This study assessed the nutritional status of cancer outpatients receiving treatment at two cancer treatment centers in Nairobi Kenya using scored PGSGA tool. Results revealed that 31% of the patients were undernourished (11.3% severely malnourished and 19.7% moderately malnourished). The findings show a statistically significant difference in nutrition status with more males (54.7%) than females (45.3%) reported to be severely malnourished (p < 0.001). There was a statistically significant (p < 0.001) difference in nutrition status among patients with different cancer stages with more stage 4 patients being moderately and severely malnourished than patients in other stages. A mean(SD) PGSGA Score of 6.79(5.17) was established and this indicated that nearly all patients require symptom management as indicated in the Ottery guidelines . When categorized based on the type of intervention the second highest proportion (33.8%) of participants required critical nutrition care (Score > 9).
Results revealed that 31% of the patients were undernourished (11.3% severely malnourished and 19.7% moderately malnourished). Malnutrition has been known to occur mostly as a comorbidity among cancer patients with an estimated prevalence of 20–80% [2, 3, 13]. Combined effects of the cancer and treatment option often predispose cancer participants to nutrient depletion and inadequate food intake resulting in poor nutritional profiles [14,15,16].
Results from our study were consistent with those from an Australian study which showed that 17% of cancer outpatients were severely malnourished based on an assessment carried out using subjective global assessment . Although showing a slightly lower prevalence, our results were also consistent with findings from a study carried out among elderly cancer patients which showed that 14.6% of participants were severely malnourished . PGSGA is used as an assessment tool that better identifies established malnutrition than nutritional risk . In Kenya, malnutrition remains a challenge among cancer outpatients in Kenya because most of the nutrition interventions are carried out among cancer inpatients . A study carried out among cancer patients established that only 18% of cancer outpatients reported to have received nutrition services . Majority of these patients have limited information on appropriate nutrition practices during cancer treatment and rely on myths and misconceptions that later influence dietary intake resulting to poor nutrition status. As much as Kenya is faced with these challenges compared to the developed world, this study provides opportunities that can be tapped into to improve nutritional outcomes for cancer patients. For instance, there is need to scale up nutrition interventions for cancer outpatients, develop appropriate guidelines for managing side effects of treatment and promoting better practices among cancer patients especially while they are at home. There is also need for appropriate education and counselling for caregivers of these patients to prevent malnutrition.
The findings show a significant difference in nutrition status with more males (54.7%) than females (45.3%) reported to be severely malnourished (p < 0.001). In Kenya, among male cancer patients, majority suffer from prostate, oesophageal and colorectal cancer compared to women who present with breast and cervical cancer . Studies have revealed that digestive organ cancers; Oesophageal, Colorectal and Stomach cancer present a higher risk of malnutrition compared to cancers related to reproductive system  hence men in Kenya are more likely to suffer malnutrition compared to women on the basis of cancer type. In addition, men are more likely to experience severe effects from cancer compared to women because of their poor health seeking behaviors; they often seek for medical attention at a later stage when the damage is already done . Moreover, the Kenya Demographic Health Survey indicates that one third (33%) of women in Kenya are overweight and obese with only 9% undernourished  hence lower cases of severe malnutrition in women compared to men. Therefore, there is need for nutritionists managing cancer patients to continuously offer nutrition support, nutrition education, counselling and follow up of male cancer patients. There is also need to carry out training, provide information to empower male cancer patients on the role of nutrition therapy in improvement of treatment outcomes.
Our findings show that stage 4 patients were significantly (p < 0.001) moderately and severely malnourished compared to patients in the other stages. Our findings concur with results from a study carried in Korea among hospitalized cancer patients with advanced stages (60.5%) who had a higher prevalence of malnutrition than other patients (p < 0.0001). Similarly, patients with digestive organ and lip cancers had higher levels of under nutrition compared to those with breast and cancers that affect female reproductive organs. Studies have shown that participants with lip/oral cancers report highest levels of malnutrition  hence need for timely nutrition intervention among these patients. Most of these patients experience dysphagia hence consume less food especially in cases where enteral or parenteral modes of feeding have not been initiated. In a similar study among 498 participants with advanced GI cancers in Beijing, results identified that 54% required improved nutrition support with PGSGA score of ≥9 . Evidence has shown that the prevalence of malnutrition depends on the type, location, stage of tumor, and type of treatment used [7, 25]. Our findings concur with a study carried out to determine factors influencing nutrition status among cancer patients which indicated that malnutrition is related to type and site of origin of tumor and in early stages of disease is more pronounced in patients with oesophagus and stomach cancer . In addition the same study showed that malnutrition gets more severe as the disease progresses to advanced stages except for breast and cervical cancer . Another study among women with female genital tumors showed no significant difference in nutrition status by PGSGA according to different cancer stages . In settings with limited dieticians as Kenya, provision of systems and guidelines for malnutrition based on the cancer type will be ideal. There is need to promote early diagnosis of malnutrition and create awareness on management of cancer and treatment side effects that lead to undernutrition among cancer patients for effective outcomes.
A PGSGA Score of 6.79 (5.17) in the findings is an indication that nearly all patients require symptom management as indicated in the Ottery guidelines . When categorized based on the type of intervention the second highest proportion (33.8%) of participants require critical nutrition care (Score > 9). A similar study carried out in India among cancer participants showed that 35.7% of participants had PG-SGA score between 4 and 8 hence require intervention by dietitian; 20% had score > 9 hence recommended critical nutritional intervention . The scored PGSGA tool is unique such that it helps identify malnourished hospital participants as well as give guidelines for triaging patients for nutrition intervention. Additionally, the score helps identify impact of symptoms on nutrition status of the participants which in turn impacts on treatment outcomes and prognosis therefore highly recommended for use in decision making on appropriate nutrition care processes for cancer patients .
PGSGA tool being subjective, relies heavily on information reported by the patients especially on dietary history and changes in the physiological state of the patients in the past 2 weeks and 1 month. One of the study limitations was the recall bias where some patients could not recall changes in their dietary practices in the past 1 month or past 2 weeks, and in a few circumstances the weight history. In such scenarios, research assistants probed for more and sought clarification from caregivers where necessary. In addition, information on patient’s weight history was extracted from medical records. In cases where the information was missing, reported weight by the patients was used.