Pain Increases Risk for Malnutrition and Poor Performance Status in Cancer Patients

In a poster presented at the ECCO 15 – ESMO 34 Joint Congress, KM Mallath and colleagues from the Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Centre, Mumbai, India, noted that cancer pain is an important independent risk factor for poor performance status in newly diagnosed patients and significantly associated with malnutrition.

In a poster presented at the ECCO 15 — ESMO 34 Joint Congress, KM Mallath and colleagues from the Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Centre, Mumbai, India, noted that cancer pain is an important independent risk factor for poor performance status in newly diagnosed patients and significantly associated with malnutrition.

The authors conducted a prospective observational audit of 1191 patients seen at their clinical nutrition service in 2008. Patients were interviewed by research dieticians using a structured questionnaire, and several data variables were collected from each patient. The researchers assessed malnutrition through the subjective global assessment (SGA), with SGA-A indicating patients were well-nourished, SGA-B indicating mild or moderate undernourishment, and SGA-C indicating severe undernourishment. Performance status was assessed using the eastern cooperative oncology group (ECOG) scale, and an ECOG score of 0 or 1 was considered good performance status and a score between 2 and 4 indicated poor performance status. Pain was evaluated using a visual analogue score, on which 0 indicated no pain; 1 to 3, mild pain; 4 to 6, moderate pain; and 7 to 10, severe pain. A multivariate analysis was performed to identify independent risk factors for poor performance status.

Dr Mallath and colleagues found that 75% of patients had mild or moderate pain on initial evaluation. They also found a highly significant association between pain scores and malnutrition indicators such as SGA scores, serum albumin levels, and body mass index. A multivariate analysis revealed poor performance status was significantly associated with SGA-B, SGA-C, pain scores, older age, male sex, and the presence of moderate or severe anemia; mild anemia (hemoglobin, 10-12 g/dL) was not an independent risk factor of poor performance status.

Based on their findings, the authors concluded that pain is an important contributor to cancer-related malnutrition at initial presentation and an important independent risk factor for poor performance status in newly diagnosed patients. Because pain is significantly associated with malnutrition, Dr Mallath and colleagues stressed the importance of quantifying and treating cancer pain in everyday practice and during clinical trials.

ECCO/ESMO Poster 3038

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