Evaluation of a Multidimensional Assessment Tool to Simultaneously Determine Physical Activity, Nutritional and Quality of Life Status in Cancer Patients
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Background
In cancer patients, the assessment of malnutrition, muscular and neurological deficits and quality of life are usually performed independently from each other, which neglects mutual interactions, and thus, lowers the potential of supportive interventions. Therefore, we developed the “resource-oriented needs assessment (RoBa)” as a multidimensional assessment battery that simultaneously captures i) the nutritional status, ii) physical fitness and iii) the psycho-oncological status based on four validated tools or questionnaires in each domain. In a prospective, multicenter pilot study, we evaluated the feasibility and reliability of the RoBa score in real-world cancer care.
Methods
Consecutive cancer patients from clinical routine care at two university cancer centers were prospectively included and underwent all twelve assessments. The physical fitness domain contained the handgrip strength test, spiro-ergometry, one-leg stand test, and seven-day accelerometry. Assessments of the nutritional status domain covered the Patient-Generated Subjective Global Assessment (PG-SGA), Body-Mass-Index (BMI), Bioelectrical Impedance Analysis (BIA), and the modified Glasgow-Prognostic-Score (mGPS). The quality-of-life status was assessed by the Multidimensional Fatigue-Inventary (MFI-20), Functional Assessment of Cancer Therapy/Gynecologic Oncology Group – Neurotoxicity (FACT/GOG-Ntx), Hospital Anxiety and Depression Scale (HADS), and the EORTC QLQ-C30 questionnaire. The results of each individual assessment were scored 0 (no needs), 1 (moderate needs), or 2 (severe needs) based on published cut-off values of each assessment or international guidelines. Individual scores were summarized to domain and total RoBa scores. Correlation analyses were performed with individual, domain and total RoBa score data.
Results
Between 2022 and 2024 a total of 62 consecutive cancer patients (GI cancer (40.3%), non-GI cancer (59.7%) were included in to the study at two academic cancer centers in Germany. From all three RoBa domains, quality of life individual scores showed the lowest deviation from the respective domain score. Within the three domains, the two strongest correlations of individual scores with the domain score were seen for PG-SGA (r = 0.64) and BIA (r = 0.54) within the nutrition domain, spiroergometry (r = 0.85) and accelerometry (r = 0.55) within the physical fitness domain, and MFI-20 (r = 0.81) and EORTC-Q30 (r = 0.74). With regard to the total RoBa score, high correlations of each domain score were also observed: nutrition domain (r = 0.59), physical fitness (r = 0.69), and quality of life (r = 0.65). Subgroup analyses of GI versus non-GI-cancer patients revealed differences in the nutritional domain scorings
Conclusion
The RoBa scoring system proved feasible and strong correlations to the published assessment evaluations but also within the domain and total RoBa scoring system were observed in this pilot study. The score yielded consistent classifications regardless of the tested tumor entity, supporting its implementation for integrated estimation of support needs in nutrition, exercise, and psycho-oncology. Further research in larger cohorts is warranted.
