COLUMBUS, OhioA large research study has validated a short
questionnaire for cancer patients designed to assess nutritional risk
and to establish a triage system for intervention, Faith Ottery, MD,
PhD, president of Ottery & Associates, Oncology Care Consultants,
said at the Fourth Annual Congress of the Society for Nutritional
Oncology Adjuvant Therapy (NOAT). Dr. Ottery founded NOAT in 1993.
The study, sponsored by NOAT, showed the effectiveness of the
Patient-Generated Subjective Global Assessment (PG-SGA) as an
inexpensive, easy-to-use tool for nutritional assessment. The
volunteer research study, begun in 1996, included nearly 2,000
patients from 33 sites. Patients with various cancers, as well as
patients with chronic renal failure, were included.
The one-page PG-SGA includes questions for the patient regarding
weight change, food intake, participation in activities of daily
living, and symptoms that have prevented the patient from eating
well. The clinician scores each section of the questionnaire and adds
those scores together.
The scores are used to evaluate nutritional risk and to assign the
patient to one of four intervention pathways: no intervention;
patient education and, if necessary, symptom management; aggressive
oral nutrition; and enteral/parenteral nutrition triage with an
Although 60% of patients who completed the PG-SGA reported no
problems eating, 55% of this group checked off one or more nutrition
impact symptoms on the questionnaire, including mouth sores,
constipation, pain, and nausea. Notably, both patients and
clinicians rarely think of such symptoms as affecting nutrition,
Dr. Ottery said. The PG-SGA scoring system, however, considers
the presence of these symptoms in its evaluation.
Overall, the majority of nurses and dietitians who participated in
the study agreed with the interventions recommended to patients based
on their PG-SGA scores. One area of substantial disagreement,
however, concerned patients who received high scores.
A high score indicated the need for aggressive nutritional
intervention. Thirty-two percent of clinicians disagreed with
this triage score and noted that they believed high-scoring patients
need better symptom management rather than nutritional
intervention, Dr. Ottery said. As a result, additional emphasis
on symptom management was added to the intervention pathways.
The PG-SGA is widely used by members of the Oncology Nursing
Society and has been accepted as the standard for oncology patients
by the American Dietetics Association, Dr. Ottery said.