Department of Nutrition, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China.
Department of Nutrition, Tianjin Nankai Hospital, Tianjin, China.
Nutr Cancer. 2022;74(1):168-174. doi: 10.1080/01635581.2021.1882510. Epub 2021 Feb 11.
The incidence of nutritional risk and malnutrition are high in patients with cancer pain. It is very important to choose an effective tool to identify these patients promptly. However, few studies have discussed this issue. The primary objective of this study is to clarify the similarities and differences between the two nutritional screening and assessment tools, and to estimate the anthropometry and biochemical indicators of the patients with cancer pain, with a view to provide help for treatment of these patients.
Data of 146 patients with cancer pain were collected from August 2018 to May 2019 in the Pain Therapy Department of Tianjin Cancer Hospital. The information of numerical rating scale (NRS), nutritional risk screening-2002 (NRS-2002), patient-generated subjective global assessment (PG-SGA), anthropometry and biochemical indicators were collected for pain assessment, nutritional risk screening, and nutritional status assessment.
NRS scores had a positive correlation with NRS-2002 ( = 0.273, = 0.001) and PG-SGA ( = 0.341, = 0.000) separately. NRS-2002 and PG-SGA had a significant positive correlation with each other ( = 0.468, = 0.000). NRS-2002 was finished in a shorter time period (4.2 ± 0.8 min vs. 12.8 ± 0.8 min, = 0.001), while PG-SGA had a higher detection rate of malnutrition (86.3% vs. 65.8%). In the stepwise multiple regression analysis, NRS (0.258, = 0.001), PA (-0.297, = 0.000), TP (0.178, = 0.030) are the indicators of NRS-2002; and NRS (0.317, = 0.000), PA ( = 0.288, = 0.000) and BMI (-0.281, = 0.000) are the related variables of PG-SGA. The kappa coefficient was lower than 0.4 (kappa value = 0.396) when choosing the score of NRS-2002 ≥ 3 and PG-SGA ≥ 9 as the diagnostic criteria. If choosing the score of NRS-2002 ≥ 2 and PG-SGA ≥ 9, both the correlation coefficient ( = 0.699, = 0.000) and the kappa coefficient (kappa value = 0.698, = 0.000) became more coefficient.
Both NRS-2002 and PG-SGA could identify patients with nutritional risk and malnutrition accurately. NRS-2002 is simpler and takes less time to finish, while PG-SGA is more cumbersome with a higher detection rate of malnutrition. NRS, PA, TP and BMI are the most important reference indicators predicting on nutritional risk index and malnutrition status. We recommend NRS-2002 ≥ 2 as the diagnostic criteria in order to avoid missing the patients with nutritional risk.
癌症疼痛患者的营养风险和营养不良发生率较高，因此及时选择有效的工具识别这些患者非常重要。然而，很少有研究讨论这个问题。本研究的主要目的是阐明两种营养筛查和评估工具的异同，并估计癌症疼痛患者的人体测量和生化指标，以期为这些患者的治疗提供帮助。
2018 年 8 月至 2019 年 5 月，在天津市肿瘤医院疼痛治疗科收集了 146 例癌症疼痛患者的数据。收集数字评分量表（NRS）、营养风险筛查 2002 版（NRS-2002）、患者主观整体评估（PG-SGA）、人体测量和生化指标信息，用于疼痛评估、营养风险筛查和营养状况评估。
NRS 评分与 NRS-2002（ = 0.273， = 0.001）和 PG-SGA（ = 0.341， = 0.000）分别呈正相关。NRS-2002 和 PG-SGA 之间存在显著正相关（ = 0.468， = 0.000）。NRS-2002 完成时间更短（4.2 ± 0.8 min 与 12.8 ± 0.8 min， = 0.001），而 PG-SGA 营养不良检出率更高（86.3% 与 65.8%）。在逐步多元回归分析中，NRS（0.258， = 0.001）、PA（-0.297， = 0.000）、TP（0.178， = 0.030）是 NRS-2002 的指标；NRS（0.317， = 0.000）、PA（ = 0.288， = 0.000）和 BMI（-0.281， = 0.000）是 PG-SGA 的相关变量。选择 NRS-2002≥3 分和 PG-SGA≥9 分作为诊断标准时，kappa 值低于 0.4（kappa 值=0.396）。如果选择 NRS-2002≥2 分和 PG-SGA≥9 分，相关系数（ = 0.699， = 0.000）和 kappa 值（kappa 值=0.698， = 0.000）都变得更高。
NRS-2002 和 PG-SGA 均可准确识别有营养风险和营养不良的患者。NRS-2002 更简单，完成时间更短，而 PG-SGA 则更繁琐，营养不良检出率更高。NRS、PA、TP 和 BMI 是预测营养风险指数和营养不良状况的最重要参考指标。为避免漏诊有营养风险的患者，建议将 NRS-2002≥2 作为诊断标准。
