Nutritional status assessed by Patient-Generated Subjective Global Assessment is associated with toxicity to chemoradiotherapy in women with cervical cancer: a prospective study

Abstract

Background: Patient-generated subjective global assessment (PG-SGA), a validated tool for nutritional assessment, has been associated with worse clinical outcomes in patients with cancer. However, studies assessing its relationship in chemoradiotherapy outcomes are scarce. The study aimed to determine the prevalence of malnutrition according to PG-SGA and its association with the incidence of toxicity to chemoradiotherapy treatment in women with cervical cancer. Methods: In a single-centre prospective observational study, we enrolled 391 women with locally advanced cervical cancer. Patients were assessed on the day of their first chemotherapy infusion, when nutritional status was evaluated by the PG-SGA form and anthropometric measurements. Sociodemographic and clinical data were also collected. Toxicity to chemoradiotherapy was assessed weekly and toxicity-induced modification of treatment (TIMT) was defined as any serious adverse event that resulted in treatment delay, interruption, or dose reduction. Multivariate mixed-effects Poisson and Logistic regression models were performed to identify the factors contributing to the outcome number of adverse events ≥ grade 3 and TIMT, respectively. Results: Malnutrition was found in 47.6% of the population. Roughly 1/3 had TIMT and 54.2% experienced at least one symptom ≥grade 3. In the adjusted models, PG-SGA B and C, as well as the score ≥9 were independent predictors of the number of toxicity events ≥grade 3 and higher incidence of TIMT. Conclusions: PG-SGA may represent an important assessment tool to predict toxicity outcomes in women with cervical cancer, besides being considered a simple, fast, and low-cost tool, which allows early nutritional care.