PG-SGA: Key to InterdisciplinaryPrevention and Treatment ... · Patient-Generated Subjective Global Assessment (PG-SGA) Bibliography for Speech Therapists Faith Ottery, MD, PhD, FACN

Patient-Generated Subjective Global Assessment (PG-SGA) Bibliography for Speech Therapists

Faith Ottery, MD, PhD, FACNHanze UAS 13 Jun 2017

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PG-SGA: Key to Interdisciplinary Prevention and Treatment of MalnutritionFaith Ottery, MD, PhD, FACN Research Group Healthy Ageing, Allied Health Care and Nursing

© PG-SGA/Pt-Global Platform 2017

Michael Douglas – What do you see?Faith Ottery, MD, PhD, FACN Research Group Healthy Ageing, Allied Health Care and Nursing




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Anabolic Competence Paradigm:Multimodality, Interdisciplinary Approaches

Anabolic Competence:That state which optimally supports protein synthesis and lean body mass, as well as global aspects of muscle & organ function, immune competence, and quality of life and quality of survivorship

Nutritional Milieu

Exercise

Hormonal Milieu

Optimal body composition

and physiologic

function

© Ottery, 2002


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Definitions and Implications

• Anabolic Competence:– The state that optimally supports anabolism, i.e.,

protein synthesis and lean body mass, as well as global aspects of organ function, immunocompetence, functionality and quality of survivorship

• Simple starvation vs catabolic weight loss

Anabolism

Catabolism




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Lung Cancer: Success or Failure?

© Ottery, 2002


Catabolic & Anabolic ForcesTumor / Host• Proinflammatory cytokines• AnorexiaTherapy• Perioperative catabolism• Neutropenic fevers, infection• Cytokine-mediated responsesOther• Mechanical, physiologic

impediments to intake, digestion, absorption

• Inactivity, bedrest, muscle loss• Pulmonary insufficiencyPharmacological• Exogenous corticosteroids

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Tumor / Host Anti-cachectic cytokinesTherapy Surgical resection Complete response Resolution of inflammatory

reactionsOther Resolution of impediments to

intake, digestion, absorption Enteral nutrition Parenteral nutrition with insulin Resistance exercisePharmacological Anabolic – oxandrolone Anticatabolic – COX-2

inhibitors/NSAIDS, EPA

© Ottery, 2002




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Time Course

Degree of

Weight LossSignificant Severe

1 week 2% 2%

1 month 5% 5%

3 months 7.5% 7.5%6 months 10% 10%

Common Toxicity Criteria

Toxicity Grade Weight Criterion

0 < 5%

1 5-9.9%

2 10-19.9%

3 20%

4 Life-threatening

5 Death

Blackburn et al. JPEN 1977NIH, NCI, CTEP. Common Toxicity Criteria Manual. Version 2.0. June 1, 1999

Defining Critical Weight Loss


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Implications of Catabolism & Unintentional Weight Loss across Medical Conditions

Weight loss as little as 2%–5% is associated with:

• Decreased performance status

• Increased fatigue

• Decreased quality of life

• Increased therapy toxicity

• Increased risk of dose modification, treatment delays

• Decreased overall and progression-free survival

• Decreased patient compliance and completion of planned therapy




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Lean Tissues: Functional Issues

Smooth Muscle• Delayed gastric emptying• Delayed intestinal transit• Loss of cardiovascular

responsiveness and stability

Skeletal Muscle• Fatigue• Activity• Bed rest• Risk DVT, PE• Decubitus risk• Ability to cough• Ability to clear pulmonary

secretions

Other Components• Visceral protein• Antibodies• Growth Factors• Altered enzymes


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Global Assessment of Nutritional Status1984 Evaluating accuracy of nutritional assessment techniques applied to hospitalized patients:

methodology & comparisons using the Subjective Global Assessment (SGA) developed at the University of Toronto

1987 Original SGA published in usable format1993 Oncology modification by Ottery 1995 Patient-Generated SGA (PG-SGA) in unscored format1996 Spanish & French PG-SGA, Scored PG-SGA; Multi-site validation of scoring and triage in

volunteer research network of the Society for Nutritional Oncology Adjuvant Therapy (NOAT); incorporation of the Scored PG-SGA in the American Dietetic Association’s Medical Nutrition Therapy across the Continuum of Care

1997 Multiple other translations by individual permissions2002 Australian & other international research groups2005 BIG PRINT version, fatigue added2013 Initial interactions with Harriët Jager-Wittenaar, PhD, RD, Hanze UAS and Tizin Mobil

utilizing the first validated and cross-culturally adapted language translation 2014 Beta launch of multilingual Pt-Global app; launch of PG-SGA/Pt-Global Platform and

www.pt-global.org website2015 Initiation of several regional and country-specific volunteer global translation networks;

launch of Portuguese PG-SGA & website; Ottery inauguration as Visiting Professor at Hanze UAS, Groningen, The Netherlands




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Clinical Evolution: Easier to Read, Less Intimidating

1 Page PG-SGA

BIG PRINT Version PG-SGA 2005, 2006


Clinical Evolution: Multilingual App - Quick and Easy




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Welke van deze patiënten is ondervoed?

Patiënt 1 Vak 1-4 Score: 16

Patiënt 2Vak 1-4 Score: 4

Patiënt 3 Vak 1-4 Score: 16

Hogere score = hoger risico of tekort/verlies

The photograph is representative of the case presentation included and is used as an example for illustration purposes only.


Example 1

The photograph is representative of the case presentation included and is used as an example for illustration purposes only. 14© PG-SGA/Pt-Global Platform 2017



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Example 2

15© PG-SGA/Pt-Global Platform 2017

The photograph is representative of the case presentation included and is used as an example for illustration purposes only.

Example 3

16The photograph is representative of the case presentation included and is used as an example for illustration purposes only.




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AcknowledgmentsMajor 9601 Sites AR: St Mary’s Regional Med Center CO: Denver VA Medical Center HI: Queen’s Medical Center IA: Central Iowa Oncology IL: Ingall’s Memorial Hospital IL: St. Anthony’s Medical Center KS: Hays Medical Center KY: Baptist East Radiation Center KY: Central Baptist Medical Center MD: NIH Clinical Center MD: U of Maryland-Thoracic Surgery Div. ME: MidMaine Medical Center MI: Karmanos Cancer Institute MI Munson Medical Center MO: St. Johns Mid America Cancer

Center NJ: Cooper Medical Center NY: Vassar Bros. Hospital NY: Calvary Hospital Hospice OH: Med Central Health System

• OK: Cancer Care Assoc of OK • OK: Cancer Treatment Center of OK• OR: Willamette Medical Center • PA: U. of Pittsburgh • PA: St. Lukes Hospital• PA: Hahne Valley Cancer Center• RI: Women’s & Infants Hospital, Program in

Women’s Oncology • TN: U of Tenn Medical Center• TX: Cliffview Dialysis • WI: Gunderson Lutheran Medical Center• AU: The Wesley Hospital, Queensland,Australia• CA: North Eastern Ontario Regional Cancer Ctr

(Canada)• MX: National Medical Center Siglo XXI (Mexico)

International Collaborators: • Austria, Australia, Belgium, Brazil, Canada,

Denmark, France, Germany, Greece, Indonesia, Iran, Italy, Japan, Korea, Netherlands, Norway, Poland, Portugal, Switzerland, Thailand, United States, others

• Particularly, Harriët Jager-Wittenaar, RD, PhD, Martine Sealy, RD, MSc, Susan DeBolt, PhD, RD & Suzanne Kasenic, RD, CSO, LDN

17© PG-SGA/Pt-Global Platform 2017

[email protected] or [email protected] Website: www.pt-global.orgPhone: +1-215-694-1600www.facebook.com/PatientGlobalwww.twitter.com/PatientGlobalwww.youtube.com/PatientGlobalwww.instagram.com/PatientGlobalwww.linkedin.com/grp/home?gid=8156532




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Changing the Face of Malnutrition: PG-SGA ReferencesFaith Ottery, MD, PhD, FACN Research Group Healthy Ageing, Allied Health Care and Nursing


PG-SGA: Hanze 20171. Jager-Wittenaar H, Ottery FD. Assessing nutritional status in cancer: role of

the Patient-Generated Subjective Global Assessment. Curr Opin Clin NutrMetab Care. 2017 May 30. doi: 10.1097/MCO.0000000000000389.

2. Sealy MJ, Haß U, Ottery FD, van der Schans CP, Roodenburg JLN, Jager-Wittenaar H. Translation and Cultural Adaptation of the Scored Patient-Generated Subjective Global Assessment: An Interdisciplinary Nutritional Instrument Appropriate for Dutch Cancer Patients. Cancer Nurs. 2017 May 19. doi: 10.1097/NCC.0000000000000505.




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PG-SGA: Head & Neck Cancer1. Orell-Kotikangas H, Österlund P, Mäkitie O, Saarilahti K, Ravasco P, Schwab

U, Mäkitie AA. Cachexia at diagnosis is associated with poor survival in head and neck cancer patients. Acta Otolaryngol. 2017 Jan 26:1-11.

2. Mulasi U, Vock DM, Kuchnia AJ, Jha G, Fujioka N, Rudrapatna V, Patel MR, Teigen L, Earthman CP. Malnutrition Identified by the Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition Consensus Criteria and Other Bedside Tools Is Highly Prevalent in a Sample of Individuals Undergoing Treatment for Head and Neck Cancer. JPEN J Parenter Enteral Nutr. 2016 Oct 7. pii: 0148607116672264.

3. Talwar B, Donnelly R, Skelly R, Donaldson M. Nutritional management in head and neck cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol. 2016 May;130(S2):S32-S40. PMC4873913.

4. Spotten L, Corish C, Lorton C, Dhuibhir PU, O'Donoghue N, O'Connor B, Cunningham M, El Beltagi N, Gillham C, Walsh D. Subjective taste and smell changes in treatment-naive people with solid tumours. Support Care Cancer. 2016 Jul;24(7):3201-8


PG-SGA: Head & Neck Cancer5. Britton B, Baker A, Clover K, McElduff P, Wratten C, Carter G. Heads Up: a

pilot trial of a psychological intervention to improve nutrition in head and neck cancer patients undergoing radiotherapy. Eur J Cancer Care (Engl). 2016 Apr 28. doi: 10.1111/ecc.12502.

6. Orell-Kotikangas H, Österlund P, Saarilahti K, Ravasco P, Schwab U, MäkitieAA. NRS-2002 for pre-treatment nutritional risk screening and nutritional status assessment in head and neck cancer patients. Support Care Cancer. 2015 Jun;23(6):1495-502.

7. Farhangfar A, Makarewicz M, Ghosh S, Jha N, Scrimger R, Gramlich L, Baracos V. Nutrition impact symptoms in a population cohort of head and neck cancer patients: multivariate regression analysis of symptoms on oral intake, weight loss and survival. Oral Oncol. 2014 Sep;50(9):877-83.

8. Correira Pereira MA, Santos CA, Almeida Brito J, Fonseca J. Scored Patient-Generated Subjective Global Assessment, albumin and transferrin for nutritional assessment of gastrostomy fed head or neck cancer patients. NutrHosp. 2014 Feb 1;29(2):420-6.




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PG-SGA: Head & Neck Cancer9. Ma L, Poulin P, Feldstain A, Chasen MR. The association between

malnutrition and psychological distress in patients with advanced head-and-neck cancer. Curr Oncol. 2013 Dec;20(6):e554-60.

10.Citak E, Tulek Z. Longitudinal quality of life in Turkish patients with head and neck cancer undergoing radiotherapy. Support Care Cancer. 2013 Aug;21(8):2171-83.

11.Arribas L, Hurtós L, Milà R, Fort E, Peiró I. [Predict factors associated with malnutrition from patient generated subjective global assessment (PG-SGA) in head and neck cancer patients]. Nutr Hosp. 2013 Jan-Feb;28(1):155-63.

12.Schmidt KN, Olson K, Kubrak C, Parliament M, Ghosh S. Validation of the Head and Neck Patient Symptom Checklist as a nutrition impact symptom assessment tool for head and neck cancer patients. Support Care Cancer. 2013 Jan;21(1):27-34.

13. Jeffery E, Sherriff J, Langdon C. A clinical audit of the nutritional status and need for nutrition support amongst head and neck cancer patients treated with radiotherapy. Australas Med J. 2012;5(1):8-13.


PG-SGA: Head & Neck Cancer

14.Britton B, Clover K, Bateman L, Odelli C, Wenham K, Zeman A, Carter GL. Baseline depression predicts malnutrition in head and neck cancer patients undergoing radiotherapy. Support Care Cancer. 2012 Feb;20(2):335-42.

15.Capuano G, Gentile PC, Bianciardi F, Tosti M, Palladino A, Di Palma M. Prevalence and influence of malnutrition on quality of life and performance status in patients with locally advanced head and neck cancer before treatment. Support Care Cancer. 2010 Apr;18(4):433-7.

16.Kubrak C, Olson K, Jha N, Jensen L, McCargar L, Seikaly H, Harris J, Scrimger R, Parliament M, Baracos VE. Nutrition impact symptoms: key determinants of reduced dietary intake, weight loss, and reduced functional capacity of patients with head and neck cancer before treatment. Head Neck. 2010 Mar;32(3):290-300.

17.Ramos Chaves M, Boléo-Tomé C, Monteiro-Grillo I, Camilo M, Ravasco P. The diversity of nutritional status in cancer: new insights. Oncologist. 2010;15(5):523-30.




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PG-SGA: Head & Neck Cancer18.Oates J, Clark JR, Read J, Reeves N, Gao K, O'Brien CJ. Integration of

prospective quality of life and nutritional assessment as routine components of multidisciplinary care of patients with head and neck cancer. ANZ J Surg. 2008 Jan-Feb;78(1-2):34-41.

19.Mahdavi R, Faramarzi E, Mohammad-Zadeh M, Ghaeammaghami J, Jabbari MV. Consequences of radiotherapy on nutritional status, dietary intake, serum zinc and copper levels in patients with gastrointestinal tract and head and neck cancer. Saudi Med J. 2007 Mar;28(3):435-40.

20.Ravasco P, Monteiro-Grillo I, Vidal PM, Camilo ME. Nutritional deterioration in cancer: the role of disease and diet. Clin Oncol (R Coll Radiol). 2003 Dec;15(8):443-50.

21. Isenring E, Bauer J, Capra S. The scored Patient-generated Subjective Global Assessment (PG-SGA) and its association with quality of life in ambulatory patients receiving radiotherapy. Eur J Clin Nutr. 2003 Feb;57(2):305-9.


PG-SGA: Esophageal Cancer1. Quyen TC, Angkatavanich J, Thuan TV, Xuan VV, Tuyen LD, Tu DA.

Nutrition assessment and its relationship with performance and Glasgow prognostic scores in Vietnamese patients with esophageal cancer. Asia Pac J Clin Nutr. 2017 Jan;26(1):49-58.

2. Poziomyck AK, Weston AC, Lameu EB, Cassol OS, Coelho LJ, Moreira LF. Preoperative nutritional assessment and prognosis in patients with foregut tumors. Nutr Cancer. 2012;64(8):1174-81.

3. Chasen MR, Bhargava R. A rehabilitation program for patients with gastroesophageal cancer--a pilot study. Support Care Cancer. 2010 May;18 Suppl 2:S35-40. Epub 2010 Feb 23. PubMed PMID: 20177712.

4. Ramos Chaves M, Boléo-Tomé C, Monteiro-Grillo I, Camilo M, Ravasco P. The diversity of nutritional status in cancer: new insights. Oncologist. 2010;15(5):523-30. doi: 10.1634/theoncologist.2009-0283.




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PG-SGA: Dysphagia1. Farhangfar A, Makarewicz M, Ghosh S, Jha N, Scrimger R, Gramlich L, Baracos V.

Nutrition impact symptoms in a population cohort of head and neck cancer patients: multivariate regression analysis of symptoms on oral intake, weight loss and survival. Oral Oncol. 2014 Sep;50(9):877-83.

2. Arribas L, Hurtós L, Milà R, Fort E, Peiró I. [Predict factors associated with malnutrition from patient generated subjective global assessment (PG-SGA) in head and neck cancer patients]. Nutr Hosp. 2013 Jan-Feb;28(1):155-63.

3. Martin L, Watanabe S, Fainsinger R, Lau F, Ghosh S, Quan H, Atkins M, FassbenderK, Downing GM, Baracos V. Prognostic factors in patients with advanced cancer: use of the patient-generated subjective global assessment in survival prediction. J Clin Oncol. 2010 Oct 1;28(28):4376-83.

4. Kubrak C, Olson K, Jha N, Jensen L, McCargar L, Seikaly H, Harris J, Scrimger R, Parliament M, Baracos VE. Nutrition impact symptoms: key determinants of reduced dietary intake, weight loss, and reduced functional capacity of patients with head and neck cancer before treatment. Head Neck. 2010 Mar;32(3):290-300.

5. Martineau J, Bauer JD, Isenring E, Cohen S. Malnutrition determined by the patient-generated subjective global assessment is associated with poor outcomes in acute stroke patients. Clin Nutr. 2005 Dec;24(6):1073-7.


PG-SGA: Chronic Graft vs Host Disease (cGVHD)

1. El-Ghammaz AMS, Ben Matoug R, Elzimaity M, Mostafa N. Nutritional status of allogeneic hematopoietic stem cell transplantation recipients: influencing risk factors and impact on survival. Support Care Cancer. 2017 Apr 24. doi: 10.1007/s00520-017-3716-6.

2. Bassim CW, Fassil H, Dobbin M, Steinberg SM, Baird K, Cole K, Joe G, Comis LE, Mitchell SA, Grkovic L, Edwards D, Mays JW, Cowen EW, Pulanic D, Williams KM, Gress RE, Pavletic SZ. Malnutrition in patients with chronic GVHD. Bone Marrow Transplant. 2014 Oct;49(10):1300-6.




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PG-SGA: Stroke1. Sheard JM, Ash S, Mellick GD, Silburn PA, Kerr GK. Improved

nutritional status is related to improved quality of life in Parkinson's disease. BMC Neurol. 2014 Nov 18;14:212.

2. Sheard JM, Ash S, Silburn PA, Kerr GK. Nutritional status in Parkinson's disease patients undergoing deep brain stimulation surgery: a pilot study. J Nutr Health Aging. 2013 Feb;17(2):148-51.

3. Sheard JM, Ash S, Mellick GD, Silburn PA, Kerr GK. Markers of disease severity are associated with malnutrition in Parkinson's disease. PLoSOne. 2013;8(3):e57986.

4. Sheard JM, Ash S, Mellick GD, Silburn PA, Kerr GK. Malnutrition in a sample of community-dwelling people with Parkinson's disease. PLoSOne. 2013;8(1):e53290.


Documents

PG-SGA: Key to InterdisciplinaryPrevention and Treatment ... · Patient-Generated Subjective Global Assessment (PG-SGA) Bibliography for Speech Therapists Faith Ottery, MD, PhD, FACN