The Application of Self-Administered Nutrition Screening Tools and Evaluations of the Impact of

143 Pages·2017·2.34 MB·English

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Mark J. P. Lynch, The University of Western Ontario
Supervisor: Philip C. Doyle, The University of Western Ontario
A thesis submitted in partial fulfillment of the requirements for the Master of Science degree in
Health and Rehabilitation Sciences
© Mark J. P. Lynch 2017
Follow this and additional works at: https://ir.lib.uwo.ca/etd
Part of the Dietetics and Clinical Nutrition Commons, Investigative Techniques Commons, Oncology
Commons, and the Other Nutrition Commons
RReeccoommmmeennddeedd CCiittaattiioonn
Lynch, Mark J. P., "The Application of Self-Administered Nutrition Screening Tools and Evaluations of the
Impact of Malnutrition on Quality of Life in Individuals with Head and Neck Cancer" (2017). Electronic
Thesis and Dissertation Repository. 4804.
https://ir.lib.uwo.ca/etd/4804
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Abstract

Background: Individuals with head and neck cancer (HNCa) are at an increased risk of
malnutrition. Therefore, self-administered nutrition screens which attempt to
address their nutritional concerns may yield benefits for treatment outcomes and
quality of life (QOL).
Methods: 34 participants (26 men, 8 women) completed one demographic and two
QOL surveys, two nutrition self-screening tools, a nutrition assessment and an ease-
of-use questionnaire. Results of the screens were compared to those of the
assessment, and relationships between QOL, nutrition status, and demographics
were examined.
Results: 32.3% of participants were identified as nutritionally compromised. The
sensitivity and specificity for the PG-SGA SF and Pt-Global Application were found to
be 81.8% and 100%, and 63.6% and 100%, respectively. Additionally, alterations in
nutrition status were found to influence QOL.
Conclusions: Data suggest that self-administered nutrition screens may be a viable
option which enable proactive identification of nutritional concerns associated with
HNCa.

Keywords: head and neck cancer, nutrition screening, quality of life, PG-SGA, Pt-
Global, PG-SGA SF

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Acknowledgements
Many individuals were involved in this project, without each of their
contributions the final result would have been difficult to achieve. First, I would like
to thank my supervisor Dr. Philip Doyle. It was Dr. Doyle who initially encourage me
to consider pursuing a post-graduate degree and he eventually took me on as a
graduate student. His guidance was crucial in navigating through the post-graduate
world and he went to great lengths to make sure he was readily available whenever I
required support. It was through the unique opportunities he provided that this
project was able to be completed, such as working with the Department of
Otolaryngology. For all of the opportunities and guidance he has provided me with
over the past two years I will be forever grateful.
I would also like to express that I am appreciative of the two labs (The
Laboratory for Well-being and Quality of Life in Oncology and the Voice Production
and Perception Laboratory) that I was given the opportunity to be a part of. My
colleagues who were also a part of the two labs were additional sources of support
and encouragement throughout the completion of this project.
I am further in debt to my advisory committee member Dr. Julie Theurer. Her
insights early on helped me to ensure that I had considered all relevant topics and
perspectives. I am also thankful to the Department of Otolaryngology at London
Health Sciences Centre, Dr. Yoo, and Dr. Fung, and their patients who were willing to
offer their time to participate in my study. It provided opportunities that would not
otherwise have been available. I am further grateful to Western University and the
department of Health and Rehabilitation Sciences. Western has been my home for
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the past six years and every program I have been involved with, especially the Health
and Rehabilitation Sciences program has exceeded my expectations and provided me
with many future opportunities which I am now able to pursue.
Also the support of my family and friends, particularly my parents, has made
this possible. Whether it was support financially, encouragement, or simply offering
their advice, my family and friends were always there for me. When things were
frustratingly slow, or when I felt stuck, they reassured me that I had the ability to
complete this project and make an important contribution to science moving
forward. I cannot thank them enough for what they have done for me and I can only
hope that I have the opportunity to repay them in the future.
Finally, I would like to remember and acknowledge past family and friends
who have been lost to cancer as they provided both the initial push to get me
involved in this area of research as well as ongoing motivation over the duration of
this study. Any contributions which I can make to the field of oncology which eases
the treatment process for these individuals of for that of their family and friends will
render this study a success. I shall never forget the family and friends who had their
time with us cut short as a result of cancer. I will hold close the lessons they taught
us and use them as a source of inspiration moving forward.

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Table of Contents

Abstract........................................................................................................................................ i
Acknowledgements .................................................................................................................... ii
Table of Contents ...................................................................................................................... iv
List of Tables ............................................................................................................................. vii
List of Figures ........................................................................................................................... viii
List of Appendices ..................................................................................................................... ix
CHAPTER 1: INTRODUCTION AND REVIEW OF LITERATURE ..................................................... 1
Overview ................................................................................................................................. 1
HNCa and Compromised Nutrition Status ............................................................................. 4
Lack of a Universal Definition of Malnutrition and Screening Method............................ 7
Causes of Malnutrition in HNCa Populations ...................................................................... 11
Tumour Related Causes of Malnutrition in HNCa ........................................................... 11
Treatment Related Causes of Malnutrition in HNCa ....................................................... 13
Objective Personal Factors Causing Malnutrition in HNCa ............................................. 16
Subjective Personal Factors Causing Malnutrition in HNCa ........................................... 18
Cancer Cachexia as a Cause of Malnutrition in HNCa ..................................................... 19
Consequences of Malnutrition in HNCa .............................................................................. 21
Screening Nutrition Status in HNCa ..................................................................................... 23
Current Situation of Nutritional Screening Tools ............................................................ 25
Current Issues Regarding the Implementation of Routine Nutrition Screens ............... 27
The Ideal Nutritional Screening Tool ............................................................................... 28
Assessment of Nutritional Status in HNCa .......................................................................... 31
Methods of Nutrition Assessment ................................................................................... 32
SGA Nutrition Assessment ............................................................................................... 32
PG-SGA Nutrition Assessment ......................................................................................... 34
Statement of Problem .......................................................................................................... 35
iv
Significance of Project .......................................................................................................... 37
CHAPTER 2: METHOD ............................................................................................................... 40
Participants ........................................................................................................................... 40
Initial Identification of Potential Participants ................................................................. 42
Inclusion Criteria............................................................................................................... 42
Exclusion Criteria .............................................................................................................. 43
Measurement Instruments .................................................................................................. 43
Patient Generated – Subjective Global Assessment (PG-SGA) version 3.22.15 ............. 43
Patient Generated – Subjective Global Assessment Short Form (PG-SGA SF) ............... 45
Pt-Global Application ....................................................................................................... 46
The European Organization for the Research and Treatment of Cancer Quality of Life
Questionnaire (EORTC QLQ-C30) ..................................................................................... 48
The European Organization for the Research and Treatment of Cancer Head and Neck
Cancer Module (EORTC QLQ- H&N35) ............................................................................. 49
Ease-of-Use Questionnaire .............................................................................................. 50
Data Acquisition Procedure ................................................................................................. 50
Data Analysis ........................................................................................................................ 52
Descriptive and Comparative Statistics ........................................................................... 52
Assessment of Reliability ................................................................................................. 53
CHAPTER 3: RESULTS ................................................................................................................ 54
Patient Generated – Subjective Global Assessment (PG-SGA) ........................................... 54
Patient Generated – Subjective Global Assessment Short Form (PG-SGA SF) ................... 57
Pt-Global Application ........................................................................................................... 59
Ease-of-Use Survey ............................................................................................................... 62
Results of the EORTC QLQ-C30............................................................................................. 63
Results of the EORTC QLQ-H&N35 ....................................................................................... 66
Consistency of Responses .................................................................................................... 68
Correlation Assessment of Measures .................................................................................. 69
v
Supplemental Observational Analysis of Data .................................................................... 71
Gender Comparisons ........................................................................................................ 71
Treatment modality ......................................................................................................... 71
Smoking status ................................................................................................................. 73
Age .................................................................................................................................... 74
Summary ............................................................................................................................... 74
CHAPTER 4: DISCUSSION .......................................................................................................... 76
Patient Generated – Subjective Global Assessment (PG-SGA) ........................................... 77
Patient Generated – Subjective Global Assessment Short Form (PG-SGA SF) ................... 79
Pt-Global Application ........................................................................................................... 81
Ease-of-Use Survey ............................................................................................................... 84
Results of the EORTC QLQ-C30............................................................................................. 85
Results of the EORTC QLQ-H&N35 ....................................................................................... 87
Consistency of Responses .................................................................................................... 89
Correlational Analysis .......................................................................................................... 90
Supplemental Observational Analysis ................................................................................. 92
Summary ............................................................................................................................... 93
Clinical implications .............................................................................................................. 94
Limitations of Present Study ................................................................................................ 96
Directions for Future Research ............................................................................................ 97
Conclusions ........................................................................................................................... 99
REFERENCES ............................................................................................................................ 101
APPENDICES ............................................................................................................................ 118
CURRICULUM VITAE ............................................................................................................... 132

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List of Tables
Table 1. Participant Demographic Information ........................................................... 41
Table 2. PG-SGA Assessment Score ............................................................................. 56
Table 3. PG-SGA SF Screen Scores ............................................................................... 58
Table 4. Pt-Global Application Screen Scores .............................................................. 61
Table 5. Ease-of-Use Survey Scores ............................................................................. 63
Table 6. EORTC QLQ-C30 Domain/Symptom Scores ................................................... 66
Table 7. EORTC QLQ-H&N35 Symptom Scores ............................................................ 68
Table 8. Correlation Matrix .......................................................................................... 70

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List of Figures
Figure 1. PG-SGA SF ROC Curve ....................................................................................59
Figure 2. Pt-Global ROC Curve ......................................................................................62
Figure 3. PG-SGA Scores by Treatment Modality .........................................................72
Figure 4. PG-SGA Scores by Smoking Status .................................................................73
Figure 5. PG-SGA Scores by Participant Age .................................................................74

viii
List of Appendices

APPENDICES ............................................................................................................................ 118
APPENDIX A ............................................................................................................................ 118
APPENDIX B ............................................................................................................................ 119
APPENDIX C ............................................................................................................................ 121
APPENDIX D ............................................................................................................................ 124
APPENDIX E ............................................................................................................................. 126
APPENDIX F ............................................................................................................................. 128
APPENDIX G ............................................................................................................................ 130
APPENDIX H ............................................................................................................................ 131

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