatment, the quality of care, and the availability of intermediary and long-term care facilities [3]. Reducing the LOS, therefore, has the potential to decrease health care costs, the risk of infections, and other hospital-acquired diseases and to improve patients’ quality of life [14].…”

Predicting clinical outcome of cardiac patients by six malnutrition screening tools

“…In a study done in a tertiary-care geriatric hospital in Switzerland [13] as well as in a study done in a sub acute care facility in Australia [14], the ability of MNA-SF to predict increased risk of mortality and transfers is reported. Length of hospital stay is a substitute marker of patients' well-being during treatment and is positively associated with malnutrition and other co-morbidities [24]. Nevertheless establishing a relationship between malnutrition and hospital death is a difficult task due to the various confounding factors [25,26].…”