apjcc.waocp.

com G Hari Prakash, et al: Impact of Chemotherapy on Nutritional Status in Cancer Patients

DOI:10.31557/APJCC.2024.9.1.93 RESEARCH ARTICLE

Exploring Malnutrition Risk in Cancer Chemotherapy

Patients: An Assessment of Associated Factors in a Tertiary
Care Cancer Center
G Hari Prakash1, Sunil Kumar D1, Kiran PK2, Vanishri Arun3, Deepika Yadav1,
Arun Gopi1
1
Department of Community Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, India.
2
Department of Medical Oncology, JSS Medical College, JSS Academy of Higher Education and Research Mysuru, India.
3
Department of Information Science and Engineering, SJCE, JSS STU, Mysuru, India.

Abstract
Objective: This study aimed to assess the risk of malnutrition in cancer chemotherapy patients and identify
associated factors. Materials and methods: This cross-sectional study employed purposive sampling to collect
data from patients at a tertiary care cancer center. The study included 101 participants. Data was collected using
a malnutrition screening tool (MST) to assess the risk of malnutrition. Results: The majority of participants were
female (61.4%) and diagnosed with cancer in stage 3 or 4 (57.4% and 41.6%, respectively). Sixty-three point four
percent (63.4%) of participants reported unintentional weight loss during chemotherapy, and 60.4% were at risk
for malnutrition. Cancer stage was significantly associated with malnutrition risk, while other clinical variables
were not. Conclusion: Malnutrition is a significant issue among cancer chemotherapy patients in this study’s
population. The findings highlight the need for interventions to prevent and manage malnutrition in cancer patients.
This could potentially improve the effectiveness of cancer treatment, particularly within the Indian population.

Keywords: Cancer patients- Chemotherapy- Malnutrition- Risk assessment

Asian Pac J Cancer Care, 9 (1), 93-96 Submission Date: 09/07/2023 Acceptance Date: 01/25/2024

Introduction
Cancer is a major health issue worldwide, with India stays, and increased mortality rates [2, 3].
being no exception. Cancer incidence is increasing rapidly In India, malnutrition is a significant public health
in India, and it is estimated that there will be 1.7 million concern; it is estimated that more than 50% of cancer
new cancer cases by 2035 [1]. Chemotherapy is one of patients are malnourished [4]. Malnutrition in cancer
the primary treatment modalities used in cancer patients patients is a complex issue involving various factors,
and is associated with various adverse effects, including including socioeconomic status, lack of access to
malnutrition. adequate nutrition, cultural factors, and dietary habits. The
Malnutrition is a common complication in patients prevalence of malnutrition is particularly high in cancer
with cancer and can negatively affect the effectiveness patients from low-income and marginalized communities
of cancer treatment and quality of life. Various factors, [5].
such as loss of appetite, side effects of chemotherapy, and Despite the high prevalence of malnutrition among
cancer, can cause malnutrition. Malnutrition in cancer patients with cancer in India, there is limited research on
patients can lead to various adverse outcomes, including the assessment of malnutrition risk among cancer patients
decreased tolerance to chemotherapy, reduced response undergoing chemotherapy. Therefore, there is a need to
to treatment, increased risk of infections, longer hospital explore factors associated with malnutrition in cancer

Corresponding Author:
Dr. Sunil Kumar D
Professor and Head, Department of Community Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, India.
Email: [email protected]

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 apjcc.waocp.com G Hari Prakash, et al: Impact of Chemotherapy on Nutritional Status in Cancer Patients

chemotherapy patients in the Indian population. Table 1. Clinical Characteristics of the Study Participants
The rationale of this study is to identify the factors
Personal history n %
associated with malnutrition in cancer chemotherapy
patients. This study will help to understand the nutritional Stage of cancer
status and needs of cancer chemotherapy patients and to 3 58 57.40
provide appropriate nutritional interventions to improve 4 42 41.60
their treatment outcomes and quality of life. The current Type of tumour
study will contribute to the existing literature on Regional 4 4.00
malnutrition in cancer patients and provide evidence-based
Localized Metastasis 84 83.20
recommendations for policy and practice. The main
objective of the current study is to screen cancer patients Metastasis 13 12.90
undergoing chemotherapy for Malnutrition Risk. Comorbidities
Diabetes Mellitus 3 3.00
Materials and Methods Diabetes Mellitus & Cardio Vascular 3 3.00
Diseases
It is a Cross-sectional study. Purposive sampling was
Diabetes Mellitus & Hypertension 6 5.90
used to collect data from a tertiary care cancer in Mysuru
Hypertension 4 4.00
district, Karnataka, India. The sample size was determined
based on the prevalence of cancer in the district, which Nil 85 84.20
was 2% according to the ICMR-Hospital Based Cancer Treatment
Registry (HBCR) 2021. With a prevalence of 2%, Chemotherapy 67 66.30
absolute precision of 2.8%, and confidence interval of Surgery + Chemotherapy 15 14.90
5%, 97 participants were recruited for the current study.
Chemotherapy & Radiation 6 5.90
Considering a non-response rate of 5%, 101 samples
were required for the study. Data were collected over two Surgery + Chemotherapy + Radiation 13 12.90
months from the tertiary care hospital. This study adhered Type of Cancer
to the ethical standards outlined in the 1964 Declaration Acute leukaemia 6 5.90
of Helsinki and its later amendments. All procedures Carcinoma of breast 13 12.90
involving human participants were conducted following
Carcinoma of colon 2 2.00
the guidelines of the institutional ethical committee.
The study was approved by the Institutional Ethical Carcinoma of oesophagus 11 10.90
Committee (approval number: JSSMC/IEC/03072023). Carcinoma of leiomyosarcoma 3 3.00
Informed consent was obtained from each participant Carcinoma of lung 34 33.70
before the commencement of the study. Data were entered Carcinoma of ovary 5 5.00
into Microsoft Excel 2019 and analyzed using SPSS
Carcinoma of rectum 18 17.80
version 25 (IBM Corp, USA). Data analysis involved
Carcinoma of stomach 9 8.90
descriptive statistics in determining the frequency and
percentage of different needs, and the chi-square test Values are expressed as frequency and percentages.
was used to explore the associations between dependent
to socioeconomic class V (Rs 1050 and below).
and independent variables. Malnutrition risk assessment
Most of the participants in the current study had joint
was done using the Malnutrition Screening Tool (MST)
families (49.5%), followed by nuclear families (42.6%)
developed by Abbott Laboratories.
and three-generation families (7.9%).

Results Personal History and disease profile

Table 1 shows that most of the participants in the
Data were collected from a total of 101 participants.
current study were in 3rd stage of cancer (57.4%), and
Most participants in the current study were females
41.6% were in 4 th stage. Localized metastasis was
(61.4%), and 38.6% were men. Most participants in the
observed in 83.2% of the participants, whereas regional
current study belonged to the Hindu religion (92.1%),
tumours were observed in 4%. Comorbidities were absent
whereas only 4% belonged to Muslims and Christianity.
in most participants (84.2%), and hypertension and
Of the participants, 54.5% belonged to rural areas,
diabetes were observed in very few cases.
and 45.5% were from urban areas. Most participants in
The majority of participants were undergoing
the current study were illiterate (33.7%), and 12.9% had
chemotherapy (66.3%), followed by surgery +
a diploma or degree.
chemotherapy (14.9%), and triple therapy (surgery +
Most of the participants in the current study were
chemotherapy + radiation) (12.9 %).
semi-skilled (33.7%), and the least were unskilled
Of the participants, 33.7% had lung cancer, and 17.8%
(13.9%).
had rectal carcinoma, followed by breast carcinoma
The majority of the participants belonged to
(12.9%), oesophagal carcinoma (10.9%), and stomach
socioeconomic class II; that is, their income was
carcinoma (8.9%). Acute leukaemia was present in 5.9%
between 3504 -7007(INR), and the least (5%) belonged

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Table 2. Recent Weight Loss among the Study Participants

Have you recently lost weight without trying? N %
0.9 - 5.9 Kg 43 42.6
6.35 - 10.43 24 23.8
Values are expressed as frequency and percentages.

Table 3. Factors Associated with Malnutrition Risk in Chemotherapy Patients

Clinical characteristics MST Risk
NOT At Risk At Risk
N (%) N (%) Chi-square value p-value
Stage of cancer 3 21 (52.50) 37 (61.70) 1.828 0.04*
4 19 (47.50) 23 (38.30)
Diabetes Mellitus 0 (0.00) 3 (4.90) 6.306 0.177
Comorbidities Diabetes Mellitus & 0 (0.00) 3 (4.90)
Cardio Vascular Diseases
Diabetes Mellitus & Hypertension 3 (7.50) 3 (4.90)
Hypertension 3 (7.50) 1 (1.60)
Nil 34 (85.00) 51 (83.60)
Treatment Surgery 0 (0.00) 0 (0.00) 1.462 0.691
Chemotherapy 28 (70.00) 39 (63.90)
Radiation 0 (0.00) 0 (0.00)
Surgery & Chemotherapy 4 (10.00) 11 (18.00)
Chemotherapy & Radiation 3 (7.50) 3 (4.90)
Surgery + Chemotherapy + Radiation 5 (12.50) 8 (13.10)
Type of Cancer Acute leukaemia 1 (2.50) 5 (8.20) 12.296 0.138
Carcinoma of breast 6 (15.00) 7 (11.50)
Carcinoma of colon 1 (2.50) 1 (1.60)
Carcinoma of oesophagus 4 (10.00) 7 (11.50)
Carcinoma of leiomyosarcoma 2 (5.00) 1 (1.60)
Carcinoma of lung 11 (27.50) 23 (37.70)
Carcinoma of ovary 5 (12.50) 0 (0.00)
Carcinoma of rectum 8 (20.00) 10 (16.40)
Carcinoma of stomach 2 (5.00) 7 (11.50)
Values are expressed as frequency and percentage. The P-value is by chi-square test. A p-value of less than 0.05 is considered statistically significant.

of the participants. shows statistical significance. Other clinical variables did

not show any associations (Table 3).
Recent weight loss
In the current study, most participants experienced
weight loss (63.4%) without trying chemotherapy. Discussion
Of these, 42.6% had weight loss between 0.9 to 5.9 Kg,
and 23.8% had weight loss between 6.35 to 10.4 Kg The present study investigated the prevalence
(Table 2). of malnutrition among cancer patients undergoing
Of the participants, 56.4% reported that they had chemotherapy in rural and urban settings in India.
been eating poorly because of their decreased appetite. The results indicated that most participants experienced
The weight loss score of the participants was 2.09±1.6, weight loss without trying, with most reporting a poor
the appetite score was 0.57±0.4, and the malnutrition appetite. The malnutrition screening test score revealed
screening test score ranged from 0 to 5, with a mean of that the majority of the participants were at risk of
2.5±2.0. malnutrition. These findings are consistent with previous
The malnutrition screening risk showed that most studies conducted in patients with cancer undergoing
participants were at risk for malnutrition (60.4%), whereas chemotherapy.
the rest were not (39.6%). Several studies have demonstrated a high
Cancer stage was associated with malnutrition risk prevalence of malnutrition among cancer patients
with a chi-square value of 1.8 and a p-value of 0.04, which undergoing chemotherapy. A study by Isenring et al.

Asian Pacific Journal of Cancer Care• Vol 9• Issue 1 95

 apjcc.waocp.com G Hari Prakash, et al: Impact of Chemotherapy on Nutritional Status in Cancer Patients

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disadvantaged backgrounds.
In conclusion, the present study provides further
evidence of the high prevalence of malnutrition among
cancer patients undergoing chemotherapy in India.
These findings suggest the need for routine screening This work is licensed under a Creative Commons Attribution-
and timely management of malnutrition among cancer Non Commercial 4.0 International License.
patients undergoing chemotherapy, particularly those
with advanced cancer. Moreover, targeted interventions
are needed to address the unique needs of patients with
cancer from disadvantaged backgrounds to ensure that
they receive adequate nutrition during chemotherapy.

Acknowledgements
Authors would like to thank the Department of
Medical Oncology nursing staff for their valuable support
in ensuring smooth data collection.

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