Factors Influencing Nutrition Impact Symptoms in Outpatients with Advanced Cancer in Palliative Care: A Longitudinal Analysis

Abstract

Introduction:

Nutrition impact symptoms (NIS) are defined as symptoms that may adversely affect an individual’s health and increase the risk of malnutrition and adverse clinical outcome.

Objective:

To examine factors associated with longitudinal changes in the number of NIS over time in outpatients with advanced cancer receiving oral nutritional supplements (ONS) or enteral nutrition (EN).

Methods/Approach:

This prospective longitudinal study included adults with advanced cancer referred for exclusive palliative care at a national cancer center in Brazil. NIS was assessed using the Patient-Generated Subjective Global Assessment Short Form. Generalized estimating equations (GEE) were used to model changes in the number of NIS across three time points: baseline (T0), a median of 23 days (T1), and a median of 49 days (T2). Explanatory variables included demographic, clinical, inflammatory, and functional parameters.

Results:

A total of 244 patients were included in the analysis (69.7% ≥60 years; 50.4% women). The most common primary tumor sites were head and neck (32.4%), upper gastrointestinal (18.0%), and gynecological cancers (13.9%). At baseline, 78.3% had ≥1 NIS. The prevalence of most NIS decreased significantly from T0 to T1, with no additional reductions from T1 to T2. In the multivariable GEE model, factors independently associated with a reduction in the number of NIS over time included receiving ONS rather than EN (β = –0.441; p < 0.001), higher Karnofsky Performance Status (β = –0.113; p < 0.001), and higher serum albumin values (β = –0.120; p = 0.049). Reductions in NIS were also associated with improvements in global quality of life.

Conclusion:

In outpatients with advanced cancer starting exclusive palliative care, the route of nutritional support, functional status, and albumin levels were independently associated with changes in NIS over time. These findings underscore the importance of early, individualized, and multimodal nutritional strategies to support symptom management.