Weight loss and nutritional deterioration are associated with adverse
outcomes in terms of cancer prognosis (response rate and survival) as
well as increased complications, prolonged hospitalizations, increased
risk of unplanned hospitalization, increased disability, and increase
d overall cost: of care. The nutritional oncology service at Fox Chase
Cancer Center defined a proactive, standardized assessment and interv
entional approach from 1987-1994. In 186 consecutive patients referred
to the nutrition clinic and managed solely by oral intervention and a
ggressive symptom management, the team demonstrated a 50%-80% success
rate in getting patients to maintain or gain weight during therapy, wi
th a similar success in maintaining or improving visceral protein stat
us as determined by serum transferrin and/or albumin. Evaluation of th
e home parenteral nutrition program (n = 65, from 1987-1993) demonstra
ted similar success when appropriate triaging was carried out, with 58
% of patients able to be tapered off parenteral nutrition (PN) entirel
y or with transition to enteral tube feeding. The assessment of succes
s for a nutritional intervention (e.g., a disease-specific nutritional
supplement) requires the standardization of definitions,assessment to
ols, criteria for nutritional intervention, and appropriate end points
for the assessment of outcomes. The Patient-Generated Subjective Glob
al Assessment of nutritional status is used in conjunction with the nu
tritional risk of planned cancer therapy to define a standardized inte
rventional approach in oncology patients, which can be used in clinica
l practice, cooperative oncology group protocols, and clinical trials
of nutritional intervention regimens.