The incidence of malnutrition in cancer patients is as high as 80.4%, with moderate to severe malnutrition accounting for 58.2%. According to a survey conducted by the Oncology Nutrition and Supportive Care Committee of the Chinese Anti-Cancer Association, nearly two-thirds of cancer patients in China experience varying degrees of malnutrition. Among patients who die from cancer, the incidence of malnutrition is nearly 100%.
l What causes malnutrition in cancer patients?
l What are the dangers of malnutrition in cancer patients?
l Why is nutritional risk screening important?
Foresea Yihe International Medical Center will officially launch the Comprehensive Cancer Treatment Center on December 27, with specialized departments to be established gradually. In the future, the center will adopt a personalized and integrated treatment model for both comprehensive and specialized cancer care.
As a key discipline, the Department of Cancer Metabolism and Internal Medicine will focus on medical management of malignant bowel obstruction, therapeutic interventions for cancer-related cachexia, and pharmacological interventions for cancer-related malnutrition.
Expert Insights: Dr. Duge from the Department of General Medicine
Uncover the hidden health risks behind malnutrition in cancer patients.
l What causes malnutrition in cancer patients?
Cancer, as a wasting disease, causes cancer cells to consume the patient's own nutrients during their growth, leading to malnutrition. The core causes of malnutrition in cancer patients can be summarized into three main categories:
The body, burdened by tumor tissue, experiences metabolic disturbances in energy and nutrient utilization. This involves both the patient's body and the abnormal metabolic characteristics of the tumor tissue itself. As a result, most malnourished cancer patients suffer from "protein-energy malnutrition (PEM)", accompanied by metabolic disturbances in all three macronutrients.
Cancer patients undergoing surgery, chemotherapy, radiation therapy, and other treatments may experience direct or exacerbated malnutrition. Some anticancer agents also cause gastrointestinal side effects such as vomiting and diarrhea, leading to reduced appetite and insufficient nutrient intake.
The presence of multimorbidity leads to a nutrient deficiencies and imbalances in the body, creating a mismatch with the body's nutritional needs. This involves three key factors: imbalanced intake, nutrient malabsorption, and increased consumption.
For cancer patients, malnutrition is not only an undesirable consequence but also a key factor that worsens disease progression and negatively impacts prognosis. It significantly impacts the patient’s quality of life and psychological well-being.
l What are the dangers of malnutrition in cancer patients?
Malnutrition in cancer patients, coupled with metabolic disturbances, not only affects their quality of life but also interferes with prognosis and potentially shortens survival. The main impacts can be summarized in the following four areas:
Malnutrition can affect the tolerance to cancer treatments. For example, patients undergoing chemotherapy and radiation therapy are prone to side effects such as anorexia, oral mucositis, and others after treatment. Moreover, postoperative wound healing in cancer patients is slower.
Malnutrition leads to a weakened immune system, making patients more susceptible to infections, which increases the risk of complex infections. As organ function and cellular activity gradually decline, severe complications such as renal impairment may emerge.
adipose tissue, leading to weight loss and even the development of sarcopenia. This leads to weakness, fatigue, and the gradual inability to care for oneself, ultimately interfering with the patient's survival.
Malnutrition causes deficiencies in nutrients such as vitamin D, magnesium, and B vitamins, which can exacerbate cancer-related pain and significantly increase the psychological burden, leading to depression and anxiety.
Proper nutritional support for cancer patients can prevent the worsening of malnutrition. Before formulating a scientific nutrition plan, it is crucial to assess the patient’s nutritional status, identify malnutrition issues early, and intervene promptly for treatment.
l PG-SGA Cancer Patient Nutritional Assessment
For cancer patients, the PG-SGA (Patient-Generated Subjective Global Assessment) is commonly used for nutritional evaluation. It consists of two main parts: the patient self-assessment and the healthcare provider assessment. The assessment covers seven key areas: weight, dietary intake, symptoms, activity and physical function, relationship between disease and nutritional needs, metabolic demands, and physical examination.
The specific assessment items are as follows:
PG-SGA Nutritional Assessment
Patient Self-Assessment Form
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1/体重（表）weight(table) My current weight is approximately: · Decreased · Remained the same · Increased Score for this section:
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2/进食情况 Dietary Intake In the past month, compared to my usual eating habits: l No change (0) l Increased intake (0) l Decreased intake (1) My current eating condition: l Normal diet, but less than usual (1) l Soft diet (2) l Full liquid diet (3) l Restricted to oral nutritional supplements (3) l Hardly able to eat anything (4) l Dependent on enteral or parenteral nutrition (0) Score for this section: |
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3/症状Symptoms In the past two weeks, I have experienced the following issues that affected my ability to consume enough food: l Loss of appetite, reluctance to eat (3) l Vomiting (3) l Diarrhea (3) l Dry mouth (1) l Aversion to food odors (1) l Early satiety (1) l No issues with eating (0) l Nausea (1) l Constipation (1) l Oral ulcers (2) l Altered taste perception (1) l Difficulty swallowing (2) l Pain: (Specify location) (3) l Other: (Depression, financial problems, dental issues) (1) Score for this section:
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1/活动和身体功能（表）Activities and Physical Functions (Table) In the past month, my activity level was: l Normal, no restrictions (0) l Not as usual, but still able to get up and do light activities (1) l Limited mobility, remained in bed or a chair for less than half a day (2) l Hardly able to do anything, spent most of the day in bed or in a chair (3) l Almost completely bedridden, unable to get up (3) Score for this section:
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PG-SGA Nutritional Assessment
Medical Staff Assessment Form
5. the relationship between disease and nutritional needs(Single or multiple-choice selection with cumulative scoring)
Relevant Diagnosis (Pending): Age: ___ years
Primary Disease Stage (if known or applicable): Ⅰ Ⅱ Ⅲ Ⅳ
Other:
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Table 2: Disease and Nutrition Relationship |
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Diseases: |
Rating |
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Cancer |
1 |
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AIDS |
1 |
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Cachexia due to respiratory or heart disease |
1 |
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Presence of open wounds, intestinal fistula, or pressure ulcers |
1 |
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Trauma |
1 |
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Age over 65 |
1 |
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Total Score: |
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6. metabolic requirements
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Table 3: Medical Staff Assessment – Stress Score |
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Stress |
None(0 points) |
Mild (1 point) |
Moderate (2 points) |
Severe (3 points) |
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Fever |
None |
37.2–38.3°C |
38.2–38.8°C |
> 38.8°C |
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Duration of Fever |
None |
<72h |
72h |
>72h |
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Use of Steroids (Prednisone) |
None |
Low dose (<10mg prednisone or equivalent/day) · |
Medium dose (10–30mg prednisone or equivalent/day) |
High dose (>30mg prednisone or equivalent/day) |
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Total Score: |
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7. physical examination(Partial)
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Table 4: Medical Staff Assessment – Physical Examination |
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Items |
Normal (0 points)· |
Mild (1 point) |
Moderate (2 points) |
Severe (3 points) |
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· Fat Reserves · Orbital fat pad · Triceps skinfold thickness · Subcostal fat thickness · Overall fat depletion level · Muscle Condition · Abdomen (abdominal muscles) · Clavicular area (pectoralis major) · Shoulder (deltoid) · Interosseous muscles · Scapular area (latissimus dorsi, trapezius, and deltoid) · Thigh (quadriceps) · Calf (gastrocnemius) · Overall muscle wasting score · Fluid Status · Ankle edema · Foot edema · Ascites
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Overall edema score |
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Total Score |
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For cancer patients, targeted and symptom-based treatment is certainly important, but nutrition, as the foundation for maintaining physiological functions, is equally indispensable. Cancer patients should undergo nutrition risk screening within 24 hours of admission, so that doctors can more accurately assess the patient's nutritional status and develop an appropriate nutritional treatment plan.
