Effect of nutrition on quality of life in advanced cancer patients.
- Conditions
- Eligible cancer patients attending Palliative Care clinic will be recruited
- Registration Number
- CTRI/2015/06/005851
- Lead Sponsor
- AIIMS
- Brief Summary
**Title of the project:** To assess thecorrelation between nutritional status and quality of life in Indian adultpalliative cancer patients.
**Introduction:**
Cancer may becured if present early stage. But at times, when these cancers become advancedor metastatic, definitive therapy is not feasible. Then these patients requirepalliative therapy for symptom management.
***Malnutrition in cancer patients***: The prevalence of malnutrition among cancer patients is up to 80% (1, 2). Ascancer develops, a patient’s nutritional status is progressively affected. Themultiple metabolic changes and nutritional depletion may impact bodycomposition, functional status, psychological status and response to cancertreatment (3). Chemotherapeutic agents not only causecancer cell death but also affect healthy cells of the body, which furtherleads to gastrointestinal symptoms (like anorexia, nausea and vomiting),deteriorating patients’ nutritional status (4,5). Recentobservational study has concluded that advanced cancer patients withsignificant weight loss were associated with reduced survival (6,7).Weight losing cancer patients have shown reduced mobility, immunity and chemotherapyendurance (8, 9). In a recent study on weight-losing advanced cancer patients,it was shown that along with weight loss and lower mid upper arm circumference (MUAC)these patients had reduced functional abilities (functional ability was definedas walking on the treadmill) (10).
***Nutritional assessment***: Patient GeneratedSubjective Global Assessment (PG-SGA) has been accepted as the standardnutrition assessment tool for patients with cancer (11). PG-SGA is mosteffective and sensitive tool for assessing and evaluating cancer patients’nutritional status and validated on Indian cancer patients (12,13,14). Anthropometric parameters such as bodymass index (BMI), skin fold thickness and mid upper arm circumference (MUAC)are useful in identifying malnutrition (14).
***Qualityof life in cancer patients*:** WHO defines quality of life as “individuals perception of their position in life in the context of the culture andvalue systems in which they live and in relation to their goals, expectations,standards and concerns†(15). Apart from clinical indicators, patient’spsychological and social health along with physical functioning is importantand categorized as quality of life (QoL) (16,17). Nutrition has an effecton patients’ social aspects of life (18, 19, 20). Research has documented increased prevalence ofdepression among malnourished cancer patients (21). Observationson malnourished cancer patients suggests decline in quality of life with bodyweight loss (10, 22). There was a negative correlation between malnutrition status andfunctioning scales and positive correlation with symptom scales. Well-nourishedpatients had significantly better qualityof life scoresin the global, physical, and role function scales (23). Isering et al. 2003,reported that PGSGA score and EORlTC QLQC30 (European Organisation for Researchand Treatment of Cancer quality of life questionnaire) score are correlated.Analysis showed that a deterioration in PG-SGA by a score of nine would resultin a deterioration in QoL by 17 points. The scored PG-SGA will not only provideinformation about nutritional status, but also will give an indication to theQoL of the patient (17).
***Quality of life assessment:*** EORTCQLQC30 is a validated self-assessment instrument used for assessing quality oflife in patients with cancer (19, 24, 25). The questionnaire has been validatedon Indian population (26, 27, 28, 29).
**Lacunae in existing Knowledge:**
· The impact of nutritional status on quality of lifehas not been studied in palliative care setting of cancer patients in IndianPopulation.
Research Question:· Is quality of life affected by nutritional status ofcancer patients in palliative care setting in Indian Population? Aim of the study: · Theaim of study is to assess the prevalence of malnutrition among palliativecancer patients and its impact on their quality of life.
**Objectives****:**
The objectives of the study are:
1.To determine the level of malnutrition in adult palliative cancer patients.
2.To study the correlation between nutritional status and quality of life inadult palliative cancer patients.
Hypothesis:· Malnourishedadult palliative cancer patients will experience worse quality of life.
Anticipated result oftheprojectThe result of theproject will help institution to:
· Designnutritional assessment techniques for malnourished palliative cancer patients.
· Correcttheir nutritional status via counseling and therapy.
**Review ofLiterature:**
Cancer is one ofthe main causes of death among developed countries and the second cause ofdeath in developing countries (30). International Agency for Research on Cancer (GLOBOCANproject, 2012) reported approximately 14.1 million new cancer cases and 8.2million cancer deaths worldwide. Out of these there were a little over 1million cancer cases and 683,000 cancer deaths in India (31). The incidence andmortality rate are higher in metropolitan cities of India. The National CancerRegistry revealed that the Delhi male (103.0/10,000) and female (113.9/100,000)population had the highest cancer incidence rate when adjusted for minimum age among allIndian states (32). Neglect ofundernourished cancer patients and inappropriate nutritional care may lead themto a cachectic state (33).
Cancer cachexia can be described as“a multifactorial syndrome defined by an ongoing loss of skeletal muscle mass(with or without loss of fat mass) that cannot be fully reversed byconventional nutritional support and leads to progressive functionalimpairment. Its pathophysiology is characterised by a negative protein andenergy balance driven by a variable combination of reduced food intake andabnormal metabolism†(34). Few tumorsites are widely associated with cachexia (like pancreatic, gastric, head andneck) but the same tumor site may exhibit cachexia of varying degree or beabsent in different patients. Nearly 50% of cancer patients progress tocachexic stage (35).
Weight loss in cachexia is due towasting of skeletal muscle as well as adipose tissue. In skeletal muscle, dueto protein breakdown amino acids are generated, which thereby contribute tofuel hepatic protein and glucose synthesis (36). Reduced immunity and mobilityare results of skeletal muscle wasting (37). As weight loss advances to 30%of pre-treatment body weight, death becomes inevitable (35). Cachexia negatively impactspatients’ capability to endure chemotherapy and fight infection (38). Increased energy expenditureand anorexia are key factors among cachexia patients leading to weight loss (39, 40).
Cachexia is the most common cause ofdeath in advanced cancer. Nutritional status of patients suffering fromcachexia is negatively impacted due to tumor induced alterations in metabolismduring cancer (41). Pro-cachectic factors includingproteolysis inducing factor (PIF) and lipid mobilizing factor (LMF) areproduced by the tumor cells whilst the production of pro-inflammatory cytokinessuch as tumor necrosis factor alpha (TNF-α), interleukin - 1β (IL-1) andinterleukin – 6 (IL-6) are the hosts inflammatory tumor presenceresponse. These cytokines inhibit lipoprotein lipase which in turn restrictsfatty acid storage by adipocytes. LMF production promotes lipid breakdown frombody fat stores (42). PIF and pro-inflammatory cytokines lead to proteinbreakdown by activating the ATP ubiquitin-proteasome proteolytic pathwaycontributing to muscle atrophy (43). The body’s response to cytokine-derivedinflammation is called acute phase protein response (APPR). During APPR,protein synthesis in the liver is altered as albumin production is substitutedby C-reactive protein, fibrinogen, serum amyloid A, 2-macroglobulin and α-1antitrypsin production. Released cytokines TNF-α and IL-1 are responsible forloss of appetite and anorexia. They act upon the hypothalamic areas of thebrain which control food intake. As fat stores are reduced during cachexia,serum leptin levels decrease which lead to suppression of appetite. IL-1affects food intake by reducing neuropeptide-Y levels (appetite stimulant) inthe hypothalamus (42).
Figure 1: Pathogenesisof Cancer Cachexia (44)
The scored PG-SGA is a validnutrition assessment tool specifically designed for the assessment of patientswith cancer (12). It is an adaptation of subjective global assessment(SGA) (45), which, as well as incorporating three global ratings of nutritionalstatus (well nourished, moderately or suspected of being malnourished andseverely malnourished), includes a numerical score (0–35) and additionalnutrition impact symptoms (46). PG-SGA questionnaire evaluates variables suchas weight losses, variations in food intake, nutrition symptoms, physicalactivity status, and clinical examination and the resulting scores are used toclassify the patients for treatments plans. The SGA has been used in Indiancancer patients to assess nutritional status and proved to be a good predictor(14).
Cancer and treatment-induced changesin metabolism can lead to alterations in physiological and psychologicalfunctions, which, in turn, can reduce a patient’s quality of life by negativelyinfluencing nutritional status (47). QoL will be measured using the EuropeanOrganisation for Research and Treatment of Cancer (EORTC) quality of life questionnaire(QLQ-C30 Version 3) (19). The EORTC QLQC30 questionnaire is a validatedself-assessment instrument used for assessing quality of life in patients withcancer and is the most widely used tool (24, 25). Translated version in Hindi isavailable from the official website. The questionnaire has been validated onIndian population (26, 27, 28, 29). The EORT QoL is composed of 30 items, whichentails five functional scales (physical, role, emotional, cognitive, andsocial), three symptom scales (pain, fatigue, nausea and vomiting), six singleitem scales (dyspnea, insomnia, appetite loss, financial difficulties, diarrhoea,and constipation) and one global quality of life scale. Each item is scored ona 4-point scale, with a score of 1 for "not at all" to a score of 4"very much", except for the last 2 questions for the global QoLscale, which is scored on a 7-point scale ranging from 1 "very poor"to 7 "excellent". A score will be calculated for all the15 domains. Forthe global and the functional scales, a higher score indicates better globaland physical functioning; and for the symptom scale, a higher score wouldindicate worse symptoms (48).
Nutritionscreening is rarely carried out routinely in Indian hospitals. We herebysuggest nutritional status screening for all patients attending palliative careclinic to address malnourishment effectively and except better treatment response.Correcting malnutrition by counselling and nutritional intervention can furtherimprove their quality of life.
Study design and methodology: This prospective observationalstudy will be carried at Pain and Palliative Care Clinic, Dr BRA InstituteRotary Cancer Hospital, AIIMS, New Delhi, India. Eligible cancer patients attendingPalliative Care clinic will be recruited. Informed consent form will be signedprior to participation and ‘patient information’ sheet will be distributed andexplained to all participants.
***Eligibility criteria:***
· Adult, age 18 years and above.
· Suffering from cancer and receiving palliative care management.
***Exclusion criteria:***
· Incapable to provide written consent.
· Patientswith known psychological disorder or having brain tumor or metastasis.
After enrolment, anthropometric measurements in form of body weight,height (to measure body mass index, BMI), mid upper arm circumference (MUAC) andskin fold thickness measurement will be taken by the investigator. PG-SGA(Appendix 1) and EORTC QLQ C30 questionnaire (Appendix 2) will be filled up bydiscussions with the patient and caregiver. The 24 Hour dietary recall and foodfrequency questionnaire (FFQ) will be asked using standard kitchen utensils tounderstand their dietary pattern.
Aftersuccessful completion of the study the research variables will be investigated.
Research variablesAnthropometric measurements: Body weight will betaken using bathroom weighing scale and height using a measuring tape againstthe wall. BMI will be calculated using weight and height measured. MUAC will bemeasured using a non-stretchable measuring tape. Four site skin fold thicknessmeasurement (i.e. triceps, biceps, subscapular and suprailiac) will betaken by the help of scientific Harpenden Skinfold Caliper (0120 by BatyInternational) and noted to the nearest 0.2mm reading, to calculate percentagebody density. Body fat percentage will be calculated using body density valuein Siri equation (50).
Malnutrition assessment: PG-SGA questionnaireto be completed and patient will be categorized according to the level ofmalnutrition. Questionnaire will be filled by discussing with the patient andcaregiver. FFQ and 24 hour dietary recall is an accurate method becausepatients are asked to record the frequency of consumption of individual foodsand can help provide information on eating patterns (Appendix 3 & 4).
Quality of Life assessment: EORTC QLQ C30questionnaire will be used to analyse patients’ QoL and asked personally by theinvestigator.
**Sample Size and Statistics**:
Sample size for the study has beencomputed to compare mean global health status (QoL) between normal versusmoderate/severe malnourished patients with following assumptions: mean ± SD ofglobal health status (QoL) in normal and moderate/severe group as 69±2.0 and58±17 respectively; confidence level 95%, and power 90%, we require to enrol 60patients in each of the two groups (based on nutritional status assessment in120 patients).(49).
Data collected from thequestionnaire and patients’ anthropometric measurements will be collated andanalyzed statistically using SPSS version 20.0 software to study thesignificance and validity of collected results.
Ethical ConsiderationsThroughout the project,confidentiality and anonymity of the patients will be maintained. Participationin the project will be voluntarily and shall take into consideration thewelfare of the subjects.
Before enrolment, the study will be carefullyexplained to all participants describing the purpose of the study, theprocedures to be followed, and benefits of participation. No adverse effectsare expected following the information collection from the patient or hospitalstaff. The necessary ethical approvals will be obtained from the AIIMS EthicsCommittee before implementation of the project.
**ProjectFunding**
The project will receive no fundingfrom any funding body. As it is an observational study in hospital premises nofunding will be needed by the investigators to carry on with it.
**References**
1. Bauer J, Capra S,Ferguson M (2002). Use of the scored patient generated subjective globalassessment (PG-SGA) as a nutrition assessment tool in patients with cancer. *EurJ Clin Nut*, **56**, 779-85.
2. Kubark C (2008). Evaluating in voluntary weight loss in head& neck cancer patient, PhD thesis, University of Alberta.
3. Doyle, N. and ShawC., (2011). Cancer in the twenty-first century. In: Shaw, C., (ed.) Nutritionand cancer. 1st ed. UK: Wiley-Blackwell. pp. 1-12.
4. Kyle UG, Genton L,Pichard C: Hospital length of stay and nutritional status. Curr Opin Clin NutrMetab Care 2005; 8: 397–402.
5. Odelli C, Burgess D, Bateman L, Hughes A, Ackland S, GilliesJ, Collins CE: Nutrition support improves patient outcomes, treatment toleranceand admission characteristics in oesophageal cancer. Clin Oncol (R Coll Radiol)2005; 17: 639–645.
6. Solheim, T.S., [Blum D](http://www.ncbi.nlm.nih.gov/pubmed?term=Blum%20D%5BAuthor%5D&cauthor=true&cauthor_uid=23998647)., [Fayers P.M](http://www.ncbi.nlm.nih.gov/pubmed?term=Fayers%20PM%5BAuthor%5D&cauthor=true&cauthor_uid=23998647)., [Hjermstad M.J](http://www.ncbi.nlm.nih.gov/pubmed?term=Hjermstad%20MJ%5BAuthor%5D&cauthor=true&cauthor_uid=23998647)., [Stene G.B](http://www.ncbi.nlm.nih.gov/pubmed?term=Stene%20GB%5BAuthor%5D&cauthor=true&cauthor_uid=23998647)., [Strasser F](http://www.ncbi.nlm.nih.gov/pubmed?term=Strasser%20F%5BAuthor%5D&cauthor=true&cauthor_uid=23998647)., [Kaasa S](http://www.ncbi.nlm.nih.gov/pubmed?term=Kaasa%20S%5BAuthor%5D&cauthor=true&cauthor_uid=23998647)., (2014). Weightloss, appetite loss and food intake in cancer patients with cancer cachexia:three peas in a pod? - analysis from a multicenter cross sectional study. *Actaoncologica (Stockholm, Sweden)*, **53** (4),539–46.
7. [Topkan, E](http://www.ncbi.nlm.nih.gov/pubmed?term=Topkan%20E%5BAuthor%5D&cauthor=true&cauthor_uid=24035331)., [Parlak, C](http://www.ncbi.nlm.nih.gov/pubmed?term=Parlak%20C%5BAuthor%5D&cauthor=true&cauthor_uid=24035331). and [Selek, U](http://www.ncbi.nlm.nih.gov/pubmed?term=Selek%20U%5BAuthor%5D&cauthor=true&cauthor_uid=24035331). (2013).Impact of weight change during the course of concurrent chemoradiation therapyon outcomes in stage IIIB non-small cell lung cancer patients: retrospectiveanalysis of 425 patients. International Journal of Radiation Oncology BiologyPhysics. 87(4), 697-704.
8. MacDonald, N., Easson, A., Mazurak,V., Dunn, G. and Baracos, V., (2003). Understanding and managing cancercachexia. *Journal of the American College of Surgeons*, **197** (1), 143–61.
**9.**Theologides, A., (1979). Cancer cachexia. *Cancer*,**43** (5 Suppl), 2004–2012.
**10.**Wallengren, O., Lundholm, K. and Bosaeus, I., (2013).Diagnostic criteria of cancer cachexia: relation to quality of life, exercisecapacity and survival in unselected palliative care patients. *Supportivecare in cancer : official journal of the Multinational Association ofSupportive Care in Cancer*, **21**(6),1569–77.
**11.**Huhmann MB, August DA. Review ofAmerican society for parenteral and enteral nutrition (ASPEN) clinical guidelines fornutrition support in cancer patients: Nutrition screening andassessment. Nutr Clin Pract. 2008;23:182–8.
**12.**Roulston, McDermott R (2009).Comparison ofthree validated nutritional screening tools in the oncology setting, ClinicalOncology, 15, 443-50.
**13.**[Ushashree Das](http://www.ncbi.nlm.nih.gov/pubmed/?term=Das%20U%5Bauth%5D), [Shilpa Patel](http://www.ncbi.nlm.nih.gov/pubmed/?term=Patel%20S%5Bauth%5D), [Kalpana Dave](http://www.ncbi.nlm.nih.gov/pubmed/?term=Dave%20K%5Bauth%5D), and [Ronak Bhansali](http://www.ncbi.nlm.nih.gov/pubmed/?term=Bhansali%20R%5Bauth%5D). Assessment ofnutritional status of gynecological cancer cases in India and comparison ofsubjective and objective nutrition assessment parameters South Asian J Cancer.2014 Jan-Mar; 3(1): 38–42.
14. M Shirodkar, K MMohandas. Subjective global assessment: a simple and reliable screening toolfor malnutrition among Indians. Indian J Gastroenterol 2005;24:246-250.Preoperative Nutritional Assessment in Elderly Cancer Patients UndergoingElective Surgery: MNA or PG-SGA?; [IndianJournal of Surgery](http://link.springer.com/journal/12262); 10.1007/s12262-012-0780-5.
**15.**World Health Organization (1997) Measuring quality of life. <http://www.who.int/mental_health/media/68.pdf> (Accessed on 6January 2015)
**16.**Sanz Ortiz J, Moreno Nogueira JA,GarcÃa de Lorenzo y Mateos A. Protein energy malnutrition (PEM) in cancerpatients. Clin Transl Oncol 2008 Sep;10(9):579-582.
**17.**Isenring E, Bauer J, Capra S. Thescored Patient-generated Subjective Global Assessment (PG-SGA) and itsassociation with quality of life in ambulatory patients receiving radiotherapy.Eur J Clin Nutr 2003 Feb;57(2):305-309.
18. Schlettwein-Gsell D. Nutrition andthe quality of life: a measure for the outcome of nutritional intervention? AmJ Clin Nutr 1992;55:1263S–1266S.
19. Aaronson NK, Ahmedzai S, Bergman B, Bullinger M,Cull A, Duez NJ, et al. The European Organization for Research and Treatment ofCancer QLQ-C30: a quality-of-life instrument for use in international clinicaltrials in oncology. J Natl Cancer Inst 1993 Mar;85(5):365-376.
20. Cella DF, Lloyd SR, Wright BD. Cross-culturalInstrument Equating: Current Research and Future Directions. 1992: 707-715.
21. WestinT, Jansson A, Zenckert C, Ha¨ llstro¨m T, Edstro¨m S. Mental depression isassociated with malnutrition in patients with head and neck cancer. ArchOtolaryngol Head Neck Surg 1988;114:1449–1453.
22. Thoresen, L. Frykholm, G., Lydersen, S., Ulveland, H., Baracos, V., Birdsell, L.,Falkmer, U., (2012). The association ofnutritional assessment criteria with health-related quality of life in patientswith advanced colorectal carcinoma. *European journal of cancer care*, **21**(4), 505–16.
23. Gupta D, Lis CG, Granick J, et al (2006). Malnutritionwas associated with poor quality of life in colorectal cancer: a retrospectiveanalysis. *J Clin Epidemiol*, **59**, 704-9.
24. Nourissat A, Vasson M, Merrouche Y, et al (2008).Relationship between nutritional status and quality of life in patients withcancer. *Eur J Cancer*, **44**, 1238-42.
25. Lis, C., Gupta, D., Lammersfeld, C.,Markman M. and Vashi, P., (2012). Roleof nutritional status in predicting quality of life outcomes in cancer – asystematic review of the epidemiological literature. *Nutrition Journal,* **11**,27.
26. Bansal, M., Mohanti, B.K., Shah, N., Chaudhry, R., Bahadur, S. and Shukla,N.K. (2004). Radiation related morbidities and their impact on quality of lifein head and neck cancer patients receiving radicalradiotherapy. *Quality of Life Research*,**13**, 481–488.
27. [Chaukar](http://www.indianjcancer.com/searchresult.asp?search=&author=DA+Chaukar&journal=Y&but_search=Search&entries=10&pg=1&s=0), D. A., [Das](http://www.indianjcancer.com/searchresult.asp?search=&author=AK+Das&journal=Y&but_search=Search&entries=10&pg=1&s=0), A.K., [Deshpande](http://www.indianjcancer.com/searchresult.asp?search=&author=MS+Deshpande&journal=Y&but_search=Search&entries=10&pg=1&s=0), M.S., [Pai](http://www.indianjcancer.com/searchresult.asp?search=&author=PS+Pai&journal=Y&but_search=Search&entries=10&pg=1&s=0), P.S., [Pathak](http://www.indianjcancer.com/searchresult.asp?search=&author=KA+Pathak&journal=Y&but_search=Search&entries=10&pg=1&s=0), K.A., [Chaturvedi](http://www.indianjcancer.com/searchresult.asp?search=&author=P+Chaturvedi&journal=Y&but_search=Search&entries=10&pg=1&s=0), P., [Kakade](http://www.indianjcancer.com/searchresult.asp?search=&author=AC+Kakade&journal=Y&but_search=Search&entries=10&pg=1&s=0), A.C., [Hawaldar](http://www.indianjcancer.com/searchresult.asp?search=&author=RW+Hawaldar&journal=Y&but_search=Search&entries=10&pg=1&s=0), R.W. and [DCruz](http://www.indianjcancer.com/searchresult.asp?search=&author=AK+DCruz&journal=Y&but_search=Search&entries=10&pg=1&s=0) A.K., (2005). Quality of life of head and neckcancer patient: Validation of the European organization for research andtreatment of cancer QLQ-C30 and European organization for research andtreatsment of cancer QLQ-H&N35 in Indian patients. *Indian Journal of Cancer*, **42**(4), 178 – 184.
28. Parmar, V., Badwe, R. A., Hawaldar,R., Rayabhattanavar, S., Varghese, A., Sharma,R. and Mittra, I. (2005). Validation of EORTC quality-of-life questionnaire in Indian women withoperable breast cancer. *NationalMedical Journal of India*, **18**(4). 172-177.
29. Mohan,A., Singh, P., Singh, S., Goyal, A., Pathak, A., Mohan, C. and Guleria R.(2007).Quality of life in lung cancer patients: impact of baseline clinicalprofile and respiratory status, *EuropeanJournal of Cancer Care,* **16**,268–276.
30. World Health Organization(2008). The Global Burden of Disease: 2004 Update. Geneva:World HealthOrganization.
31. Ferlay J, Soerjomataram I,Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D. and Bray,F. (2012). GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARCCancerBase No. 11 [Internet]. Lyon, France: International Agency for Researchon Cancer; 2013. Available from: http://globocan.iarc.fr. Retrieved on August05, 2014.
32. Indian Council ofMedical Research, National Cancer Registry Programme 2003-2008. Available at:http://www.ncrpindia.org/cancer\_atlas\_india/chapter4\_1.htm. Accessed on 2January 2015.
33. Braun, T. and Marks, D., (2010). Pathophysiology andtreatment of inflammatory anorexia in chronic disease. *Journal of Cachexia Sarcopenia Muscle.***1** (2), 135–45.
34. Fearon,K., Strasser, F., Anker, S., Bosaeus, I., Bruera, E., Fainsinger, R., Jatoi,A., Loprinzi, C., MacDonald, N., Mantovani, G., Davis, M., Muscaritoli, M.,Ottery, F., Radbruch, L., Ravasco, P., Walsh, D., Wilcock, A., Kaasa, S. andBaracos, V., (2011). Definition and classification of cancer cachexia: aninternational consensus. *The lancet oncology*, **12** (5), 489–95.
35. Tisdale, M., (2004). Tumor-host interactions. *Journal ofCell Biochemistry*, **93** (5),871–877.
36. Tisdale, M., (2002). Cachexia in cancerpatients. *Nature Reviews Cancer*, **2**,862–871.
37. MacDonald,N., Easson, A., Mazurak, V., Dunn, G. and Baracos, V., (2003). Understandingand managing cancer cachexia. *Journal of the American College of Surgeons*,**197** (1), 143–61.
38. Theologides, A., (1979). Cancer cachexia. *Cancer*, **43** (5 Suppl), 2004–2012.
39. Young,V., (1977). Energy Metabolism and Requirements in the Cancer Patient. *CancerResearch.* **37**, 2336–2347.
40. Dhanapal, R., Saraswathi, T. and Rajkumar,N., (2011). Cancer cachexia. *Journal of Oral Maxillofacial Pathology*, **15**, 257–60.
41. DeWys, W.,(1986). Weight loss and nutritional abnormalities in cancer patients:Incidence, severity and significance. In: Calman, K. and Fearon, K.(ed). Clinics in Oncology. Vol. 5. London: Saunders. pp. 251–61.
42. Tisdale,M., (2009). Mechanisms of cancer cachexia. *PhysiologicalReviews*. **89** (2), 381-410.
43. Acharya, S.and Guttridge, D., (2007). Cancer cachexia signaling pathways continue toemerge yet much still points to theproteasome. *Clinical Cancer Research**.***13**, 1356-1361.
44. Gordon, J., Green, S. and Goggin P., (2005). Cancercachexia. *QJM: An InternationalJournal of Medicine.* **98** (11),779–88.
45. Detsky AS,McLaughlin JR & Baker JP et al. (1987). What is subjectiveglobal assessment of nutritional status? J Parenteral InteralNutr ; 11: 8−13.
46. Ottery,F., (1994). Cancer cachexia: prevention, early diagnosis and management. CancerPractice, 2, 123-131.
47. Marin Caro, M., Laviano, A. andPichard C., (2007). Impact of nutrition on quality of life during cancer. *Current Opinion Clinical NutritionMetabolism Care*, **10**, 480–487.
48. Fayers,P., Aaronson, N., Bjordal, K., Groenvold, M., Curran, D. and Bottomley, A.,(2001). EORTC Quality of Life Group. The EORTC QLQ-C30 Scoring Manual (3rdEdition).
49. CapuanoG, Gentile PC, Bianciardi F, Tosti M, Palladino A, Di Palma M: Prevalence andinfluence of malnutrition on quality of life and performance status in patientswith locally advanced head and neck cancer before treatment. Support CareCancer 2010, 18:433–437.
50. Durnin,J. and Womersley, J. (1974). Body fat assessed from the total body density andits estimation from skin fold thickness: measurements on 481 men and women agedfrom 16 to 72 years. British Journal of Nutrition, 32, 77-97.
51.[Satija A](http://www.ncbi.nlm.nih.gov/pubmed?term=Satija%20A%5BAuthor%5D&cauthor=true&cauthor_uid=22680313), [Taylor FC](http://www.ncbi.nlm.nih.gov/pubmed?term=Taylor%20FC%5BAuthor%5D&cauthor=true&cauthor_uid=22680313), [Khurana S](http://www.ncbi.nlm.nih.gov/pubmed?term=Khurana%20S%5BAuthor%5D&cauthor=true&cauthor_uid=22680313), [Tripathy V](http://www.ncbi.nlm.nih.gov/pubmed?term=Tripathy%20V%5BAuthor%5D&cauthor=true&cauthor_uid=22680313), [Khandpur N](http://www.ncbi.nlm.nih.gov/pubmed?term=Khandpur%20N%5BAuthor%5D&cauthor=true&cauthor_uid=22680313), [Bowen L](http://www.ncbi.nlm.nih.gov/pubmed?term=Bowen%20L%5BAuthor%5D&cauthor=true&cauthor_uid=22680313), [Prabhakaran D](http://www.ncbi.nlm.nih.gov/pubmed?term=Prabhakaran%20D%5BAuthor%5D&cauthor=true&cauthor_uid=22680313), [Kinra S](http://www.ncbi.nlm.nih.gov/pubmed?term=Kinra%20S%5BAuthor%5D&cauthor=true&cauthor_uid=22680313), [Reddy KS](http://www.ncbi.nlm.nih.gov/pubmed?term=Reddy%20KS%5BAuthor%5D&cauthor=true&cauthor_uid=22680313), [Ebrahim S](http://www.ncbi.nlm.nih.gov/pubmed?term=Ebrahim%20S%5BAuthor%5D&cauthor=true&cauthor_uid=22680313). (2012) Differences in consumptionof food items between obese and normal-weight people in India. National MedicalJournal of India Volume 25 (1), pp 10-13.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- Not Yet Recruiting
- Sex
- All
- Target Recruitment
- 120
- •Adult, age 18 years and above.
- •Suffering from cancer and receiving palliative care management.
- •Incapable to provide written consent.
- •Patients with known psychological disorder or having brain tumor or metastasis.
Study & Design
- Study Type
- Observational
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method To study the correlation between nutritional status and quality of life in adult palliative cancer patients. Eligible cancer patients attending Palliative Care clinic will be recruited and assessed once only.
- Secondary Outcome Measures
Name Time Method To determine the level of malnutrition in adult palliative cancer patients. SINGLE POINT
Trial Locations
- Locations (1)
AIIMS New Delhi
🇮🇳South, DELHI, India
AIIMS New Delhi🇮🇳South, DELHI, IndiaDR RAKESH GARGPrincipal investigator9810394950drrgarg@hotmail.com